I was hoping you could write an article to parents about viruses and antibiotics. The reason I ask is that I work in a Pediatric Alliance office and we seem to have a lot of parents who just want to come in and be treated with a quick antibiotic for a simple virus. They get very upset when one is not offered and go off to MedExpress or another “Doc-in-the-Box” where they will just be given what they want. I don’t think parents understand what the long-term effects can be of constantly taking an antibiotic, just because it might be a “quick fix”.
Let’s start off by examining the differences between viruses and bacteria:
>> Viruses are tiny infectious agents. The largest virus is many times smaller than the tiniest bacterium. Viruses are basically parasites: they work by invading another organism, gaining access to the inside of the host’s cells, and taking over that cell’s genetic machinery in order to replicate itself. Examples of viral infections which can be prevented with childhood vaccines include polio, measles, mumps, rubella, hepatitis A, hepatitis B, varicella (chickenpox), rotavirus, influenza, and human papillomavirus (HPV). Typical courses from these viral infections can run from mild-to-catastrophic.
>> Bacteria are single-cell organisms that are much bigger than viruses. They are creatures that live and multiply outside of cells. Some bacteria are beneficial to the body in which it resides, whereas virus are not helpful at all. Bacterial infections prevented by routine childhood immunizations are typically severe-to-devastating and include diphtheria, tetanus, pertussis (whooping cough), haemophilus influenza b (Hib), pneumococcus, and meningococcus.
Antibiotics are only effective against bacteria, which is the major point stressed in the CDC’s “Get Smart About Antibiotics” campaign:
Taking antibiotics for viral infections, such as colds, flu, most sore throats, bronchitis, and many sinus or ear infections:
- Will not cure the infection
- Will not keep other people from getting sick
- Will not help you or your child feel better
- May cause unnecessary and harmful side effects
- May contribute to antibiotic resistance, which is when bacteria are able to resist the effects of an antibiotic and continue to cause harm
For the most part, infections caused by viruses are not cured with medications; antibiotics don’t kill viruses. Instead, we treat the symptoms by resting, drinking plenty of fluids, reducing fever if appropriate, and using other assorted remedies passed down through the generations (cool mist, saline nasal sprays and irrigations, honey for cough after 12 months of age, menthol chest rubs, popsicles for mouth and throat pain, etc.).
Antibiotics kill bacteria, not viruses, which is why doctors try to prescribe antibiotics only for infections caused by bacteria, like strep throat. With some infections, like many ear infections, sinus infections, and pneumonias, it can be difficult for physicians to determine whether they are caused by viruses or bacteria. Since lab tests, x-rays, and invasive procedures are often not helpful in finding the cause of the infection, many doctors will prescribe antibiotics. In may ways, this better-safe-than-sorry strategy makes sense — especially in children, where a seemingly mild ear infection can quickly progress into an up-all-night-scream-fest. But in the long-run, giving children and adults antibiotics when they are not needed — when the illness is clearly caused by a virus — is a very bad idea, and physicians are doing their patients a disservice by prescribing them. Dr. Coleen Cunningham, a pediatric infectious disease specialist at Duke University Medical Center, explains why:
There are three primary dangers of antibiotic misuse or overuse. No. 1 is cost: Drugs are expensive, and anything spent on unnecessary meds is at best, a waste of money. No. 2 is side effects: All drugs have toxic side effects. If it is unnecessary, then it isn’t worth taking a chance of an adverse effect. No. 3 is the selection of bacteria that are resistant to antibiotics. Once drugs are widely used, the bacteria develop resistance to those antibiotics. Eventually, a drug may become not useful. We have this now with some staphylococcus and enterococcal organisms (among others) where there are now very few drugs that can be used.
The CDC advises patients that for most common illnesses, antibiotics aren’t the answer:
- Do not demand antibiotics when your healthcare professional says they are not needed.
- Do not take an antibiotic for a viral infection.
- Do not take antibiotics prescribed for someone else. The antibiotic may not be right for your illness. Taking the wrong medicine may delay correct treatment and allow bacteria to grow.
If your healthcare professional prescribes an antibiotic for a bacterial infection:
- Do not skip doses.
- Do not stop taking the antibiotics early unless your healthcare professional tells you to do so.
- Do not save any of the antibiotics for the next time you or your child gets sick.
The American College of Physicians published the following guidelines for doctors in the journal Annals of Internal Medicine:
Reducing unneeded antibiotic prescribing will improve care, lower costs, and help to stop antibiotic resistance. In most patients, symptoms get better in 1 to 2 weeks. Coughs can sometimes last up to 6 weeks. The ACP recommends the following:
•Clinicians should not prescribe antibiotics for patients with bronchitis. Antibiotics should only be used if patients have pneumonia.
•Clinicians should test patients with symptoms that could be strep throat. Because symptoms alone are not reliable, antibiotics should only be prescribed when testing confirms strep throat. Other sore throat infections do not need antibiotics.
•Clinicians should not prescribe antibiotics for sinus infections unless patients have severe symptoms or symptoms that last more than 10 days. Patients whose symptoms improve but eventually get worse may also need antibiotics.
•Clinicians should not prescribe antibiotics for patients with the common cold.
No one likes to be sick, and no one likes it when their child is sick. Everyone wants to get better, fast. Having said that, I rarely come across a parent who “demands” that I prescribe an antibiotic for their child — as long as I take the time and explain why an antibiotic is, or is not, needed. In fact, I find that more and more parents these days are relieved when they learn their child doesn’t need one. (No fighting to get a dose down the hatch, no diarrhea, no allergic reactions, no keeping to a medication schedule for 10 days.)
Finally, we should all remind ourselves that people get demanding when they are scared. For parents, those fears — especially when a child is sick — can be pretty intense. It’s important that we, as health care providers, recognize and respect that.
Watch this short video from the CDC — “Get Smart About Antibiotics: For Patients and Parents”: