The Secret of Great Health Care
An antibiotic is a powerful medicine that treats bacterial infections in two major ways. One, it kills bacteria. Two, it slows down the growth of bacteria to allow your natural body defenses to kill the bacteria. Different antibiotics work through different mechanisms.
Antibiotics do not work against viruses, fungus or parasites. They are not helpful for the common cold, and many other illness that are caused by viruses. Even though most people understand this, many people feel the need to get an antibiotic when they are sick irregardless of whether bacteria or a virus causes the infection.
The frequent use of antibiotics has lead to the development of resistant bacteria. There are over 150 antibiotics currently developed to fight disease. The use of antibiotics for infections that are not caused by bacteria have greatly contributed to resistance.
Resistance is not a new phenomenon; it was noticed shortly after penicillin was developed.
Methicillin-resistant Staphylococcus aureus (MRSA) is a well known resistant bacteria. It was only seen in the hospital, but over recent years it has been found in the community.
Proper use of antibiotics is critical to prevent the spread of antibiotic resistance.
As bacteria becomes more resistant to antibiotics, people may die from infections that were once easily treatable. In addition, illness will last longer and will be more contagious.
When common antibiotics are unable to fight infection because of antibiotic resistance more powerful antibiotics will be needed to combat disease. These more powerful antibiotics are often associated with more severe side effects. When the more powerful antibiotics become resistant, there may be no antibiotic that can fight that disease.
Illness will be more costly, in both time and money, as antibiotic resistance increases. It will require the use of hospitalization, for intravenous therapy, laboratory monitoring and time away from the family.
Antibiotics must be used correctly if we want to reserve the future efficacy of antibiotics. Here are some things that you can do to promote the proper use of antibiotics.
Antibiotic resistance is everybody’s problem. Almost all bacteria has some resistance to antibiotics. Individuals who do not use antibiotics correctly contribute to the problem. Proper use of antibiotics not only affects your health, but the health of the community at large.
Allergy to antibiotic
Allergy to antibiotics is a common problem. Health care consumers can be allergic to any medication, but some medications are more likely to cause an allergy. To highlight allergy to antibiotics, two common medications that cause allergy will be discussed: penicillin and sulfa drugs.
Allergy to penicillin is common, but serious reactions to penicillin are not. About 90% of people who report an allergy to penicillin are either not allergic or the allergy diminished or went always over time. Only twenty percent of people are allergic to penicillin ten years after their allergic reaction if they have not taken the antibiotic over that time. On the other hand, 10% of people who report allergy have serious allergy.
Another common allergy is sulfa. Common antibiotics that have sulfa in them are Bactrim, Septra and Pediazole. About 3% of the population has allergy to sulfa antibiotics. Some individuals are more commonly affected with sulfa allergy such as those with diseases of the immune system such as HIV or AIDS.
Common sulfa reactions include:
Those who are allergic to sulfa antibiotics are often allergic to many other drugs. Other than the drugs already listed the following drugs may also cause problems in those that are allergic to sulfa:
Some people with allergy to antibiotics need to be treated anyways. A doctor who is experienced with this should treat these people. It can be handled in a couple of ways.
If the side effects are mild the antibiotic can be given and the patient is monitored closely. Mild allergic reactions would include a mild rash or sun sensitivity. These patients would be watched and given treatment to deal with the allergic reaction. For example, if the allergic reaction was an itchy rash, anti-histamines - such as Benadryl – would be given to manage the symptoms.
Desensitization can also be done. This means that a small amount of the drug is given while the dosage is increased over a period of time to allow the person to tolerate the drug. This is rarely done, but sometimes needs to occur to allow a patient to be treated with the proper antibiotic.
Drugs cause people to get sick, especially the older population. Adverse drug reactions occur many times every day. It is estimated that 1.5 million people are admitted to the hospital and 100,000 deaths occur every year because of adverse drug reactions ([i]).
Medication Errors
The causes of medication errors are varied and vary by health care setting. In the outpatient setting a common error is the pharmacist filling the wrong prescription due to inability to read the physician’s handwriting. Patients not understanding the instructions to take the medicine are another common cause of error. Communication with the doctor and pharmacist can reduce errors in the outpatient setting.
As the patient, it is essential that your doctor communicates with you about the drug he or she is prescribing. A critical step in reducing errors is knowing how to communicate with doctors. Take notes on any new drug prescribed by the doctor If you have good notes on what the doctor prescribed, you will be able to question the pharmacy if any inconsistency is noted.
In the hospital, errors often result form lack of attention rather than lack of knowledge. The nursing staff is often overworked and make errors in administering medicine. Another common cause of hospital errors is not getting an accurate history from the patient. The doctor performing the initial work-up on the patient may not get an accurate list of the medications the patient takes. This results in the patient not getting medications that are needed.
Side Effects
Not all adverse drug reactions are a result of error. Medicines are dangerous substances and great care must be taken when they are prescribed. All medicines have side effects and many side effects are known and considered normal. Some medicines have more side effects than others. Some side effects get better when the patient gets used to the drug while others persist indefinitely. Some side effects are easy to spot such as diarrhea and others are subtler, such as fatigue.
Side effects vary by drug and can range from a mild inconvenience to life threatening. Common side effects include: fatigue, diarrhea, constipation, nausea, vomiting, decreased appetite, memory impairment and kidney dysfunction. Life threatening side effects include: abnormal heart rhythms and lung damage. Some medications have more side effects than others and it is important to discuss side effects with your doctor when you are being placed on a new drug.
Reporting the side effects is an important aspect to drug therapy. Some side effects are expected and if present will not change the course of treatment. Other side effects may be life threatening or so severe that the risk of therapy is not worth the benefit of treatment.
Knowing about the new drug is a key feature to health care responsibility. Understanding why the drug is taken, its side effects, and follow up needed for the drug is essential. Always ask the questions listed in Table 2 when you are prescribed a new drug.
Table 2: Questions to know about newly prescribed antibiotics
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Drug Interactions
Drug interactions are negative effects resulting from the mixing of two or more medications. Drugs have variable effects on other drugs - they can intensify or blunt the desired effect of another mediation.
For example, patients on a blood thinner called coumadin need to have tight control of the blood level requiring frequent laboratory evaluation to assure the drug is therapeutic. The addition of an antibiotic has the potential to increase or decrease the amount of drug in the blood, placing the patient at elevated risk for bleeding complications if levels become to high or risk of clots if levels are too low. Individual variation is common with drug interactions. Certain medications will interact more in one individual than another individual with variation being explained by individual body chemistry.
Medical science lacks extensive research on drug interactions, especially when patients are on more than two or three drugs. The addition of medication to any patient has the potential for negative outcomes. The interaction between the other drugs, disease states and the individual’s body chemistry is variable.
Drug interactions are a complex topic - entire books have been written about the topic. Whenever you are started on a new drug, talk to the doctor and pharmacist about any potential interactions. The pharmacist may have a better idea of the interactions present because they have computer programs available to help sort out complicated drug regimes.
Complications
Complications are adverse events from drugs that cannot be classified as a side effect, interaction or error. A bacterial infection causing severe diarrhea secondary to antibiotic therapy, called Clostridium difficile (also known as C. diff.), is one common complication. Clostridium difficile is a bacterium that invades the gastrointestinal tract causing severe diarrhea.
Clostridium difficile is one of the great concerns of antibiotic therapy. The use of yogurt or a probiotics supplement may be helpful in preventing c. diff.
Antibiotics have saved many lives, but they are not without risk. Keep in mind that antibiotics are not benign drugs and they need to be used cautiously.
[i] Lazarou J, Pomeranz, BH Corey PN Incidence of adverse drug reactions in hospitalized patients: a meta-analysis of prospective studies. Journal of the American Medical Association, 1998, 279(15), 1200-5
