Ask the Pharmacist
by Ron & Marla Chapleau
January 24, 2016
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Q) I went to the emergency last night to get treated for my chest cold, but the doctor refused to give me an antibiotic. Why does she not believe me that I am really sick?
A) I feel like I write a version of this article every year or two as it is a discussion/ complaint we deal with fairly regularly at the pharmacy. In fairness, however, I do believe the sheer volume of these conversations is lessening as the years go by and more and more of us become better educated about the usefulness and perils of antibiotics. Let’s start out with some basics.
Antibiotics do not cure viruses. They are only effective for bacterial illnesses. This means that taking them to relieve the symptoms of a cold or the flu (although there are very effective antiviral drugs to treat the flu) will not help. The vast majority of infections are viral in nature.
For instance, only 10 percent of sore throats are caused by the bacteria streptococcus, the rest are viruses. The story is the same when it comes to sinus infections where experts suggest that between 90-98 percent are caused by viruses. The numbers aren’t quite as high for ear or chest infections but the majority is still viral in nature.
While health care practitioners are doing their best to acknowledge these numbers, it is still estimated by experts that half of the antibiotics prescribed may be unnecessary. This in turn comes with serious ramifications, both in terms of our health and the economy. The amount of dollars (both taxpayer and otherwise) that are wasted on inappropriate antibiotics is in the 100’s of millions.
As well, the overuse of antibiotics is contributing to the spread of antibiotic resistant superbugs (as is the use of antibiotics in the agriculture industry) for which we have no defense against other than supportive care (i.e. controlling fever, maintaining hydration…) and our own immune system which in many of our seniors is likely somewhat impaired.
In the United States, it is estimated that each year, 2 million people develop these resistant infections and 23,000 eventually succumb to them.
Furthermore, antibiotics can cause side effects. Many of these are mild nuisance type ones such as heartburn, indigestion, altered taste perception, mild diarrhea and yeast infections. Unfortunately, they far too frequently can also cause significant adverse events such as a second infection like C. difficile.
A recent estimate in the States suggested that antibiotics are a leading reason for emergency room visits for drug side effects which are responsible for one out of every five visits. As such, new guidelines have been issued instructing physicians as to how to treat the sorts of infections they are likely to encounter in their clinics or emergency departments.
For chest infections like bronchitis, the feeling is that for the average patient (this would not include those with increased risk such as those diagnosed with COPD) an antibiotic should not be issued unless pneumonia is suspected. Measures that can be used to relieve your symptoms include cough suppressants, expectorants, antihistamines and inhalers. For those with sore throats, antibiotics should be reserved only for those whose throat swabs have tested positive for a bacterial infection. For the rest of us, analgesics such as acetaminophen or ibuprofen, throat lozenges and mouth rinses such as benzydamine can provide significant pain relief for the 4-7 days that these infections generally last for.
For patients who present with sinus infections, antibiotic treatment should be saved for those whose symptoms have persisted for longer than 10 days, or are presenting with temperatures over 39C along with a greenish nasal discharge or facial pain that lasts at least three days or who started to feel better and then began to go downhill again. There are all kinds of treatments available to ease your discomfort including nasal rinses, decongestants, antihistamines, pain killers and assorted nasal sprays.
Remember, the take home message here is that when your physician refuses to write you a prescription, they do not doubt your honesty or toughness. They realize how sick you are, they’re just doing you a favour by not wasting your money or jeopardizing your health on a drug that is unlikely to help.
For more information about this or any other health related questions, contact the pharmacists at Gordon Pharmasave, Your Health and Wellness Destination in Port Elgin and Kincardine.
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Saturday, January 23, 2016