Proper Use of Antibiotics


I ask you to imagine this setting: A mother takes her sick child to a medical clinic, and after an examination, the health care provider tells the family she has severe pneumonia. They are then told to prepare for the worst, because there is no effective treatment to offer the child.

You would probably guess that this episode occurred before the 1930’s and the advent of antibiotics. Although this scenario did play out many times before we had antibiotics, it is no exaggeration to state that this is not just a look back in time, but also a frightening glance into the near future.

The overuse of antibiotics has led to a serious crisis in which bacteria that were once easily killed by weak types of penicillin are now resistant to even the most potent synthetic “super antibiotics”. The scientific explanation for this phenomenon is that bacteria, although considered simple life forms, are “evolutionary geniuses”. They have a tremendous capacity to mutate and alter their genetic code to enable them to produce chemicals that can render antibiotics useless.

The primary cause of this crisis is that antibiotics are overused in this country at an alarming rate. There are many reasons for this state of affairs. Health care providers must shoulder the majority of the responsibility. We need to do a better job of educating and reassuring our patients regarding antibiotic use.

In addition, we must not bend to pressure from patients (and parents of patients) who sometimes insist, or even demand, an antibiotic when it is clearly not indicated. I appeal to each of you reading this article to work with your health care provider to slow down the rate of the development of antibiotic resistant bacteria.

Of course, there are instances where the use of antibiotics are clearly necessary and indicated. This includes strept throat, acute middle ear infections, and pneumonia that is determined to be caused by bacteria and not a virus. Simple and uncomplicated cases of sinusitis and bronchitis do not always require antibiotics in the early stages if there are no complicating factors. Each of these cases must be evaluated individually.

One method that we commonly use in our clinic is a “back up” antibiotic prescription. For example, if a healthy, non-smoking patient has an early case of sinusitis or bronchitis that does not appear to be getting worse; we often suggest treating only the symptoms for several days. We discuss the possible complications or reasons that an antibiotic might become necessary if the condition does not improve. At that time we will issue an antibiotic prescription with the understanding it will be filled only if the condition worsens and will be accepted at the pharmacy for 10 days. This has resulted both in high patient acceptance and satisfaction and a definite decrease in unnecessary use of antibiotics.

The next time you go to your primary health care provider with symptoms of an upper or lower respiratory condition (sore throat, runny nose, post-nasal drip, cough, etc.), please have a discussion with the health care provider as to whether your condition may be a viral infection or an allergy that does not warrant the use of an antibiotic. If this situation is to be reversed, be guided by the following slogan: “LOOK FOR EVERY OPPORTUNITY NOT TO USE AN ANTIBIOTIC WHEN POSSIBLE!”

Patricia Henderson MS, RN, C-FNP
Family Nurse Practitioner
Center for Family and Preventive Medicine
Affiliate of San Jacinto Methodist Hospital
14626 FM 2100, Ste. C
Crosby, Texas 77532