This week has been filled with controversy. In that vein, I feel it’s a good time to say something equally controversial:

Sometimes the best antibiotic prescription
is no prescription at all.

Okay, if you happen to be in public health, especially in Canada, this might not seem all that troublesome. After all, it’s been a mantra in the medical community for years. Yet, considering we still hear about the abuse and misuse of these life-saving drugs, the guidance hasn’t been accepted universally.

One of the reasons for the lack of compliance is based on a statement I hear quite often when I’m out in the public realm. Maybe you have heard it – or said it – at one time or another:

Prove to me I don’t need an antibiotic.

Admittedly, it’s a difficult request. But over the last few years, researchers have been exploring whether a person can deal with a bacterial infection without the use of antibiotics. The answer is yes but finding a way to show this to the public has been a real challenge. Usually, the information is hidden in statistics, which can be subject to skepticism.

However, I came across something that might demonstrate why forgoing an antibiotic may be worthwhile. It looks something like this…

 (Kinda cool, eh?)

What you’re looking at is a figure that comes from a paper entitled, Symptom response to antibiotic prescribing strategies in acute sore throat in adults: the DESCARTE prospective cohort study in UK general practice. You can click on the title to read the paper.

As you can guess from the graph above and the title of the paper, the researchers examined the progression of the traditional sore throat based on symptoms. They looked at 1512 people who had suffered the illness. The symptom information then was matched with the treatment the individuals received.

  • Some had no antibiotics (the blue);
  • Some had a regular antibiotic prescription (the red);
  • Some had what is known as a delayed antibiotics (green).

Delayed antibiotics is a recent trend going around in which a patient is asked to wait a few days after an initial visit to determine if the infection goes away. This is a great way to determine if the infection is bacterial and may need antibiotics, or viral, in which case antibiotics are useless. This approach also allows the body to fight the infection few days. There’s a good reason for this:

The immune system can handle
many infections on its own.

Based on all the results, the addition of antibiotics resulted in an observed reduction in the length of the worst symptoms. But the extent was far less than anyone might have believed. In fact, once all the numbers were crunched, the benefit ended up being equivalent to a grand total of…

One day.

That’s it. Twenty-four hours of lessened symptoms. Nothing more.

The researchers did happen to point out that those who didn’t take antibiotics had a harder time dealing with the infection throughout the period. But in the end, they recovered just as well as those who had taken the antibiotics.

The results of this study may help add credence to the mantra, but that doesn’t mean forgoing antibiotics is valid for every infection. Just recently, I came across an individual who had a sore throat and decided not to take antibiotics. The person lasted a week before caving in to the pain. The bacterial infection was more troublesome and the immune system needed a boost.

If you are wondering what the best option might be should your throat start to scratch, your urinary tract start to burn, or your eyes begin to turn red and water, let me be perfectly clear:

I can’t tell you.

This is a decision that only can be made between you and your doctor.

What I will advise is that when you do feel those troubles and you make that appointment, don’t be quick to ask for a prescription. Your doctor may want perform some tests first to find out what might be causing the troubles. You may be asked to wait and see if your immune system can pull through. Or, there may be ample evidence to make the prescription immediately.

Just remember, if you are given a prescription and fill it, you need to stick with it until the end, even if you feel better. This way you can be sure that you are clearing your body of the infection and reducing the chances for recurrence down the road.

Finally, I’m curious about the use of antibiotics. So, let me ask a relatively simple question I hope many of you won’t mind answering:

When was your last antibiotic prescription?

 

Advertisements