Excessive Use and Misuse of Antibiotics

In a very wide variety of complaints, doctors may prescribe antibiotics without a clear indication of a "bug" that is susceptible to antibiotics - "just in case". Worse yet, people without proper medical training may push antibiotics or misguided persons may "self-medicate" with them. What's wrong with the the "just in case" approach? No doubt you've heard already that "bugs will become resistant to antibiotics". Perhaps that sounds a bit "theoretical" to you; not something that will have an impact for years to come - well, think again.

First of all, there is a well-documented explosion in the prevalence of antibiotic resistant strep . This is an obvious problem today, not in the future. US Public Health Service (USPHS) and the Center for Disease Control (CDC) have publicly pleaded against the overuse of antibiotics. Each year, the bacteria are developing resistances to our "best" antibiotics and persons succumb to various illnesses needlessly because the medication is now ineffective.

But isn't it still true true that for a single patient there is no negative effect of taking antibiotics "just in case"? Answer: -think again.

In a recent article in Archives of Internal Medicine 252 adults with sinusitis were studied. In this blind study, some were given a placebo and others were given a common, expensive, highly recommended sinus antibiotic. Patients took their medication twice a day for 6 days. There was no observable difference in the recovery of the patients that took the antibiotic over those taking the placebo. However, with the antibiotic there was diarrhea and upset stomach among the users. This research is similar to another study published in Lancet that reached a similar conclusion. This study is of major importance to the 37 million people treated for sinusitis each year in US. Side effects vary in severity and with antibiotic and condition treated: in addition to diarrhea, secondary vaginal and oral thrush infections occur with antibiotics. Your body depends on many types of "good bacteria" living within it to keep you free of infection. These secondary infections occur because antibiotics kill off the good bacteria as well as the bad. Antibiotics can be life-saving miracles, but these and other side effects should bring home the point that they certainly "mess" with your body!

Pulsatile irrigation is an excellent alternative to treating sinusitis with antibiotics. Nasal and sinus cilia are the body's natural defense against sinus disease. These consist of millions of microscopic oar-like "hairs" that propel the infected mucus out of the nose and sinuses. When they work well, the body stays healthy. But after smog or diesel fumes or an infection, they may slow down and allow bacteria to grow. Pulsatile irrigation, however, has been shown in dozens of articles to restore healthy function to the nasal and sinus cilia - to actually heal the body's own defenses. Introducing salt water into the nose can be helpful in "cleaning", but only pulsatile irrigation, pulsating in harmony with the cilia's natural motion, has been shown clinically to be extremely effective in returning the cilia to their healthy function. I recommend pulsatile irrigation as the best way to recover from a sinus condition - without antibiotics.

One part of the problem with over subscribing antibiotics is that patients want something tangible for their money and trouble for an office visit. Some of you may recall the wonderful "Doctor" series with Dick Beggared. In one scene he is trying to explain to an obese female why she does not need a shot of vitamins (she is quite sufficiently nourished). Patiently he explains why. Finally she calls her husband in and says, "Honey, he won't give me medicine!" and her husband joins in on insisting on the vitamin shot and again the poor doctor tries to explain - to deaf ears - why she doesn't need it. In the case of sinusitis or any other "-itis" where patients have heard of friends or relatives getting antibiotics, patients frequently demand them. Many think their doctor is withholding care if they don't. In this case the doctor can write them a prescription in three minutes, or spend 20 minutes patiently explaining why it is better for medicine to be "withheld" from the patient. I have even overheard patients going out to the receptionist to ask to see another doctor in the same clinic - this time to get antibiotic. So, it is as important for the patient to be receptive to fewer antibiotics as it is for the doctor to make this recommendation.

If you think an infection is coming on: First and foremost, rest, plenty of hot liquids - tea, lemon and honey. Drink a lot of liquids; the urine should turn light. Avoid overuse of pills and nose sprays. Relax. Let the body do the work. Despite the constant barrage of commercials, you aren't going to perish by just taking it easy and not rushing to the medicine chest. Relaxed, positive people get well the fastest (reference 2). Grab your CDs and play some happy music. Avoid getting chilled. Warm compresses to the sinus area helps too.

Occasional use of a nose drop or spray to open the nose can give a lot of relief - but take care you don't overuse these products.

Of course, there is a place for antibiotics and medications. Always follow your doctor's instructions. But these research conclusions should make you pause. Think HOT TEA, rest, and pulsatile irrigation first, before you go running for antibiotics! Over the last 25 years of clinical practice I have seen patient after patient who received three courses of antibiotics, but who were still sick because the antibiotics did nothing to restore the natural movement of their nasal / sinus system of cilia. —And during these 25 years I have seen these supposedly "difficult" cases respond well to methods of restoring the cilia, including adequate fluids, tea, compresses, rest and pulsatile irrigation. It just makes me wonder why they didn't try it in the first place!