Overuse of Antibiotics Poses Serious Cold-Weather Health Threat
by Susan Rutter

HARRISBURG, Pa. - Four centuries after William Shakespeare asked the question, the Pennsylvania Medical Society has proof of the answer: Yes, you can desire too much of a good thing. In fact, that's why more and more Americans are having trouble fighting illnesses that - though untreatable in Shakespeare's day - have been easily curable since the mid-1900s.

Drugs taken unnecessarily, particularly over the winter months during cold and flu season, are leading to a serious public health problem in Pennsylvania and throughout the United States. The culprit, as identified by the Medical Society, is the overuse of antibiotics, often with regard to treating cold-weather upper respiratory infections.

Each year, disease-causing bacteria become increasingly drug-resistant, according to Wanda D. Filer, M.D., a Pennsylvania Medical Society member and family physician in York. Most antibiotics for pneumonia, for example, have become less and less effective in accomplishing their goal.

"If taken needlessly and repeatedly, they actually can diminish their potency to overcome resistant germs," says Dr. Filer, "resulting in the survival and growth of drug-resistant strains of pneumonia and other illnesses."

She says, "We're all at risk. It's a community issue." Whether we're routine users of antibiotics or not, increasingly powerful bacteria are a threat to all of us. Dr. Filer says that bacterial infections may lead to grave medical conditions. A World Health Organization study estimates that nearly two American deaths each hour are caused by antibiotic overuse.

In the United States, most antibiotics are prescribed to outpatients for respiratory tract infections but are ineffective, says the Medical Society. These conditions include sinusitis, bronchitis, pharyngitis, and general upper respiratory tract infections, including the common cold.

Medical authorities estimate that if antibiotics weren't overused for these common viral illnesses, outpatient prescriptions could be reduced by an estimated 40 percent or more.

Some of these respiratory infections - generally just sinusitis and pharyngitis - may prove to be bacterial and therefore require antibiotics. All others, Dr. Filer says, should be treated with over-the-counter medications that reduce fever, pain, congestion, and coughing.

Why then are so many wintertime illnesses fought with prescriptions that are unnecessary?

Typical scenarios: An ill patient sees his doctor and asks for an antibiotic so he'll be able to return to work as quickly as possible. Or, a mother requests one for her child because her day care provider requires it for the child to be readmitted.

The Medical Society says that many people don't know the difference between treating viral and bacterial infections - that antibiotics are powerless against viral infections such as most coughs, the common cold, and the flu. Their best remedy is rest and plenty of fluids.

But, no matter what the ailment, patients often demand antibiotics, believing the drugs can't do any harm. Knowing their patients are counting on the medications, some doctors feel pressured to prescribe them.

Dr. Filer suggests that physicians not give in to patients' requests for needless antibiotics and asks that patients:

Not pressure doctors for antibiotics to treat bronchitis, colds, and flu. Take their medications exactly as prescribed until they're gone. Never share or use leftover drugs. She adds that parents of a sick child may be especially concerned or angry if they feel their physician is making the child suffer by denying a prescription drug. "It's not a matter of withholding care," she says, "but of holding back unnecessary care." In other words, medicine denied today may benefit the child in the long run.

Dr. Filer has observed a positive change in behavior - in both patients and physicians - over the past several years. "Patients aren't demanding antibiotics like they once were, and doctors have been reining in their prescription and use." Though she's glad awareness is growing, she believes a serious problem remains.

Physicians first found success with antibiotics following Alexander Fleming's discovery of penicillin in 1928. Before long, these new drugs were conquering a number of diseases, including such killers as pneumonia, scarlet fever, and blood poisoning. Today, however, "we've come to rely on them to such an extent, that their overuse has led to a growing public health threat, and drugs are less effective when really required," says Dr. Filer.

Whether they're taken appropriately for bacterial infections or incorrectly for viral infections, antibiotics kill thousands of harmless bacteria as well, according to the Pennsylvania Medical Society. "This loss of competition (from harmless bacteria) allows stronger, antibiotic-resistant bacteria to spread more easily and quickly," explains Dr. Filer.

Then, when the drugs are most needed - mainly to fight ear infections, bacterial sinusitis, pneumonia, strep throat (bacterial pharyngitis), meningitis, and bladder infections - they may not be potent enough to do the job.

Consequently, more and more Americans are prone to developing diseases that were once easily curable but are becoming more difficult to defeat with current medicines.

Dr. Filer acknowledges that physicians can't always be sure whether an illness is bacterial or viral. In those cases - particularly for patients with chronic medical problems, like respiratory difficulties or diabetes, that may be exacerbated by a bacterial infection - an antibiotic may be in order. She says, "If a heavy smoker with a 102-degree fever has been miserable for four or five days, then one may be appropriate."

For most of us, though, the best course of action today for gaining strength and recovering is the same as in Shakespeare's time: rest and fluids. Then, when we're hit with pneumonia or strep throat, we and our trusty antibiotic will be ready to fight it together.