The antibiotics arms race must end

“Cha-ching!” goes urgent care. For your rhinovirus, adenovirus, or seasonal allergies you get a strep screen, flu swab, CBC, and chest X-ray. You get a steroid shot, Rocephin, and Z-Pak. A week later, you present for medical care again, because your virus is no better, and you want a stronger antibiotic.

In the meantime, your body’s normal healthy bacterial flora has been altered and will take six weeks to six months to recover. Think of the savings to our patients if we could promote education instead of unnecessary expense. Their symptoms will last several weeks, and the production or color of mucus has no bearing on bacterial etiology or healing time. Unnecessary antibiotic prescriptions will not shorten the course of the illness. Ask anyone who has dealt with methicillin-resistant Staph aureus (MRSA) or C. diff. diarrhea about the personal cost of our overusing antibiotics and developing resistant bugs.

This escalation of demand for stronger antibiotics reminds me of the evolution of the opioid issue and pain management. Administrators insisted that patients must be pain-free and satisfied. Physicians were manipulated into prescribing escalating doses and strengths of medication to maintain employment and happy patient reviews. If hydrocodone isn’t strong enough, you must increase to oxycodone, fentanyl patch … the patient satisfaction emperor had no clothes, and physicians failed when we didn’t put our patients’ health first.

We see this same escalation of concern in dealing with seasonal influenza. Viruses developed resistance to amantadine, then Flumadine, and we are now seeing resistance to oseltamivir (Tamiflu). We shouted alarm before the swine flu (H1N1) and discussion of mutating bird flu (H5N1), asking why are we prescribing Tamiflu to healthy adults? You must make the patient happy. Our microwave, everything-at-the-touch-of-a-cell-phone society demands instant health and healing.

The patient expects some treatment or prescription for their time and co-pay. Patients are not appeased when you explain that ibuprofen, naproxen, and guaifenesin were prescriptions in the past, and now available over-the-counter to sometimes ease our symptoms. A forward-thinking society would emphasize ways to educate our patients’ understanding of viruses and their contagion. When they say “it is going around our house,” or “they gave it to me,” or “I get this sinus infection every year at this time” the best thing we can do for our patient’s health is to encourage education, healthy nutrition, hydration, and rest.

Over time, our patients will be better educated, avoiding that unnecessary trip to the physician’s office and further exposure to illnesses. Their immune system will be stronger, and their microbiome will thank you.

Charles W. Olson, Jr. is an emergency physician.

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