Colds and Coughs: Do I Need Antibiotics?

Colds and Coughs: Do I Need Antibiotics? Paul Phillips, MD, Family Medicine www.SpringfieldClinic.com

Do I need an antibiotic?
Background
Definitions
Reasons for antibiotics
Reasons to avoid antibiotics
What you can do
What will help

Antibiotic resistance has been called one of the world’s most pressing public health problems.

$1.1 billion is spent annually on unnecessary adult upper respiratory infection antibiotic prescriptions.
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.

Antibiotics were prescribed in 68% of acute respiratory tract visits – and of those, 80% were unnecessary according to CDC guidelines.
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.

Definitions
Bacteria
Virus
Antibiotic
Antibiotic Resistance

Bacteria
Bacteria: Single-celled microorganisms which can exist either as independent (free-living) organisms or as parasites (dependent upon another organism for life).
Example: Strep throat, tuberculosis, MRSA skin infection

Virus
smaller than a bacteria
cannot grow or reproduce apart from a living cell.
invades living cells and uses their chemical machinery to keep itself alive and to replicate itself.
Example: HIV, Chickenpox, Herpes

Virus vs. Bacteria
Perhaps the most important distinction between bacteria and viruses is that antibiotic drugs usually kill bacteria, but they aren't effective against viruses.
In some cases, it may be difficult to determine whether a bacterium or a virus is causing your symptoms.
Many ailments — such as pneumonia, meningitis and diarrhea — can be caused by either type of microbe.
http://www.mayoclinic.com/health/infectious-disease/AN00652

Antibiotic
A drug used to treat infections caused by bacteria.

Antibiotic Resistance
The ability of bacteria to withstand an antibiotic to which they were once sensitive.

Upper Respiratory Illnesses
Sinus Infection
Sore Throat
Common Cold
Bronchitis

Sinus Infection
The sinuses are air-filled pockets make mucus
Sinusitis is an infection of the sinuses
usually occur after a cold or an allergic inflammation

What causes sinusitis?
after an upper respiratory infection (URI) or common cold.
The URI causes inflammation of the nasal passages that can lead to obstruction
Allergic disease can also lead to sinusitis because of the swelling of the nasal tissue and increased production of mucus.
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.

Sore Throat
Pharyngitis and tonsillitis are infections in the throat that cause inflammation.
These infections are spread by close contact with other individuals.
The majority of pharyngitis cases occur during the winter or colder months.

What causes pharyngitis and tonsillitis?
Viruses are the most common cause
Adenovirus
Influenza virus
Epstein-Barr virus (mononucleosis)
Bacteria
Group A beta-hemolytic streptococci (GABHS)
Neisseria gonorrhoeae
Haemophilus Influenzae type b

Common Cold
leading to more doctor visits and absences from school and work than any other illness
It is estimated that during a one-year period, people in the US will suffer one billion colds.
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.
rhinoviruses and the coronaviruses cause the majority of colds.

Respiratory System

Bronchitis
Bronchitis is an inflammation of the breathing tubes (airways) that are called bronchi, which causes increased production of mucus and other changes.
Acute bronchitis is the inflammation of mucous membranes of the bronchial tubes.

What causes acute bronchitis?
Acute bronchitis is usually caused by infectious agents such as viruses.
It may also be caused by physical or chemical agents--dusts, allergens, strong fumes--and those from chemical cleaning compounds, or tobacco smoke.
Acute bronchitis is usually a mild, and self-limiting condition, with complete healing and return to function.

Acute bronchitis may follow the common cold or other viral infections in the upper respiratory tract.
It may also occur in people with chronic sinusitis, allergies , or those with enlarged tonsils and adenoids.
Pneumonia is a complication that can follow bronchitis.

SO WHAT?
The number of bacteria resistant to antibiotics has increased in the last decade.
Many bacterial infections are becoming resistant to the most commonly prescribed antibiotic treatments.

AND…
Every time a person takes antibiotics, sensitive bacteria are killed, but resistant germs may be left to grow and multiply.
Repeated and improper uses of antibiotics are primary causes of the increase in drug-resistant bacteria.

AND…
Misuse of antibiotics jeopardizes the usefulness of essential drugs.
Decreasing inappropriate antibiotic use is the best way to control resistance.

SO…
When antibiotics fail to work, the consequences are
longer-lasting illnesses
more doctor visits
extended hospital stays
the need for more expensive and toxic medications.
Some resistant infections can even cause death.

What about the kids?
Children are of particular concern because they have the highest rates of antibiotic use.

Great Expectations
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.
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.

We’re doin’ better
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.
National Ambulatory Medical Care Survey (NAMCS).

PUBLIC HEALTH
Get Smart has contributed to 25% reduction in antimicrobial use per outpatient office visit for presumed viral infections
National Ambulatory Medical Care Survey (NAMCS).

TAKE HOME’s
Antibiotics cure bacterial infections, not viral infections such as:
Colds or flu;
Most coughs and bronchitis;
Sore throats not caused by strep; or
Runny noses.

Taking antibiotics for viral infections, such as a cold, cough, the flu, or most bronchitis, will not:
Cure the infections;
Keep other individuals from catching the illness
Help you feel better .

Who does need an antibiotic
Sinus infection
Only 2% of rhinosinusitis is bacterial
Snot is not very predictive
Last greater than 10 days or worsening at day 7
Maxillary pain/tooth pain

Sore Throat
Criteria- fever, exudate, no cough, nodes
<1- don’t test
2,3,4- get a rapid strep swab
Consider- 4 of 4  treat with penicillin or erythromycin

Bronchitis
Antibiotics don’t help uncomplicated bronchitis
Primary goal- RULE OUT Pneumonia
Look out for pertussis

What can you do
Prevention
Symptom Relief
Compliance

Prevention
Wash your hands
Keep healthy- diet, exercise, immunity
If you are sick, stay home
Avoid clusters of sick people
When around people with colds, do not touch your nose or eyes

Symptom Relief
Over-the-counter medicines may relieve symptoms, but they do not lessen the duration of illness.

Sore Throat
Soothe a sore throat with ice chips, sore throat spray, or lozenges
Use a clean humidifier or cool mist vaporizer
Take acetaminophen, ibuprofen or naproxen to relieve pain or fever

Ear Pain
Put a warm moist cloth over the ear that hurts

Runny Nose
Use a decongestant (SUDAFED)
Saline nasal spray to help relieve nasal symptoms

Sinus Pain/Pressure
Put a warm compress over the nose and forehead to help relieve sinus pressure
Use a decongestant or saline nasal spray
Breathe in steam from a bowl of hot water or shower

Cough
Use a clean humidifier
cool mist vaporizer
breathe in steam from a bowl of hot water or shower

Compliance
When you are prescribed an antibiotic
Take it exactly as the doctor tells you. Complete the prescribed course even if you are feeling better.
Throw away any leftover medication once you have completed your prescription

Major Take HOME POINTS
Most illness is viral
Antibiotics don’t help viral infections
Ibuprofen, sudafed & saline will help
“ Better Out Than In”

http://www.medical-jokes.com/category/medical-cartoons/

Thank you
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Colds and Coughs: Do I Need Antibiotics?

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Colds and Coughs: Do I Need Antibiotics? Presentation Transcript