Six-year-old Amanda Haddad has
been complaining of a sore ear for close to two days
now. She has no fever but has missed a couple of days
of school and her mother wants a quick solution that
will get her daughter back in the pink. But Amanda's
doctor isn't as cooperative as mom would like. Instead
of writing up a quick script for antibiotics, the doctor
suggests that Amanda stay home a few more days, and
rest up. If the symptoms don't go away in about 72 hours,
the doc asks that Amanda be brought back in.
Amanda's mother, however, would rather her daughter
get an antibiotic prescription right away. But the point
that mom, and many patients miss is that the unnecessary
use of antibiotics leads to bacterial resistance. "What
we're seeing today is a continuum," says Dr David
McNeely, an infectious disease specialist and a professor
at the University of Toronto. He's quick to stress that
the situation is something that has always been around.
"As fast as we put new drugs in the community,
bacteria will find a resistance."
About 20-50% of prescriptions given out in a community
setting are unnecessary, according to an article published
in Clinical Pharmacology in March 2001. Dr McNeely
goes on to add that it's the GP who get pressured by
patients who insist on getting antimicrobials. "We
can and have identified that antibiotics are being used
in the wrong circumstances -- like middle ear infections,"
says Dr McNeely.
The word is getting out that the overuse of antibiotics
can cause resistance. In fact, 60 Minutes recently
ran a report on superbugs. Yet despite more awareness
on this growing problem, patients would still rather
take antibiotics than tough it out and wait for their
bodies to get ahead of the infection. GPs are on the
frontline of the battle against resistance and need
to curb unnecessary prescribing. Here are some tips
on how to approach the subject of antibiotics and bacterial
resistance with your patients.
WHAT
TO TELL YOUR PATIENTS ABOUT ANTIBIOTIC RESISTANCE
Education Patients may not be aware that antibiotics
are only useful in fighting bacteria so that simple
bit of information might be all a patient needs to understand
why antibiotics aren't always useful. "As in any
domain it's about patient informatics," says Dr
McNeely. He recommends spending that extra 10 to 15
minutes with your patient to instruct them on the prudent
use of antibiotics and to stress preventative measures,
like vaccinations and hand washing. Also, be sure to
inform your patients that the more they use antibiotics
the more likely that they'll develop an infection that's
resistant to traditional drugs.
Bacteria vs virus It's useful
to outline which conditions are bacterial infections
and which are viral. It will help your patient put the
information into context. Let your patient know that
antibiotics will help infections like strep throat,
urinary tract infections, but that they're useless in
treating diseases like bronchitis, the flu, or the common
cold. Dr McNeely adds that most adults present to the
doctor's office with upper respiratory tract infections
of viral origin. To avoid over-prescribing, he adds
that it's a good rule of thumb to wait for the culture
before writing up the script.
Otitis media Middle ear
infections are the most common reason for prescribing
antibiotics to children. It's also one of the conditions
that figure prominently in the problem of antibiotic
resistance. "The expectation is that a child who
presents with a sore ear will get antibiotics,"
says Dr McNeely. But that shouldn't be the first choice.
He suggests using the Dutch approach; try treating the
symptoms, and if in 72 hours there's no improvement,
then resort to the antibiotics. "It will take a
lot of time and energy to convince the parent that this
is the best solution," adds Dr McNeely.
Relieving symptoms
Certain medications can help relieve the symptoms of
infections. Giving your patients these options, which
include meds such as decongestants and cough suppressants,
might help them get over their dependence on antibiotics.
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