The antibiotics debate

Some people subscribe to a more natural approach, citing preventative measures, diet and homeopathic medicines as the solution to managing illnesses. Others believe in eradicating illness through aggressive treatment and medication. For many healthcare consumers, and in particular pa-rents, antibiotics are often viewed as a cure-all.

“The reality is that, as doctors, we tend to have a fairly hard time in convincing patients that they do not need antibiotics. I believe that antibiotics are prescribed too often. If a patient doesn’t respond as predicted, more antibiotics seem to be prescribed, when often time is still the best healer,” says Dr Neville Wellington of Medicross Kenilworth in the Cape.

When you should and should not use antibiotics

According to Dr Wellington the best approach is to use antibiotics cautiously and only when they are really required. Antibiotics are best suited to treat bacterial infections and are not effective for treating illnesses that are caused by a virus like common colds, flu, most sore throats or runny noses. These will often clear by themselves.

Some ear infections, severe sinus infections, strep throat, severe chest infections, urinary tract and many wound and skin infections tend to be bacterial infections and will need to be treated with antibiotics. Yet the role of physicians to prescribe antibiotics, when appropriate, should not be underestimated. Correctly diagnosing clinical symptoms goes a long way in the appropriate treatment of illness.

“Sometimes it is difficult to tell the difference between a viral or bacterial tonsillitis. In such instances most doctors will prescribe an antibiotic. The risk of having a virulent strep throat which causes rheumatic fever is a concern and, in these instances, prescribing antibiotics is necessary and has helped to reduce the incidence of this disease,” Wellington says.

Why the overuse of antibiotics can harm you

The problem with overusing antibiotics is that continuous usage breeds more virulent bacterial strains, which then become more resistant to medication. Eventually this requires stronger drugs to be developed to treat the disease and this naturally increases the cost of treatment. In addition, new antibiotics are not being produced fast enough.

For Wellington the answer lies in using antibiotics less often to slow down the formation of more hardy and difficult-to-treat bacteria. “Ideally, the newer antibiotics should be reserved for serious infections like pneumonias, abscesses or severe tonsillitis.”

Dr Dena van den Bergh, Director Quality Leadership and IT at Netcare, agrees: “Antibiotics treat bacterial infections, so they should only be prescribed in the event of a suspected bacterial infection. The use of antibiotics for viral infections is not effective.”

According to Van den Bergh, the increasing incidence of antibiotic-resistant organisms has highlighted the importance of correct antibiotic use, including bug-drug matching, de-escalation to narrower spectrum antibiotics, appropriate duration of the course and correct dosing.

“When microbes are continuously exposed to antibiotics they can develop one or several resistance mechanisms. The genetic material coding for this resistance is easily transferred from one bacterium to the next and bacteria are also easily transferred from one person to another. It is for this reason that antibiotic ste-wardship is under the spotlight in the medical world,” explains Van den Bergh.

“Patients exposed to multiple courses of antibiotics or extended treatment with antibiotics are at risk of developing drug-resistant micro-organisms.

“For example, an uncontrolled diabetic will be at higher risk of infection in and outside of the hospital, as such a patient would typically receive more courses of antibiotics than a non-diabetic person in good health. In this case, the patient’s own, normal gut ‘flora’ of micro-organisms may become resistant,” Van den Bergh adds.