Colds and Coughs: Do I Need Antibiotics? Paul Phillips, MD, Family Medicine www.SpringfieldClinic.com
Do I need an antibiotic? <ul><li>Background </li></ul><ul><li>Definitions </li></ul><ul><li>Reasons for antibiotics </li><...
<ul><li>Antibiotic resistance has been called one of the world’s most pressing public health problems. </li></ul>
<ul><li>$1.1 billion is spent annually on unnecessary adult upper respiratory infection antibiotic prescriptions. </li></u...
<ul><li>Antibiotics were prescribed in 68% of acute respiratory tract visits – and of those, 80% were unnecessary accordin...
Definitions <ul><li>Bacteria </li></ul><ul><li>Virus </li></ul><ul><li>Antibiotic </li></ul><ul><li>Antibiotic Resistance ...
Bacteria <ul><li>Bacteria:  Single-celled microorganisms which can exist either as independent (free-living) organisms or ...
Virus <ul><li>smaller than a bacteria </li></ul><ul><li>cannot grow or reproduce apart from a living cell.  </li></ul><ul>...
Virus vs. Bacteria <ul><li>Perhaps the most important distinction between bacteria and viruses is that antibiotic drugs us...
Antibiotic <ul><li>A drug used to treat infections caused by bacteria. </li></ul>
Antibiotic Resistance <ul><li>The ability of bacteria to withstand an antibiotic to which they were once sensitive. </li><...
Upper Respiratory Illnesses <ul><li>Sinus Infection </li></ul><ul><li>Sore Throat </li></ul><ul><li>Common Cold </li></ul>...
Sinus Infection <ul><li>The sinuses are air-filled pockets make mucus  </li></ul><ul><li>Sinusitis is an infection of the ...
 
What causes sinusitis? <ul><li>after an upper respiratory infection (URI) or common cold.  </li></ul><ul><li>The URI cause...
Sore Throat <ul><li>Pharyngitis and tonsillitis are infections in the throat that cause inflammation.  </li></ul><ul><li>T...
 
What causes pharyngitis and tonsillitis? <ul><li>Viruses  are the most common cause </li></ul><ul><ul><li>Adenovirus </li>...
Common Cold <ul><li>leading to more doctor visits and absences from school and work than any other illness  </li></ul><ul>...
Respiratory System
Bronchitis <ul><li>Bronchitis is an inflammation of the breathing tubes (airways) that are called bronchi, which causes in...
What causes acute bronchitis? <ul><li>Acute bronchitis is usually caused by infectious agents such as viruses.  </li></ul>...
<ul><li>Acute bronchitis may follow the  common cold  or other viral infections in the upper respiratory tract.  </li></ul...
SO WHAT? <ul><li>The number of bacteria resistant to antibiotics has increased in the last decade.  </li></ul><ul><li>Many...
AND… <ul><li>Every time a person takes antibiotics, sensitive bacteria are killed, but resistant germs may be left to grow...
AND… <ul><li>Misuse of antibiotics jeopardizes the usefulness of essential drugs.  </li></ul><ul><li>Decreasing inappropri...
SO… <ul><li>When antibiotics fail to work, the consequences are  </li></ul><ul><li>longer-lasting illnesses </li></ul><ul>...
What about the kids? <ul><li>Children are of particular concern because they have the highest rates of antibiotic use.  </...
Great Expectations <ul><li>Parent pressure makes a difference. For pediatric care, a study showed that doctors prescribe a...
We’re doin’ better <ul><li>National Ambulatory Medical Care Survey (NAMCS) data shows that overall antibiotic prescribing ...
PUBLIC HEALTH <ul><li>Get Smart has contributed to 25% reduction in antimicrobial use per outpatient office visit for pres...
TAKE HOME’s <ul><li>Antibiotics cure bacterial infections, not viral infections such as:   </li></ul><ul><ul><li>Colds or ...
<ul><li>Taking antibiotics for viral infections, such as a cold, cough, the flu, or most bronchitis, will not:  </li></ul>...
Who does need an antibiotic <ul><li>Sinus infection </li></ul><ul><li>Only 2% of rhinosinusitis is bacterial </li></ul><ul...
Who does need an antibiotic <ul><li>Sore Throat </li></ul><ul><li>Criteria- fever, exudate, no cough, nodes </li></ul><ul>...
Who does need an antibiotic <ul><li>Bronchitis </li></ul><ul><li>Antibiotics don’t help uncomplicated bronchitis </li></ul...
What can you do <ul><li>Prevention </li></ul><ul><li>Symptom Relief </li></ul><ul><li>Compliance </li></ul>
Prevention <ul><li>Wash your hands </li></ul><ul><li>Keep healthy- diet, exercise, immunity </li></ul><ul><li>If you are s...
Symptom Relief <ul><li>Over-the-counter medicines may relieve symptoms, but they do not lessen the duration of illness. </...
Sore Throat <ul><li>Soothe a sore throat with ice chips, sore throat spray, or  lozenges  </li></ul><ul><li>Use a clean  h...
Ear Pain <ul><li>Put a  warm  moist cloth over the ear that hurts  </li></ul><ul><li>Take acetaminophen,  ibuprofen  or na...
Runny Nose <ul><li>Use a  decongestant  (SUDAFED) </li></ul><ul><li>Saline  nasal spray to help relieve nasal symptoms </l...
Sinus Pain/Pressure <ul><li>Put a  warm compress  over the nose and forehead to help relieve sinus pressure </li></ul><ul>...
Cough <ul><li>Use a clean  humidifier  </li></ul><ul><li>cool mist vaporizer  </li></ul><ul><li>breathe in  steam  from a ...
Compliance <ul><li>When you are prescribed an antibiotic </li></ul><ul><ul><li>Take it exactly as the doctor tells you. Co...
Major Take HOME POINTS <ul><li>Most illness is viral </li></ul><ul><li>Antibiotics don’t help viral infections </li></ul><...
<ul><ul><ul><li>http://www.medical-jokes.com/category/medical-cartoons/ </li></ul></ul></ul>
Thank you <ul><li>Questions </li></ul>
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Colds and Coughs: Do I Need Antibiotics?

  1. 1. Colds and Coughs: Do I Need Antibiotics? Paul Phillips, MD, Family Medicine www.SpringfieldClinic.com
  2. 2. Do I need an antibiotic? <ul><li>Background </li></ul><ul><li>Definitions </li></ul><ul><li>Reasons for antibiotics </li></ul><ul><li>Reasons to avoid antibiotics </li></ul><ul><li>What you can do </li></ul><ul><li>What will help </li></ul>
  3. 3. <ul><li>Antibiotic resistance has been called one of the world’s most pressing public health problems. </li></ul>
  4. 4. <ul><li>$1.1 billion is spent annually on unnecessary adult upper respiratory infection antibiotic prescriptions. </li></ul><ul><li>Fendrick AM, Monto AS, Nightengale B, Sarnes M: The economic burden of non-influenza related viral respiratory tract infection in the United States. Arch Int Med : 163(4): 487-94, 2003. </li></ul>
  5. 5. <ul><li>Antibiotics were prescribed in 68% of acute respiratory tract visits – and of those, 80% were unnecessary according to CDC guidelines. </li></ul><ul><li>Scott JG, Cohen D, DiCicco-Bloom B, Orzano AJ, et al: Antibiotic use in acute respiratory infections and the ways patients pressure physicians for a prescription. J Fam Pract : 50(10): 853-8, 2001. </li></ul>
  6. 6. Definitions <ul><li>Bacteria </li></ul><ul><li>Virus </li></ul><ul><li>Antibiotic </li></ul><ul><li>Antibiotic Resistance </li></ul>
  7. 7. Bacteria <ul><li>Bacteria: Single-celled microorganisms which can exist either as independent (free-living) organisms or as parasites (dependent upon another organism for life). </li></ul><ul><li>Example: Strep throat, tuberculosis, MRSA skin infection </li></ul>
  8. 8. Virus <ul><li>smaller than a bacteria </li></ul><ul><li>cannot grow or reproduce apart from a living cell. </li></ul><ul><li>invades living cells and uses their chemical machinery to keep itself alive and to replicate itself. </li></ul><ul><li>Example: HIV, Chickenpox, Herpes </li></ul>
  9. 9. Virus vs. Bacteria <ul><li>Perhaps the most important distinction between bacteria and viruses is that antibiotic drugs usually kill bacteria, but they aren't effective against viruses. </li></ul><ul><li>In some cases, it may be difficult to determine whether a bacterium or a virus is causing your symptoms. </li></ul><ul><li>Many ailments — such as pneumonia, meningitis and diarrhea — can be caused by either type of microbe. </li></ul><ul><li>http://www.mayoclinic.com/health/infectious-disease/AN00652 </li></ul>
  10. 10. Antibiotic <ul><li>A drug used to treat infections caused by bacteria. </li></ul>
  11. 11. Antibiotic Resistance <ul><li>The ability of bacteria to withstand an antibiotic to which they were once sensitive. </li></ul>
  12. 12. Upper Respiratory Illnesses <ul><li>Sinus Infection </li></ul><ul><li>Sore Throat </li></ul><ul><li>Common Cold </li></ul><ul><li>Bronchitis </li></ul>
  13. 13. Sinus Infection <ul><li>The sinuses are air-filled pockets make mucus </li></ul><ul><li>Sinusitis is an infection of the sinuses </li></ul><ul><li>usually occur after a cold or an allergic inflammation </li></ul>
  14. 15. What causes sinusitis? <ul><li>after an upper respiratory infection (URI) or common cold. </li></ul><ul><li>The URI causes inflammation of the nasal passages that can lead to obstruction </li></ul><ul><li>Allergic disease can also lead to sinusitis because of the swelling of the nasal tissue and increased production of mucus. </li></ul><ul><li>After the blockage of the flow of secretions from the sinuses, bacteria will sometimes begin to grow. This leads to a sinus infection, or sinusitis. </li></ul>
  15. 16. Sore Throat <ul><li>Pharyngitis and tonsillitis are infections in the throat that cause inflammation. </li></ul><ul><li>These infections are spread by close contact with other individuals. </li></ul><ul><li>The majority of pharyngitis cases occur during the winter or colder months. </li></ul>
  16. 18. What causes pharyngitis and tonsillitis? <ul><li>Viruses are the most common cause </li></ul><ul><ul><li>Adenovirus </li></ul></ul><ul><ul><li>Influenza virus </li></ul></ul><ul><ul><li>Epstein-Barr virus (mononucleosis) </li></ul></ul><ul><li>Bacteria </li></ul><ul><ul><li>Group A beta-hemolytic streptococci (GABHS) </li></ul></ul><ul><ul><li>Neisseria gonorrhoeae </li></ul></ul><ul><ul><li>Haemophilus Influenzae type b </li></ul></ul>
  17. 19. Common Cold <ul><li>leading to more doctor visits and absences from school and work than any other illness </li></ul><ul><li>It is estimated that during a one-year period, people in the US will suffer one billion colds. </li></ul><ul><li>Caused by a virus that inflames the membranes in the lining of the nose and throat, colds can be the result of more than 200 different viruses. </li></ul><ul><li>rhinoviruses and the coronaviruses cause the majority of colds. </li></ul>
  18. 20. Respiratory System
  19. 21. Bronchitis <ul><li>Bronchitis is an inflammation of the breathing tubes (airways) that are called bronchi, which causes increased production of mucus and other changes. </li></ul><ul><li>Acute bronchitis is the inflammation of mucous membranes of the bronchial tubes. </li></ul>
  20. 22. What causes acute bronchitis? <ul><li>Acute bronchitis is usually caused by infectious agents such as viruses. </li></ul><ul><li>It may also be caused by physical or chemical agents--dusts, allergens, strong fumes--and those from chemical cleaning compounds, or tobacco smoke. </li></ul><ul><li>Acute bronchitis is usually a mild, and self-limiting condition, with complete healing and return to function. </li></ul>
  21. 23. <ul><li>Acute bronchitis may follow the common cold or other viral infections in the upper respiratory tract. </li></ul><ul><li>It may also occur in people with chronic sinusitis, allergies , or those with enlarged tonsils and adenoids. </li></ul><ul><li>Pneumonia is a complication that can follow bronchitis. </li></ul>
  22. 24. SO WHAT? <ul><li>The number of bacteria resistant to antibiotics has increased in the last decade. </li></ul><ul><li>Many bacterial infections are becoming resistant to the most commonly prescribed antibiotic treatments. </li></ul>
  23. 25. AND… <ul><li>Every time a person takes antibiotics, sensitive bacteria are killed, but resistant germs may be left to grow and multiply. </li></ul><ul><li>Repeated and improper uses of antibiotics are primary causes of the increase in drug-resistant bacteria. </li></ul>
  24. 26. AND… <ul><li>Misuse of antibiotics jeopardizes the usefulness of essential drugs. </li></ul><ul><li>Decreasing inappropriate antibiotic use is the best way to control resistance. </li></ul>
  25. 27. SO… <ul><li>When antibiotics fail to work, the consequences are </li></ul><ul><li>longer-lasting illnesses </li></ul><ul><li>more doctor visits </li></ul><ul><li>extended hospital stays </li></ul><ul><li>the need for more expensive and toxic medications. </li></ul><ul><li>Some resistant infections can even cause death. </li></ul>
  26. 28. What about the kids? <ul><li>Children are of particular concern because they have the highest rates of antibiotic use. </li></ul>
  27. 29. Great Expectations <ul><li>Parent pressure makes a difference. For pediatric care, a study showed that doctors prescribe antibiotics 62% of the time if they perceive parents expect them and 7% of the time if they feel parents do not expect them. </li></ul><ul><li>Mangione-Smith R, McGlynn EA, Elliott MN, et al: The relationship between perceived parental expectations and pediatrician antimicrobial prescribing behavior. Pediatrics 103:711-718, 1999. </li></ul>
  28. 30. We’re doin’ better <ul><li>National Ambulatory Medical Care Survey (NAMCS) data shows that overall antibiotic prescribing dropped from 13.8 prescriptions per 100 office visits to 12.0 prescriptions per 100 office visits comparing 1997-98 to 2005-06 with a 13% reduction in overall antimicrobial prescribing. </li></ul><ul><ul><li>National Ambulatory Medical Care Survey (NAMCS). </li></ul></ul>
  29. 31. PUBLIC HEALTH <ul><li>Get Smart has contributed to 25% reduction in antimicrobial use per outpatient office visit for presumed viral infections </li></ul><ul><li>National Ambulatory Medical Care Survey (NAMCS). </li></ul>
  30. 32. TAKE HOME’s <ul><li>Antibiotics cure bacterial infections, not viral infections such as: </li></ul><ul><ul><li>Colds or flu; </li></ul></ul><ul><ul><li>Most coughs and bronchitis; </li></ul></ul><ul><ul><li>Sore throats not caused by strep; or </li></ul></ul><ul><ul><li>Runny noses. </li></ul></ul>
  31. 33. <ul><li>Taking antibiotics for viral infections, such as a cold, cough, the flu, or most bronchitis, will not: </li></ul><ul><ul><li>Cure the infections; </li></ul></ul><ul><ul><li>Keep other individuals from catching the illness </li></ul></ul><ul><ul><li>Help you feel better . </li></ul></ul>
  32. 34. Who does need an antibiotic <ul><li>Sinus infection </li></ul><ul><li>Only 2% of rhinosinusitis is bacterial </li></ul><ul><li>Snot is not very predictive </li></ul><ul><li>Last greater than 10 days or worsening at day 7 </li></ul><ul><li>Maxillary pain/tooth pain </li></ul>
  33. 35. Who does need an antibiotic <ul><li>Sore Throat </li></ul><ul><li>Criteria- fever, exudate, no cough, nodes </li></ul><ul><li><1- don’t test </li></ul><ul><li>2,3,4- get a rapid strep swab </li></ul><ul><li>Consider- 4 of 4  treat with penicillin or erythromycin </li></ul>
  34. 36. Who does need an antibiotic <ul><li>Bronchitis </li></ul><ul><li>Antibiotics don’t help uncomplicated bronchitis </li></ul><ul><li>Primary goal- RULE OUT Pneumonia </li></ul><ul><li>Look out for pertussis </li></ul>
  35. 37. What can you do <ul><li>Prevention </li></ul><ul><li>Symptom Relief </li></ul><ul><li>Compliance </li></ul>
  36. 38. Prevention <ul><li>Wash your hands </li></ul><ul><li>Keep healthy- diet, exercise, immunity </li></ul><ul><li>If you are sick, stay home </li></ul><ul><li>Avoid clusters of sick people </li></ul><ul><li>When around people with colds, do not touch your nose or eyes </li></ul>
  37. 39. Symptom Relief <ul><li>Over-the-counter medicines may relieve symptoms, but they do not lessen the duration of illness. </li></ul>
  38. 40. Sore Throat <ul><li>Soothe a sore throat with ice chips, sore throat spray, or lozenges </li></ul><ul><li>Use a clean humidifier or cool mist vaporizer </li></ul><ul><li>Take acetaminophen, ibuprofen or naproxen to relieve pain or fever </li></ul>
  39. 41. Ear Pain <ul><li>Put a warm moist cloth over the ear that hurts </li></ul><ul><li>Take acetaminophen, ibuprofen or naproxen to relieve pain or fever </li></ul>
  40. 42. Runny Nose <ul><li>Use a decongestant (SUDAFED) </li></ul><ul><li>Saline nasal spray to help relieve nasal symptoms </li></ul>
  41. 43. Sinus Pain/Pressure <ul><li>Put a warm compress over the nose and forehead to help relieve sinus pressure </li></ul><ul><li>Use a decongestant or saline nasal spray </li></ul><ul><li>Breathe in steam from a bowl of hot water or shower </li></ul><ul><li>Take acetaminophen, ibuprofen or naproxen to relieve pain or fever </li></ul>
  42. 44. Cough <ul><li>Use a clean humidifier </li></ul><ul><li>cool mist vaporizer </li></ul><ul><li>breathe in steam from a bowl of hot water or shower </li></ul>
  43. 45. Compliance <ul><li>When you are prescribed an antibiotic </li></ul><ul><ul><li>Take it exactly as the doctor tells you. Complete the prescribed course even if you are feeling better. </li></ul></ul><ul><ul><li>Throw away any leftover medication once you have completed your prescription </li></ul></ul>
  44. 46. Major Take HOME POINTS <ul><li>Most illness is viral </li></ul><ul><li>Antibiotics don’t help viral infections </li></ul><ul><li>Ibuprofen, sudafed & saline will help </li></ul><ul><li>“ Better Out Than In” </li></ul>
  45. 47. <ul><ul><ul><li>http://www.medical-jokes.com/category/medical-cartoons/ </li></ul></ul></ul>
  46. 48. Thank you <ul><li>Questions </li></ul>
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