Colds and Coughs: Do I Need Antibiotics?Paul Phillips, MD, Family Medicine

www.SpringfieldClinic.comwww.SpringfieldClinic.com

Do I need an antibiotic?

• Background

• Definitions

• Reasons for antibiotics

• Reasons to avoid antibiotics

• What you can do

• What will help

• Antibiotic resistance has been called one of the world’s most pressing public health problems.

• $1.1 billion is spent annually on unnecessary adult upper respiratory infection antibiotic prescriptions.

Fendrick AM, Monto AS, Nightengale B, Sarnes M: The economic burden of non-influenza related viral respiratory tract infection in the United States. Arch Int Med: 163(4): 487-94, 2003.

• Antibiotics were prescribed in 68% of acute respiratory tract visits – and of those, 80% were unnecessary according to CDC guidelines.

Scott JG, Cohen D, DiCicco-Bloom B, Orzano AJ, et al: Antibiotic use in acute respiratory infections and the ways patients pressure physicians for a prescription. J Fam Pract: 50(10): 853-8, 2001.

Definitions

• Bacteria

• Virus

• Antibiotic

• Antibiotic Resistance

Bacteria

• Bacteria: Single-celled microorganisms which can exist either as independent (free-living) organisms or as parasites (dependent upon another organism for life).

• Example: Strep throat, tuberculosis, MRSA skin infection

Virus

• smaller than a bacteria

• cannot grow or reproduce apart from a living cell.

• invades living cells and uses their chemical machinery to keep itself alive and to replicate itself.

• Example: HIV, Chickenpox, Herpes

Virus vs. Bacteria

• Perhaps the most important distinction between bacteria and viruses is that antibiotic drugs usually kill bacteria, but they aren't effective against viruses.

• In some cases, it may be difficult to determine whether a bacterium or a virus is causing your symptoms.

• Many ailments — such as pneumonia, meningitis and diarrhea — can be caused by either type of microbe.

http://www.mayoclinic.com/health/infectious-disease/AN00652

Antibiotic

• A drug used to treat infections caused by bacteria.

Antibiotic Resistance

• The ability of bacteria to withstand an antibiotic to which they were once sensitive.

Upper Respiratory Illnesses

• Sinus Infection

• Sore Throat

• Common Cold

• Bronchitis

Sinus Infection

• The sinuses are air-filled pockets make mucus

• Sinusitis is an infection of the sinuses

• usually occur after a cold or an allergic inflammation

What causes sinusitis?

• after an upper respiratory infection (URI) or common cold.

• The URI causes inflammation of the nasal passages that can lead to obstruction

• Allergic disease can also lead to sinusitis because of the swelling of the nasal tissue and increased production of mucus.

• After the blockage of the flow of secretions from the sinuses, bacteria will sometimes begin to grow. This leads to a sinus infection, or sinusitis.

Sore Throat

• Pharyngitis and tonsillitis are infections in the throat that cause inflammation.

• These infections are spread by close contact with other individuals.

• The majority of pharyngitis cases occur during the winter or colder months.

What causes pharyngitis and tonsillitis?

• Viruses are the most common cause– Adenovirus– Influenza virus– Epstein-Barr virus (mononucleosis)

• Bacteria– Group A beta-hemolytic streptococci

(GABHS)– Neisseria gonorrhoeae– Haemophilus Influenzae type b

Common Cold

• leading to more doctor visits and absences from school and work than any other illness

• It is estimated that during a one-year period, people in the US will suffer one billion colds.

• Caused by a virus that inflames the membranes in the lining of the nose and throat, colds can be the result of more than 200 different viruses.

• rhinoviruses and the coronaviruses cause the majority of colds.

Respiratory System

Bronchitis

• Bronchitis is an inflammation of the breathing tubes (airways) that are called bronchi, which causes increased production of mucus and other changes.

• Acute bronchitis is the inflammation of mucous membranes of the bronchial tubes.

What causes acute bronchitis?

• Acute bronchitis is usually caused by infectious agents such as viruses.

• It may also be caused by physical or chemical agents--dusts, allergens, strong fumes--and those from chemical cleaning compounds, or tobacco smoke.

• Acute bronchitis is usually a mild, and self-limiting condition, with complete healing and return to function.

• Acute bronchitis may follow the common cold or other viral infections in the upper respiratory tract.

• It may also occur in people with chronic sinusitis, allergies, or those with enlarged tonsils and adenoids.

• Pneumonia is a complication that can follow bronchitis.

SO WHAT?

• The number of bacteria resistant to antibiotics has increased in the last decade.

• Many bacterial infections are becoming resistant to the most commonly prescribed antibiotic treatments.

AND…

• Every time a person takes antibiotics, sensitive bacteria are killed, but resistant germs may be left to grow and multiply.

• Repeated and improper uses of antibiotics are primary causes of the increase in drug-resistant bacteria.

AND…

• Misuse of antibiotics jeopardizes the usefulness of essential drugs.

• Decreasing inappropriate antibiotic use is the best way to control resistance.

SO…

When antibiotics fail to work, the consequences are

•longer-lasting illnesses

•more doctor visits

•extended hospital stays

•the need for more expensive and toxic medications.

•Some resistant infections can even cause death.

What about the kids?

• Children are of particular concern because they have the highest rates of antibiotic use.

Great Expectations

• Parent pressure makes a difference. For pediatric care, a study showed that doctors prescribe antibiotics 62% of the time if they perceive parents expect them and 7% of the time if they feel parents do not expect them.

• Mangione-Smith R, McGlynn EA, Elliott MN, et al: The relationship between perceived parental expectations and pediatrician antimicrobial prescribing behavior. Pediatrics 103:711-718, 1999.

We’re doin’ better

• National Ambulatory Medical Care Survey (NAMCS) data shows that overall antibiotic prescribing dropped from 13.8 prescriptions per 100 office visits to 12.0 prescriptions per 100 office visits comparing 1997-98 to 2005-06 with a 13% reduction in overall antimicrobial prescribing.

National Ambulatory Medical Care Survey (NAMCS).

PUBLIC HEALTH

• Get Smart has contributed to 25% reduction in antimicrobial use per outpatient office visit for presumed viral infections

National Ambulatory Medical Care Survey (NAMCS).

TAKE HOME’s

• Antibiotics cure bacterial infections, not viral infections such as: – Colds or flu; – Most coughs and bronchitis;– Sore throats not caused by strep; or– Runny noses.

• Taking antibiotics for viral infections, such as a cold, cough, the flu, or most bronchitis, will not: – Cure the infections; – Keep other individuals from catching the

illness– Help you feel better.

Who does need an antibiotic

Sinus infection

•Only 2% of rhinosinusitis is bacterial

•Snot is not very predictive

•Last greater than 10 days or worsening at day 7

•Maxillary pain/tooth pain

Who does need an antibiotic

Sore Throat

•Criteria- fever, exudate, no cough, nodes

•<1- don’t test

•2,3,4- get a rapid strep swab

•Consider- 4 of 4 treat with penicillin or erythromycin

Who does need an antibiotic

Bronchitis

•Antibiotics don’t help uncomplicated bronchitis

•Primary goal- RULE OUT Pneumonia

•Look out for pertussis

What can you do

• Prevention

• Symptom Relief

• Compliance

Prevention

• Wash your hands

• Keep healthy- diet, exercise, immunity

• If you are sick, stay home

• Avoid clusters of sick people

• When around people with colds, do not touch your nose or eyes

Symptom Relief

• Over-the-counter medicines may relieve symptoms, but they do not lessen the duration of illness.

Sore Throat

• Soothe a sore throat with ice chips, sore throat spray, or lozenges

• Use a clean humidifier or cool mist vaporizer

• Take acetaminophen, ibuprofen or naproxen to relieve pain or fever

Ear Pain

• Put a warm moist cloth over the ear that hurts

• Take acetaminophen, ibuprofen or naproxen to relieve pain or fever

Runny Nose

• Use a decongestant (SUDAFED)

• Saline nasal spray to help relieve nasal symptoms

Sinus Pain/Pressure

• Put a warm compress over the nose and forehead to help relieve sinus pressure

• Use a decongestant or saline nasal spray

• Breathe in steam from a bowl of hot water or shower

• Take acetaminophen, ibuprofen or naproxen to relieve pain or fever

Cough

• Use a clean humidifier

• cool mist vaporizer

• breathe in steam from a bowl of hot water or shower

Compliance

• When you are prescribed an antibiotic– Take it exactly as the doctor tells you.

Complete the prescribed course even if you are feeling better.

– Throw away any leftover medication once you have completed your prescription

Major Take HOME POINTS

1) Most illness is viral

2) Antibiotics don’t help viral infections

3) Ibuprofen, sudafed & saline will help

4) “Better Out Than In”

• http://www.medical-jokes.com/category/medical-cartoons/

Thank you

Questions