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Antibiotics vs. Superbugs

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Dear Dr. Lanny:
I get really freaked out when I read about antibiotic-resistant bacterial infections like MRSA in the newspaper. What can I do to make sure that my kids don’t pick up a resistant bug? I know antibacterial soaps can help breed “superbugs,” and overuse of antibiotics is bad. But sometimes we really need antibiotics, right? Like for strep or a bad ear infection? I’d be interested in your advice because the recommendations I read can be really confusing.

A: It is hard to pick up a newspaper, or read articles online nowadays without getting freaked out regarding global warming, birds at the airport, terrorism or new superbugs, among other crises. Are all these crises about to come crashing down on us, or to a certain degree is this yellow journalism? The truth, as is usually the case, lies somewhere in the middle. Interesting as global warming and bird strikes are, I’d like to stick to antibiotics for now.

Over the eons animals and bacteria have evolved to a largely cooperative partnership. Our environment is filled with bacteria, our skin is normally covered with them, and our digestive system could not function without them. If bacteria were true “superbugs” capable of destroying us, we wouldn’t be here. Bacterial infections are often self-limited, meaning the body will heal itself without medications, although this may not occur fast enough for the “ civilized” life we lead. Enter the antibiotic: a compound capable of suppressing or eradicating the bad bacteria causing our pain and fever.

Messing with Mother Nature, however, can be tricky and can cause unanticipated side effects. The nearly limitless types of bacteria, usually living peacefully within, and on, us are in a dynamic balance with no one type taking over. Unless, that is, our antibiotics kill off only some species of bacteria and allow other, more resistant types to come to the fore.

Bacteria are not smart, but there are gigantic numbers of them and they reproduce like rabbits—so to speak. If antibiotics are used again and again, the risk is that suddenly one reproducing bacteria gives rise to a mutant bacterial offspring that is resistant to our antibiotics. The new offspring keeps reproducing and slowly but surely becomes the dominant species. And our previously effective antibiotic ceases to be useful. Sometimes these new varieties of bacteria are easily treated by another type of antibiotic (usually more expensive) and sometimes you start to deal with so-called superbugs. Your body does not become “resistant” or “immune”; you are merely the battlefield where the bacteria and antibiotics duke it out.

Antibiotics certainly have an important place in our fight against infection, but they should be used only when necessary and when appropriate. If ever the words virus and antibiotic are used in the same sentence, immediately you should say, “I thought that viruses were not affected by antibiotics.” And the medical provider should have a good explanation for why she is prescribing an antibiotic. Always ask, whether you are at an urgent care facility or the office of your trusted doctor, “Does my child really need an antibiotic?”

Increasingly doctors are treating ear infections in toddlers and older kids with pain medicines only. I’ll often give parents a prescription but advise them to fill it only if their child is worse. I believe people feel more confident if they have the option to treat their child. In conversations at a later date, I find that many parents do not fill these prescriptions.

When your child has a sore throat, it is likely to be viral (there’s that word) and will not benefit from antibiotics. Strep (Streptococcal pharyngitis) is only strep if it has been tested. “It looks like strep to me” is not good enough. Not all pink-eye (conjunctivitis) is bacterial, and schools and daycare centers should accept when a doctor says the problem is viral or allergic, that no medications are needed and the problem is not contagious.

Constant use of antibacterial soaps, excessive use of pesticides, antibiotics in the food we eat and the milk we drink all have potential consequences—super, or not so superbugs among them. I’ve had bacterial pneumonia, and all I can say is that I’m grateful for antibiotics. I continue to prescribe them, but to a diminishing number of children. The phone is always available to discuss a reconsideration of treatment if circumstances change.

In summary: Superbugs are not about to take over. Antibiotics are good, but in many cases they are prescribed unnecessarily. Used judiciously, they are a wonderful tool. Lastly: Don’t freak out.

Dr. Alan Freshman, father of two grown boys, practices at Syracuse Pediatrics. Consult your own physician before making decisions about your family’s health care. Send e-mail to him at editorial@familytimes.biz.

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