The unscientific lure of antibiotics

Although my father did not discover penicillin, he helped do the research showing its effectiveness in curing infective endocarditis. As an internist, he then became enamored with the role antibiotics could play in treating infections. Growing up, my siblings and I can attest to his unbridled enthusiasm, as every time we contracted a cold, we would get a shot of the wonder mold in our butts. The fact that colds were caused by viruses and not bacteria did little to dissuade him from the utility of the treatment. When I finally developed a rash after another shot, I celebrated the fact that the painful solution would never enter my buttocks again.

Fast forward 60 years, and we now know that there is still scant evidence that antibiotics help to shorten the duration of the common cold, or viral sinusitis or bronchitis. Yet, patients plead with us to “do something” after their Vitamin C, zinc, and other natural supplements fail to make them feel better. We know that by prescribing them, we might be contributing to antibiotic-resistant bugs and dangerous side effects. Nonetheless, we prescribe them.

Colds affect everyone differently. For me, they always seem to end up in my chest with purulent bronchitis. A few years back my illness was so bad that I actually had post-tussive syncope. As a doctor, I know that antibiotics may or may not help. Yet I continue to take them. You see as a patient, the scientific part of my brain takes a back seat to the less rationale victim side. I know that 50 percent of patients respond positively to placebo. I am also mindful of the old adage, “You can take an antibiotic and be better in three days or not take it and be better in three days.”

I recently had two teeth pulled and a bone graft placed in preparation for dental implants. The oral surgeon prescribed ten days of clindamycin even though there was no overt evidence of infection but the surgery was “deep.” During practice, I had seen enough antibiotic-induced C. diff to make me wary, but I still took the full course. Then a few days after that I contracted a cold and cough and rummaged through my medicine drawer and found a few doxycycline pills from my bronchitis last summer. Yes, I took them.

Thus I plead guilty to “do as I say and not as I do.” I have come to appreciate the frailty of human nature. I can now appreciate in retrospect my former patient’s needs and desires. But if you ask me “do antibiotics help treat a common cold?” I would still have to answer, “of course not.”

David Mokotoff is a cardiologist who blogs at his self-titled site, David Mokotoff.  He is the author of The Moose’s Children: A Memoir of Betrayal, Death, and Survival.

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