Penicillin first cured a grievously ill patient in 1942. [1] The patient, Anne Miller, was a young woman dying of an overwhelming Streptococcal (i.e. a bacterial) infection. A small dose of the antibiotic was so powerfully effective in that instance because the bacterium was completely crippled by the new medication’s mechanism of action. The bacterium was so exquisitely sensitive to penicillin because it had never previously encountered penicillin. By today’s standard, a trivial amount of penicillin was used. The medication, however, was available is such small quantities at the time that Mrs. Miller’s urine after treatment was collected, from which the antibiotic was extracted for reuse. Contrast that to the glib way that antibiotics are used today, whether it’s in a medical clinic or in a feedlot.
Antibiotics, as you know, are only effective in treating bacterial infections. Although there are a small number of medications which can be used to treat viral infections, discussion of those medications is beyond the scope of this essay. Suffice to say that the viral infections that those antiviral medications treat cause illnesses such as chickenpox and genital herpes. They do not treat the viruses that cause most of the respiratory illnesses that college students develop. Antibiotics work to help a person’s immune system clear a bacterial infection by many different mechanisms. Some antibiotics work by weakening the bacterial cell wall (e.g. penicillin). Others work by sabotaging the bacteria’s reproduction or metabolism. The essential point is that antibiotics do not affect a virus’s means of infecting a host.
While it’s a common place that antibiotics are ineffective against viral infections, it may surprise you to learn that antibiotics are perhaps unnecessary for some *bacterial infections* which traditionally have been treated with antibiotics. For example, amongst some children, it’s a prudent course of action to forego antibiotics when treating an ear infection. [2] More applicable to the adults in my practice, there is increasing evidence that antibiotics often are unnecessary when treating that winter time scourge of campuses everywhere, the sinus infection. [3] There is even some rationale that antibiotics not be used to treat all cases of Strep throat. [4]
Unintended consequences can occur when a person takes antibiotics. A person can have a severe allergic reaction. Antibiotics can cause gastrointestinal problems such as diarrhea and abdominal pain. Women can develop vulvovaginal yeast infections. At the very least there is cost and inconvenience associated with taking a course of antibiotics. And, of course, from the perspective of community health, widespread use of antibiotics can lead to bacterial resistance due to evolution amongst the population of bacteria subjected to antibiotics.
My colleagues and I endeavor to diagnose accurately and institute proper treatment subsequent to that. In my experience, there is sometimes disagreement between the diagnosis that the patient suspects he has and the diagnosis that I suspects he has. In those occasional situations, hopefully I can offer a compelling reason and rationale for foregoing writing a prescription for antibiotics.
If I, or one of my colleagues, think it best *not* to prescribe antibiotics for your illness, it’s not because we’re insensitive to your suffering or because we’re being stingy with medications. It’s because, using the best information we have at hand, we think that antibiotics would likely be either ineffective, or potentially harmful to you. In any case, doubtless we’ll offer other recommendations to help you navigate your illness.
If you have questions regarding the proper use of antibiotics, please do make an appointment to meet with one of my colleagues or myself. Here’s a good website if you want to learn more about proper use of antibiotics:
Get Smart: Know When Antibiotics Work
Be well.
Dan Radosevich, M.D.
[1] The New York Times on the Web: Anne Miller, 90, First Patient Who Was Saved by Penicillin
[2] Otitis media with effusion: expectant management
[3] Antibiotics and Steroids Ineffective in Sinus Infection
[4] Strep steps
