You’ve had a cold for days now. You’re sneezing. Your throat hurts. Your nose is stuffy. You’re coughing. And you’re just plain sick of being sick. Is it time to see a doctor?
Or, your kid has been in earache hell all winter. She’s just finished a course of antibiotics, but she still has fluid behind her eardrum. Should she take even more antibiotics?
Or, your face hurts. Your sinuses ache. Even your upper teeth are in agony. Yellow-green gunk is pouring out of your nose. Is this just a bad cold or something worse? Do you need antibiotics?
It’s that awful time of year, when colds, flu, allergies, sinusitis, and ear infections not only plague but perplex. How do you know which misery you’ve got? How do you know which symptoms to tolerate and which to treat? Most urgently, how do you know when you really need antibiotics?
It is a crucial question. Antibiotics are life-saving in some situations, but ineffective in others – worse than ineffective, because the more widely antibiotics are used, the more bacteria around the world become resistant to them, ultimately rendering the drugs useless.
Cancer drugs, by contrast, affect only the person who takes them. But an antibiotic affects not just your health but potentially that of everyone in the world, notes Dr. Stuart B. Levy of the Tufts University School of Medicine, who heads the Center for Adaptation Genetics and Drug Resistance.
When you take an antibiotic, it kills off some of the hundreds of strains of bacteria in your body, wiping out those that are sensitive to it but leaving those that are not, says Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases in Bethesda, Md.
“The few resistant ones that are already there will then repopulate, so you have replaced sensitive ones with resistant ones,” Fauci says. That means you now harbor more dangerous bacteria that could make you sick in the future, and next time, when you need antibiotics, the drugs may not work. It also means you can now spread more resistant bacteria to other people.
In addition to the possibility of being infected by resistant strains from someone else, you develop your own. Bacteria are always dividing, and as they do, they sometimes mutate. Some mutants by chance will be resistant.
Already, several deadly strains of bacteria are so resistant they evade every antibiotic available – more than 100 drugs, says Levy of Tufts medical school. And while some of this problem may be due to widespread use of antibiotics in cattle feed, much of it is because people take antibiotics when they don’t need to. The Centers for Disease Control and Prevention estimates that 50 million of the 150 million outpatient antibiotic prescriptions a year are unnecessary.
So, when do you really need them?:
- Sore throat. The only time antibiotics are appropriate is for strep throat, caused by the Streptococcus bacterium, says Dr. Richard Besser, a pediatrician and epidemiologist at the CDC. To know whether you have strep, you need a throat culture, which can take several days, or a five-minute “rapid test,” though some insurers won’t pay for the latter. But most sore throats are viral, not bacterial, and antibiotics do not work against viruses. If you have a runny nose and cough along with your sore throat, chances are you have a virus, not strep.
- Sinus infections and colds. Every year, Americans suffer a billion colds; kids average six to 10 a year, adults two to four, government figures show. Since colds are caused by viruses (more than 200 different ones, in fact), antibiotics won’t help. But colds can lead to secondary bacterial infections in the sinuses.
There’s no easy test to tell a cold from sinusitis, but there are clues.
Colds usually last less than 10 days; sinus infections, more than 10. With a cold, the nasal discharge is thick and whitish or thin and watery; with a sinus infection, the discharge is likely to be thick and yellow-green and you may have a fever. (The CDC, however, notes that sometimes even yellow-green mucus can be caused by a viral, not bacterial, infection.)
Other signs of sinus infection include a feeling of facial pressure, fatigue, and tooth pain, says Dr. Marvin Fried, chief of otolaryngology at Beth Israel Deaconess Medical Center and Brigham and Women’s Hospital.
If you do have a sinus infection, it’s probably bacterial, and you need antibiotics, says Dr. Ralph Metson, an ear, nose, and throat surgeon at the Massachusetts Eye and Ear Infirmary. And if you have repeated bouts that don’t respond to antibiotics – more than three a year – you may need surgery to enlarge sinuses that have become blocked by allergies, colds, or polyps.
- Coughs. In children, most coughs, and even bronchitis (inflammation of the bronchial tubes), are viral and don’t warrant antibiotics, says Besser of the CDC. In adults, especially smokers, bronchitis may be bacterial and need antibiotics. At any age, if your cough is prolonged or you’re very sick, you should see a doctor because you may have pneumonia. Since pneumonia is often caused by bacteria, antibiotics are warranted.
- Earaches. More antibiotics are prescribed for kids’ ear infections than for anything else, the American Academy of Pediatrics says, and many are unneeded. In fact, about 50 percent of the bacteria that most commonly cause ear infections are now believed to be resistant to antibiotics.
The problem is that there are two types of earaches, and only one warrants antibiotics. That one is acute otitis media, which causes pain, fever, inflammation, and pus that’s often visible behind the eardrum.
The other, otitis media with effusion, often follows the acute form, even after antibiotics, and can last for months. While there’s also fluid behind the eardrum in this condition, the fluid is clear and there’s usually no pain. Antibiotics aren’t usually needed.
In fact, if doctors differentiated between these two types of earaches and held back more often on antibiotics for otitis media with effusion, 8 million unnecessary courses of antibiotics could be avoided every year. But day-care centers often won’t re-admit kids who’ve been sick unless they kids are on antibiotics. One solution to that, the CDC says, is for doctors to write a note to the child’s day-care center explaining why antibiotics are not needed.
- Flu (influenza). People often confuse colds and flu, but the symptoms are different. With flu, there’s usually a fever, a prominent headache, and exhaustion. If you’re not sure what you have, see your doctor, and ask to be tested. There are now more than a half-dozen rapid diagnostic tests for flu, according to the US Food and Drug Administration. If you do have the flu, two drugs, amantadine and rimantadine, can reduce symptoms.
Regardless of which form of respiratory misery you’ve got, remember that “the body’s immune system cures most infections, whether they’re caused by bacteria or viruses. Otherwise, the human species would not have survived, even before the advent of antibiotics,” says Metson of Mass. Eye and Ear.
“Nevertheless, if you think your infection is severe, see your doctor. Antibiotics can relieve symptoms and can be lifesaving.”
As bacteria fight back, world health woes are feared
In the 1940s, when antibiotics were developed, they were seen, rightly, as miracle drugs. Indeed, the ability to save lives by killing deadly bacteria is a milestone of modern medicine.
But now, 50 years later, these drugs have been used so often – and often, so unnecessarily – that bacteria are becoming resistant, creating a potentially disastrous health problem.
Already, the death rates from some diseases, such as tuberculosis, are rising again after having decreased for decades, says Dr. Stuart B. Levy at Tufts University School of Medicine.
Bacteria can become resistant to antibiotics in several ways. They can spontaneously undergo mutations that allow them to evade antibiotics. They can also acquire “resistance genes” by swapping DNA with other bacteria.
And in any given body or community, strains of bacteria that are resistant can become dominant if antibiotics kill off other bacteria with which they compete.
Researchers have found, for instance, that when one member of a household chronically takes an antibiotic for acne, other members develop skin bacteria resistant to that antibiotic.
More alarmingly, in many parts of the world, strains of the deadly Staphylococcus aureus are now resistant to all antibiotics except the potent vancomycin. And many strains of “staph,” a major cause of hospital-acquired infections, are becoming resistant to vancomycin as well, says Levy.
This means that strains of bacteria “untreatable by every known antibiotic are on their way,” he adds.
Worldwide, part of the problem is that farmers use antibiotics to boost growth in animals, Levy adds. Long-term exposure to low doses of antibiotics means animals may harbor resistant bacteria that can be passed to people. So far, the World Health Organization says, there is “little documented impact of this resistance on human health,” but the potential for harm is there and more data are needed.
You can help yourself – and the rest of society – by not pressuring doctors for antibiotics for viral infections. The drugs won’t work against viruses.
You should also take all the pills in any course of antibiotics you’ve been prescribed, for several reasons. If you don’t, you may leave alive bacteria that are less susceptible and most likely to become resistant. These bacteria may also make you relapse . And you might be tempted to use leftover antibiotics for some disease for which they’re not appropriate.
You should also avoid antibacterial soaps, hand lotions, and disinfectants, says Levy. There’s no evidence they ward off infection and they may contribute to antibiotic resistance.
Doctors and nurses can help by washing their hands – with regular soap – after every patient they see. Many don’t. And they should resist patient pressure for antibiotics if they’re unneeded.
For more information, you might want to read:
- “The Antibiotic Paradox: How Miracle Drugs Are Destroying the Miracle,” by Dr. Stuart B. Levy, Plenum Publishers, 1992.
- “Drug Resistance: The New Apocalypse,” special issue of Trends in Microbiology, Vol.2, No. 10, October 1, 1994.
- “Antibiotic Resistance: Origins, Evolution, Selection and Spread,” edited by D. J. Chadwick and J. Goode, John Wiley & Sons, 1997.
- “The Challenge of Antibiotic Resistance,” by Dr. Stuart B. Levy, Scientific American, March, 1998.
- On the Web, you can also check out www.antibiotic.org, the site for the Alliance for the Prudent Use of Antibiotics.