Monday February 12, 2018
Common Ailments People Believe Should be treated with Antibiotics
Having listened to the most recent comment from the National Institute for Health and Care Excellence (NICE) on the overuse of antibiotics, I think it is very helpful to appreciate when we should and should not use antibiotics.
In my clinics I commonly hear “Doctor, I usually shake off my cold in 2-3 days, but this has lasted nearly a week, so I think I need antibiotics”
Having recently suffered with a flu like illness I can fully appreciate how miserable you can feel, and the temptation to ask your doctor for antibiotics. However, the body is a wonderful machine that can fight off some of the most common infections without antibiotics.
I feel that the severity of viruses is often underplayed. We should really move away from the “It’s only a virus” thought process. Viruses can be as bad if not worse than some bacterial infections, and if you have ever had the Flu or Glandular Fever for example, then you will appreciate what I mean.
Here are a few examples of common ailments that do not routinely require antibiotics
- Sore throats
Sore throats are most commonly caused by viral infections. The range of viruses that can cause a sore throat is enormous, which is why it is such a challenge to offer a specific cure. Most sore throats will subside within 7 days, and my personal recommendation is rest, plenty of fluids and simple pain relief such as paracetamol or ibuprofen and some good antiseptic throat lozengers.
There are some exceptions: Tonsillitis and Pharyngitis can be caused by bacteria, and this is where you need to trust the experience of your doctor, to look for signs to support bacterial infection. We use tools like the CENTOR criteria which helps to decide when to treat tonsillitis with antibiotics. If you have pus on your tonsils, tender glands, a fever and the absence of cough, then you may actually need antibiotics.
- Common colds / Viral Respiratory tract infections
Coughs, colds, and sneezes will make you feel miserable, but again are caused by viruses like Rhinovirus.
Antibiotics have no role here. If they are taken, you may feel better after a week’s course, but this is simply down to the fact your body has cleared then infection and nothing to do with the antibiotics, as these viruses tend to pass within a week or so.
You may even make yourself feel worse as you can cause undue side effects such as diarrhoea, by wiping out all of your friendly gut bacteria.
The dreaded influenza! In my opinion, Influenza is one of the most debilitating viruses. Whilst you might hear whispering of “man flu circulating, we have actually experienced an outbreak of a substantial number of strains of Influenza this year – including H3N2 (Aussie Flu) and influenza B Viruses.
The flu really does make you feel awful. The aching joints, spiking temperatures, shivers and shakes along with the sore throat, cough and a runny nose is enough to make any of us run to our local GP.
If you have that classic cocktail of symptoms, the diagnosis is fairly clear: You have the Flu!
Expect to be unwell for a good couple of weeks. Take rest, dose up on paracetamol, menthol rubs, nasal sprays and let your body take care of the virus and next year remember why we recommend the flu jab!
You can get a secondary bacterial infection with the flu, so if you are breathless, coughing discoloured sputum or feel you are getting worse rather than better, it is wise for you to ask for your GPs opinion and not ask for antibiotics; they will prescribe them if they are indicated.
Also remember that in the very young, very old, pregnant and immunosuppressed, the flu can be very serious, so do seek medical advice.
The facial pain and headaches associated with Sinusitis can make you feel miserable. The sinuses these are just an air-filled space above your eyebrows and behind your cheek bones. When you have sinusitis, the pain you experience is due to a build-up of mucous and pressure in the normally air-filled spaces.
The sinuses have a very poor blood supply. As such, antibiotics do not really get to delivered there. You need to utilise good nasal sprays, to decrease mucous production, reduce the inflammation and help you to drain the sinuses via your Eustachian tube. The over the counter sprays are useful for 1-2 days, but can cause rebound sinusitis, i.e. things get worse. So, consider using a steroid based nasal spray from your GP.
If you have chronic sinusitis, you may need long term nasal spray, and, in some instances, antibiotics are used.
The dangers of Improper Antibiotic Use
Antibiotics often feel like the easy answer. I think it is a natural human response to feel sick and want to do everything you can to get better as quickly as possible. However, antibiotics are not always the answer. If we continue to overuse or misuse antibiotics, we will quickly build up resistance. Evidence already exists to prove this point – many Urinary tract infections are now resistant to some of our commonly used first line antibiotics.
We have seen the advent of “Super Gonorrhoea” – A strain which is so resistant, that at present only one injectable antibiotic can be used to treat it. MRSA (Methicillin Resistant Staphylococcus Aureus) is another example.
If we continue to use antibiotics for viral infections, and inappropriately we will build a resistance, meaning antibiotics will not be readily available and effective when we need them most.
Whilst lots of research is going into new antibiotics, bacteria and viruses are mutating and finding ways to protect themselves against the treatments we have available. This process is happening at a rate much quicker than we can create new antibiotics.
Dr. Daniel Fenton
London Doctors Clinic