For uncomplicated colds antibiotics are not necessary

Jan 3 2005

If a runny nose and congested chest have you thinking of antibiotics, think again.

"For uncomplicated colds, zero are necessary; bronchitis, less than 10 percent are necessary; sore throats, maybe up to 10 to 15 percent of these patients need an antibiotic," says Dr. Jim Wilde, pediatric emergency medicine and infectious disease physician at the Medical College of Georgia.

"Ninety to 95 percent of all infections are viral or low-acuity bacterial infections such as ear infections or sinus infections," says Dr. Wilde. Yet studies show that more than half of patients in the United States are taking bacteria-destroying antibiotics for colds, flu and bronchitis, all caused by viruses, says Dr. Wilde.

The worrisome balance sheet has Dr. Wilde, a self-professed foe of antibiotic misuse, regularly lecturing to health care providers, residents and students about proper use of antibiotics.

Now he's also a principal investigator on a National Institutes of Health-funded study seeking to educate providers as well as patients on the hazards of antibiotic misuse.

The net effect is we are losing the war, says Dr. Wilde, with the spread of antibiotic-resistant bacteria running ahead of production of new antibiotics to fight them. "If you look at the history of antibiotic use in the last 60 years and you look at the history of resistance in the last 60 years, one is about two years behind the other. As soon as a new antibiotic is introduced, bugs develop resistance to it. If it had not been for the fact that we have been developing more antibiotics in the last 50 years, we would be in big trouble right now. Even if you use antibiotics appropriately, bugs will still find a way to get around them, but we can delay the spread of resistance so we have more time to develop new antibiotics."

Dr. Wilde believes that without big change, antibiotics – needed to treat life-threatening conditions such as meningitis and pneumonia – may be useless within 50 years. "It's a federal issue. We are in big trouble in this country if we don't get our antibiotic use under control. Sounds alarmist? It's not," says the physician, who in the last year has seen children in the emergency room with abscesses, or pus pockets, containing methycillin-resistant Staphylococcus aureus. In fact, a Web-based chat room for pediatric emergency specialists across the country is buzzing with talk of this antibiotic-resistant infection showing up in otherwise healthy children. "It's nasty stuff and it's because of inappropriate antibiotic use. This is just the tip of the iceberg," says Dr. Wilde

The NIH, in consultation with the Centers for Disease Control and Prevention, has funded a multi-year study designed to get a still-better handle on the extent of antibiotic misuse and the efficacy of educational programs designed to curb it.

MCG Medical Center and the Veterans Affairs Medical Center in Augusta are among 16 hospitals nationally participating in the four-year study. The first year looked at baseline antibiotic use rate in emergency rooms at study hospitals. Study coordinators, such as Helen Fain, study coordinator for MCG and the VA, pulled 250 charts from patients who came into the emergency room with respiratory illness and looked at how many got antibiotics. Each center also conducted follow up phone interviews with 50 of the patients asking questions such as whether they were satisfied with their visit, thought they needed antibiotics and understood why the doctor didn't prescribe antibiotics if he didn't.

Year two recently started and is about education, including stepping up Dr. Wilde's educational forums with health care providers in the emergency room at MCG Medical Center as well as a patient-focused campaign that includes a bilingual kiosk in the emergency room lobby.

Posters in exam rooms explain simple truths such as the fact that bronchitis is a chest cold meaning no antibiotic is needed 90 percent of the time, says Dr. Wilde. Patient handouts developed by the CDC reinforce what conditions merit antibiotics and what happens when antibiotics are misused.

The interactive kiosk, in use in four of eight cities in the study, runs through scenarios with patients describing familiar respiratory ills to a doctor, then asks the user questions such as whether antibiotics kill viruses. The correct answer: "No."

The third year will determine whether availability of a blood test that helps identify the some 10 percent of bronchitis patients who have a bacterial and viral infection – a 'super' infection that would benefit from an antibiotic – brings antibiotic use down. The final year will look at whether all the education has made a lasting difference.

"I started my career as an infectious disease physician, so I'm the first to say, if you need an antibiotic, take one," says Dr. Wilde, and take it correctly, meaning keep taking the drug until it is gone, not just until symptoms disappear.

But in doctors' offices and hospitals across the country, patients have come to expect antibiotics for viral infections and too many doctors are willing to give them, says Dr. Wilde. "We need to make sure we are educating the public so if they don't get an antibiotic, they understand why."

Third-world countries, where severe physician shortages preclude prescriptions for antibiotics, already are living the nightmare of common infections that no longer have a treatment.

"In this country, the most dangerous bacteria we worry about is vancomycin-resistant enterococcus, a really nasty bug that can cause bacterial heart infections, meningitis, sepsis, kidney abscesses and infections," says Dr. Wilde. "It kills a lot of people. It wasn't even on the radar screen until about 15 years ago when enterococcus found a way to get around vancomycin. The research is clear: the more a hospital uses vancomycin, the higher the rates of VRE. We must limit vancomycin use to cases where it is necessary so we can slow the spread of VRE."