Blog | Wednesday, June 18, 2014

When you demand antibiotics, you hurt us all

The discovery of penicillin was a perceived as a miracle. Men mortally wounded in war survived. Pneumonia, the Captain of the Men of Death, got a demotion. Infectious diseases were a major cause of death and the war metaphors continued.

But penicillin and the antibiotics that followed moved quickly from treating war wounds and pneumonias to the everyday treatment of just about everything. No doubt millions were cured of meningitis, pneumonia, strep throat (with the probable prevention of rheumatic fever), limb-threatening infections. But as vaccination and other public health measures improved, antibiotics became more commonly seen in severely ill hospitalized patients (often used appropriately under the supervision of experts) and doctors’ offices (often inappropriately).

Antibiotics are losing their miracle abilities, and quickly. Natural selection, with its arsenal of genes and mutations, eventually wins every time, and bacteria develop resistance.

It’s my fault, and yours. Despite the medical facts, our perception of antibiotics as miracle drugs persists. They don’t cure colds, bronchitis, most ear and sinus infections. There are few reasons to use them for everyday ailments. But people being people, the greater the urgency, the stronger the belief in miracles. I cannot make your sinuses better before your trip by giving you a “Z-Pak.” If your cough started yesterday, there’s not a helluva lot I can do to help you that your grandma hasn’t already told you.

But doctors want to help people and frequently succumb to patient demands. So this is on all of us. If your doctor thinks antibiotics will help you, take them, all of them, to avoid breeding resistance. If your doctor says you don’t need any, say “thank you” for the good news.

Together we can try to salvage our supply of useful antibiotics and stem the tide of super-bugs resistant to everything.

Peter A. Lipson, ACP Member, is a practicing internist and teaching physician in Southeast Michigan. After graduating from Rush Medical College in Chicago, he completed his internal medicine residency at Northwestern Memorial Hospital. This post first appeared at his blog at Forbes. His blog, which has been around in various forms since 2007, offers "musings on the intersection of science, medicine, and culture." His writing focuses on the difference between science-based medicine and "everything else," but also speaks to the day-to-day practice of medicine, fatherhood, and whatever else migrates from his head to his keyboard.