Antibiotics: Can I Have More Please?

As I stumbled thru my daily perusal of the USA Today, I found mention of a study published last month in Pediatrics looking at the unnecessary prescribing of antibiotics in children w/asthma.  The authors noted that from 1998 to 2007, over 60 million medical visits were made for children w/asthma, during which almost 1 out 6 received antibiotics for no other reason mentioned.  Almost half these prescriptions were for a macrolide antibiotic, most easily (often?) written as a "Z-Pak".  Why is it so popular?  It's easy to take (just once daily) and only for a short period of time (just a few days owing to its long half-life).  Unfortunately, what most of us don't realize is that we would've gotten better & recovered during that same span of time even without any antibiotics.

Why?  Most of us are more likely to succumb to viruses than we are to bacteria.  If you think of just the numbers, the odds are totally in favor of viral infection as opposed to bacterial ones.  However, viruses don't respond to antibiotics (and you/we still have to choose a specific antibiotic that is appropriate for the bacterial infection we believe you have).  For an analogy, think in terms of fuel.  91 octane gasoline is a perfectly good fuel but essentially useless in diesel engines.  Both gasoline & diesel are useless in all-electric cars such as the Tesla Roadster (although hybrids like the Fisker Karma & Chevy Volt do sip a bit of dinosaur juice).  For that matter, lipropane & natural gas are wonderful fuels for your backyard barbeque but again useless in most cars (specially made vehicles found at Disneyland, etc, are exceptions).

But aren't we just playing the odds?  We have no easy test to objectively diagnose & differentiate between a viral and a bacterial infection.  So it's often easier to just give in to the parent and move on to the next patient.  However, without proper counseling, we place the patient at risk for allergic reactions, side effects, drug interactions, and unnecessary expense.  Something to think about the next time you're approached for antibiotics for an upper respiratory infection.