Judicious use of antibiotics. But will it help?

Screen Shot 2013-08-20 at 12.43.19 PMToday s Wall Street Journal features a very informative article entitled Antibiotics Do s and Don'ts.

The article lists infections for which use of antibiotics is warranted and a longer list of those for which it is not.

For example, antibiotics are appropriate for certain bacterial infections, such as strep throat, and persistent sinus and bladder infections. On the other hand, they should not be used for viral infections, such as flu, colds and routine sore throats and ear infections, because antibiotics have absolutely no effect on viruses.

The issue is complex. Sick patients often visit their doctors demanding antibiotics, even when they are not needed (or useful). And many doctors are reluctant to say no, even though the antibiotics will be of no use.

In particular, Zithromax and Cipro are overprescribed, which is troubling because they are broad spectrum antibiotics, which will often kill the bacteria in the gut that are responsible for a healthy digestive system. In the worst case, a broad spectrum antibiotic will kill all susceptible bacteria, but there are always a few bacterial strains present that are resistant to any given drug. In the absence of a normal bacterial population, these resistant organisms will flourish, leading to infections that are very difficult to treat.

Unfortunately, the biggest hurdle with regard to proper use of these drugs is technology. It takes two days to culture a bacterial specimen, causing a waiting period that is discomforting for doctors and their patients. Rather than wait for the culture results, it is easier for doctors to simply write a prescription something that most parents of a sick child will demand.

There is good news, and bad news.

The good news is that Dr. Jeffrey Gerber, a pediatric infectious disease specialist at the Children s Hospital of Philadelphia studied prescribing practises at 18 primary care pediatric facilities, offering guidance to some offices and none to others. The offices that received guidance demonstrated a 50 percent reduction of broad spectrum antibiotic use, and an increased use of narrow-spectrum drugs, which are less likely to generate resistant organisms and still effective in treating most infections. Good news indeed.

The bad news, says ACSH s Dr. Josh Bloom is that, while judicious use of antibiotics will help combat this problem, the overarching issue is the dearth of new antibiotics to combat resistant organisms. He adds, It is impossible to use antibiotics, judiciously or otherwise without generating resistant bacteria. Indeed, within one year of the launch of penicillin, bacterial resistance to the drug was detected. Unfortunately, the FDA lost its mind in the early 1990s, requiring such Draconian clinical trials for new antibiotics that virtually all drug companies got out of the area entirely. We are now paying a very dear price for their psychotic policies.

Dr. Bloom, a former infectious disease researcher, has written extensively on this topic. Two of his recent op-eds The coming gonorrhea epidemic (New York Post) and A Welcome Boost in the Race for New Antibiotics (Wall Street Journal) discuss why we are in the such trouble.