WASHINGTON (AP) -
It’s cold season, and the miserable continue to trudge in, seeking
antibiotics because of mucus turned green, or a cough that has nagged for
weeks.
Despite years of
warnings, doctors still overprescribe antibiotics for acute respiratory
infections even though most are caused by viruses that those drugs cannot
help.
Now doctors are
getting new tips on how to avoid unnecessary antibiotics for these common
complaints - and to withstand the patient who’s demanding one.
Sure bronchitis
sounds scary. So describe it as a chest cold. And no, color changes don’t
mean it’s time for an antibiotic.
“Antibiotics are
terrific. Thank God we have them for really bad things. But we need to be
judicious in the way we use them,” said American College of Physicians
President Dr. Wayne J. Riley, an internal medicine professor at Vanderbilt
University.
Rather than sending
patients off with little advice about what to do while their bodies fight
off a virus, how about a suggestion instead for some over-the-counter or
home remedies that just might ease the cough or the pain?
“We’re calling for
the symptomatic prescription pad,” Riley said, describing information sheets
that suggest simple aids like humidifiers and plenty of fluid, have a space
to scribble directions for an OTC drug - and tell patients when to return if
they’re not getting better. The Centers for Disease Control and Prevention
has a sample on its website.
Antibiotics are
losing their effectiveness, and inappropriate prescribing is one factor.
Repeated exposure can lead germs to become resistant to the drugs. The CDC
estimates that drug-resistant bacteria cause 2 million illnesses and 23,000
deaths each year in the U.S.
Another reason not
to use them unnecessarily: side effects. Antibiotics are implicated in 1 of
5 emergency-room visits for bad drug reactions, CDC says. Particularly
troubling is an increase in severe diarrhea caused by C-diff, the
Clostridium difficile bug that can take hold in the gut after antibiotics
kill off other bacteria.
CDC has seen
improvement from pediatricians in antibiotic prescribing but overuse remains
a big problem for adults, especially with respiratory illnesses, said Dr.
Lauri Hicks, who heads CDC’s “Get Smart” antibiotic education campaign.
Monday’s
guidelines, from CDC and the American College of Physicians, move beyond
simple statements that antibiotics don’t work for viruses like the common
cold or the flu. They lay out how doctors begin deciding if antibiotics are
warranted for some other common respiratory complaints, explain that
decision to patients and offer guidance on symptom relief.
Among the advice,
published in Annals of Internal Medicine:
-Acute bronchitis
is airway inflammation, irritation that makes you cough, sometimes as long
as six weeks. The guidelines say not to perform special testing or prescribe
antibiotics unless pneumonia is suspected, something often accompanied by a
fast heartbeat, fever or abnormal breathing sounds.
Over-the-counter
symptom relief includes cough suppressants such as dextromethorphan;
mucus-thinning expectorants such as guaifenesin; and antihistamines or
decongestants.
-Sore throats are
hugely common but adults are far less likely than children to have the strep
throat that requires an antibiotic. A rapid strep test is available if
patients have suspicious symptoms such as persistent fever, night sweats or
swollen tonsils.
Pain-relieving
options for adults include aspirin, acetaminophen, nonsteroidal
anti-inflammatory drugs such as ibuprofen, and throat lozenges.
-Sinus infections
can be very painful but usually clear up without antibiotics even if
bacteria are to blame. The guidelines say antibiotics should be reserved for
patients with no signs of improvement after 10 days, severe symptoms such as
fever higher than 102, or what’s called double-sickening, when someone
starts to recover and then gets worse.
Possible symptom
relievers include decongestants, nasal sprays, saline nasal irrigation and
pain medications.
Riley often has to
explain how to tell if cough and cold relievers contain a sedating
antihistamine, and that nasal sprays clear congestion quickly but that using
them for too many days can trigger rebound symptoms. He asks if patients are
taking multiple products that contain acetaminophen, best known as Tylenol,
because too much can damage the liver. Often, his patients say an
over-the-counter drug isn’t working when in fact, they didn’t take it as
directed.
"There is a
dizzying array” of drugstore symptom relievers, so don’t make miserable
patients sort through them without help, said CDC’s Hicks.
“There isn’t a
right answer that works for everybody,” she said. But sometimes something as
basic as a humidifier “can make a difference in terms of how you feel when
you wake up in the morning.”
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