Every year your family might face its share of colds, sore throats and viruses. When you go to the doctor for these illnesses, do you automatically expect a prescription for antibiotics? But your doctor could be doing you and your family a favor by not reaching for the prescription pad. Antibiotic resistance is a widespread problem. In fact, the Centers for Disease Control and Prevention are calling it a widespread health problem.
Listen in as Kenneth Szwak, PA-C explains that doctors understand that you want to get better, but in most cases routine viral illnesses will clear up on their own without much more than rest, some extra fluids and time.
Selected Podcast
Is Antibiotic Overuse a Health Threat?
Featured Speaker:
Kenneth Szwak, PA-C
Kenneth Szwak, PA-C is a board-certified physician assistant and senior PA/EMS director at Our Lady of Lourdes Medical Center-Camden.Transcription:
Melanie Cole (Host): When used appropriately, antibiotics can help our bodies to fight bacteria. However, as overuse becomes an issue in this country, we're seeing a resistance to the actions of some antibiotics. My guest today is Ken Szwak. He's Chief Physician Assistant and EMS director in the Emergency Department at Lourdes Medical Center. Welcome to the show, Ken. Tell us about antibiotics, what can they be used for and what can't they be used for? People get very confused about this.
Ken Szwak (Guest): First of all, thank you for having me on here. I really greatly appreciate it. Antibiotics are a very useful tool in the medical tool bag. They are used for when we have certain bacterial infections and they're only effective against bacterial infections. What they are not effective against and where the confusion can lie a lot of times is they have no use against viral pathogens, viral illnesses. A lot of the illnesses that we get, a lot of the common illnesses that cause sore throats, ear pain, and coughs, a lot of them wind up being viruses that will not be affected by the antibiotics and then taking antibiotics in that scenario can cause some unintended consequence that a lot of people don't realize.
Melanie: People sometimes go into the doctor's office, especially when kids are involved, and they get angry if they don't leave with an antibiotic, whether we're talking about strep throat which does need one, ear infections which may not need one, and everything in between. They think if there's green mucus, it right away means there's an infection. So, clear some of that myth up for us?
Ken: I mean, certainly some people can be upset; some people can't understand why in this scenario they're not getting an antibiotic. They may feel like that they're not getting the proper care or enough care. Part of that falls on the healthcare providers themselves. We went through a period of time when healthcare providers were over prescribing them, and they were over prescribing them in an unnecessary situations without even thinking, ourselves, of the possible consequences to it. Over the years, we’ve realized that when we give them to people who have viral illnesses, not only aren't they doing anything but they cause the bacteria that we're trying to fight to become resistant over time. Where the confusion lies is, unfortunately, when you get a sore throat, a majority of the time that winds up being something like a virus, which there are a hundreds of viruses that cause sore throats and fevers. Then, the fever is another area of confusion. Viruses are going to cause fever just like a bacterial infection causes fever. Now, if it’s strep that's causing the sore throat, certainly that's something that is treated with an antibiotic, but the great majority of time that’s not bacterial. It's a virus and even sometimes not even a virus. Sometimes allergies can give you a very bad sore throat, things like bad acid reflux can give people a chronic sore throat. There are lots of things that aren't bacterial in nature can cause these symptoms.
Melanie: That's where I think some of the confusion lies, Ken. It’s that people see these and they think if they've got that mucus or if they're coughing too much its bronchitis. How does a patient know the difference? Is there a test to tell whether you have a bacterial infection or a viral infection?
Ken: Sometimes it's very difficult and can be near impossible as the patient to be able to tell the difference, because there's a lot of overlay between symptomology. For strep, there certainly is a test. There's a rapid strep test. There are cultures that can be done if the rapid strep test is questionable. For other things, it's not always something that needs to be tested. Another common thing is people come in, they have one or two days of sinus pain, cough, and nasal congestion and they automatically think that they have a sinus infection that requires antibiotics. What we've learned through studies is that, in most of the cases when you're only one to two days in it, it's not a bacterial infection at that point. It's still just a viral infection. Now, if those symptoms last five to seven days, and you're running a fever, and you're getting the green purulent nasal discharge, or you are coughing it up from the post-nasal drip, then at that point, you start considering that it changed into or become a bacterial sinus infection that requires antibiotics. Sometimes it's a matter of timing. Sometimes it's a clinical diagnostic.
Melanie: Do you think that with the overuse, as you see this resistance developing, because there are “sanitization theories” going around, Ken, about autoimmune diseases and the increase in these. Do you think we have overused antibiotics up until now? What do you want to tell people about what's been going on?
Ken: I think we're at a time where we can still nip this in the bud. Like I said, we did go through a period of time when they were being used too much. We are certainly still at a moment where we can effect change on this and part of that comes from the healthcare practitioners being responsible when they're prescribing antibiotics. Then, the other thing is the patients, when they're at their doctors, is to understand that if a physician is saying, “You don't need an antibiotic,” they're not doing it to be punitive in any way. They're not doing it to give you any type of lesser care. It is just that over time, we've learned that when they are prescribed in an inappropriate situation they can lead to an increased amount of bacterial resistance we have for certain bacteria. I think part of the take home message for a patient is, talk to your physician. When you get sick, talk to your physician and if you don't understand why you're not getting an antibiotic, ask them. I think most clinicians worth their weight in gold, will be happy to explain why, in this scenario, they feel that you don't need an antibiotic.
Melanie: For people that do need one, Ken, give them your best advice about taking that antibiotic and making sure that they take it all the way through the prescription. Give us some advice about antibiotics.
Ken: Taking them as prescribed is very important. If your healthcare provider does feel you have a bacterial infection, it is very important to take the antibiotic every day as prescribed and finish out the course of the therapy. Another thing that leads to antibiotic resistance is when we don't finish the antibiotic. The reason being is kind of twofold. One, you will kill off some of the bad bacteria that's causing your infection but you won't kill them all off. Then, certainly the ones that have evolved and become resistant can then, actually, through something called “genes transference,” transfer their resistance gene to the remainder of the bacteria that have been killed off, so they've now become resistant. Number two is, if you don't finish the course of therapy, a lot of people require being retreated. So, now you're going on two courses of antibiotics, in which one course would have sufficed if you had finished it the first time. So, it's very important to finish your prescription as prescribed.
Melanie: In just the last few minutes, give us your best advice about overuse of antibiotics, when it's appropriate to be dispensing antibiotics and when it's not appropriate.
Ken: At the end of the day, that's something that when you have an infection, or you suspect you have an infection to go and see your doctor, and to be examined by your doctor to get any tests that they recommend done. And, again, if there's any question in your treatment, if they're prescribing antibiotics, make sure that they're comfortable that it's a bacterial infection. If you're not being prescribed antibiotics, simply inquire why and have that discussion with your physician, and understand that it's not something that your physician is doing to shortchange you in your treatment. Number two, if you do have a suspected infection another thing that's very important is to not take any antibiotics that you may have left over. As I've already mentioned, you should be taking any prior prescriptions to completion. So, if you have any left over, A) that hasn't been done to begin with but B) another mistake a lot of people make is, they'll say, "Oh, I think I have bronchitis,” or
“I think I have pneumonia. I'm going to take this penicillin that's leftover from my tooth infection that I didn't finish." The problem is that it's not a “one size fits all” when it comes to antibiotics. The things that you're going to take for a dental infection aren't going to necessarily cover the bacteria you have for a pulmonary infection, a lung infection. A lot of patients don't realize that. It's something that I see in the emergency room. Patients come in and they think they have an infection, and they tell me that they've been taking antibiotics that they had leftover, which we would never use for said infection if it is bacterial. So, that's the other thing. Don't take anything you have leftover. See your doctor, do any tests that need to be done. If they do prescribe antibiotics, finish them to completion. If they don't and you're concerned, have that talk with them, and there are very legitimate reasons when we don't use them.
Melanie: Thank you so much. It’s really great information, Ken. Thanks for being with us today. You're listening to Lourdes Health Talk, and for more information you can go to www.lourdesnet.org. That's www.lourdesnet.org. This is Melanie Cole. Thanks so much for listening.
Melanie Cole (Host): When used appropriately, antibiotics can help our bodies to fight bacteria. However, as overuse becomes an issue in this country, we're seeing a resistance to the actions of some antibiotics. My guest today is Ken Szwak. He's Chief Physician Assistant and EMS director in the Emergency Department at Lourdes Medical Center. Welcome to the show, Ken. Tell us about antibiotics, what can they be used for and what can't they be used for? People get very confused about this.
Ken Szwak (Guest): First of all, thank you for having me on here. I really greatly appreciate it. Antibiotics are a very useful tool in the medical tool bag. They are used for when we have certain bacterial infections and they're only effective against bacterial infections. What they are not effective against and where the confusion can lie a lot of times is they have no use against viral pathogens, viral illnesses. A lot of the illnesses that we get, a lot of the common illnesses that cause sore throats, ear pain, and coughs, a lot of them wind up being viruses that will not be affected by the antibiotics and then taking antibiotics in that scenario can cause some unintended consequence that a lot of people don't realize.
Melanie: People sometimes go into the doctor's office, especially when kids are involved, and they get angry if they don't leave with an antibiotic, whether we're talking about strep throat which does need one, ear infections which may not need one, and everything in between. They think if there's green mucus, it right away means there's an infection. So, clear some of that myth up for us?
Ken: I mean, certainly some people can be upset; some people can't understand why in this scenario they're not getting an antibiotic. They may feel like that they're not getting the proper care or enough care. Part of that falls on the healthcare providers themselves. We went through a period of time when healthcare providers were over prescribing them, and they were over prescribing them in an unnecessary situations without even thinking, ourselves, of the possible consequences to it. Over the years, we’ve realized that when we give them to people who have viral illnesses, not only aren't they doing anything but they cause the bacteria that we're trying to fight to become resistant over time. Where the confusion lies is, unfortunately, when you get a sore throat, a majority of the time that winds up being something like a virus, which there are a hundreds of viruses that cause sore throats and fevers. Then, the fever is another area of confusion. Viruses are going to cause fever just like a bacterial infection causes fever. Now, if it’s strep that's causing the sore throat, certainly that's something that is treated with an antibiotic, but the great majority of time that’s not bacterial. It's a virus and even sometimes not even a virus. Sometimes allergies can give you a very bad sore throat, things like bad acid reflux can give people a chronic sore throat. There are lots of things that aren't bacterial in nature can cause these symptoms.
Melanie: That's where I think some of the confusion lies, Ken. It’s that people see these and they think if they've got that mucus or if they're coughing too much its bronchitis. How does a patient know the difference? Is there a test to tell whether you have a bacterial infection or a viral infection?
Ken: Sometimes it's very difficult and can be near impossible as the patient to be able to tell the difference, because there's a lot of overlay between symptomology. For strep, there certainly is a test. There's a rapid strep test. There are cultures that can be done if the rapid strep test is questionable. For other things, it's not always something that needs to be tested. Another common thing is people come in, they have one or two days of sinus pain, cough, and nasal congestion and they automatically think that they have a sinus infection that requires antibiotics. What we've learned through studies is that, in most of the cases when you're only one to two days in it, it's not a bacterial infection at that point. It's still just a viral infection. Now, if those symptoms last five to seven days, and you're running a fever, and you're getting the green purulent nasal discharge, or you are coughing it up from the post-nasal drip, then at that point, you start considering that it changed into or become a bacterial sinus infection that requires antibiotics. Sometimes it's a matter of timing. Sometimes it's a clinical diagnostic.
Melanie: Do you think that with the overuse, as you see this resistance developing, because there are “sanitization theories” going around, Ken, about autoimmune diseases and the increase in these. Do you think we have overused antibiotics up until now? What do you want to tell people about what's been going on?
Ken: I think we're at a time where we can still nip this in the bud. Like I said, we did go through a period of time when they were being used too much. We are certainly still at a moment where we can effect change on this and part of that comes from the healthcare practitioners being responsible when they're prescribing antibiotics. Then, the other thing is the patients, when they're at their doctors, is to understand that if a physician is saying, “You don't need an antibiotic,” they're not doing it to be punitive in any way. They're not doing it to give you any type of lesser care. It is just that over time, we've learned that when they are prescribed in an inappropriate situation they can lead to an increased amount of bacterial resistance we have for certain bacteria. I think part of the take home message for a patient is, talk to your physician. When you get sick, talk to your physician and if you don't understand why you're not getting an antibiotic, ask them. I think most clinicians worth their weight in gold, will be happy to explain why, in this scenario, they feel that you don't need an antibiotic.
Melanie: For people that do need one, Ken, give them your best advice about taking that antibiotic and making sure that they take it all the way through the prescription. Give us some advice about antibiotics.
Ken: Taking them as prescribed is very important. If your healthcare provider does feel you have a bacterial infection, it is very important to take the antibiotic every day as prescribed and finish out the course of the therapy. Another thing that leads to antibiotic resistance is when we don't finish the antibiotic. The reason being is kind of twofold. One, you will kill off some of the bad bacteria that's causing your infection but you won't kill them all off. Then, certainly the ones that have evolved and become resistant can then, actually, through something called “genes transference,” transfer their resistance gene to the remainder of the bacteria that have been killed off, so they've now become resistant. Number two is, if you don't finish the course of therapy, a lot of people require being retreated. So, now you're going on two courses of antibiotics, in which one course would have sufficed if you had finished it the first time. So, it's very important to finish your prescription as prescribed.
Melanie: In just the last few minutes, give us your best advice about overuse of antibiotics, when it's appropriate to be dispensing antibiotics and when it's not appropriate.
Ken: At the end of the day, that's something that when you have an infection, or you suspect you have an infection to go and see your doctor, and to be examined by your doctor to get any tests that they recommend done. And, again, if there's any question in your treatment, if they're prescribing antibiotics, make sure that they're comfortable that it's a bacterial infection. If you're not being prescribed antibiotics, simply inquire why and have that discussion with your physician, and understand that it's not something that your physician is doing to shortchange you in your treatment. Number two, if you do have a suspected infection another thing that's very important is to not take any antibiotics that you may have left over. As I've already mentioned, you should be taking any prior prescriptions to completion. So, if you have any left over, A) that hasn't been done to begin with but B) another mistake a lot of people make is, they'll say, "Oh, I think I have bronchitis,” or
“I think I have pneumonia. I'm going to take this penicillin that's leftover from my tooth infection that I didn't finish." The problem is that it's not a “one size fits all” when it comes to antibiotics. The things that you're going to take for a dental infection aren't going to necessarily cover the bacteria you have for a pulmonary infection, a lung infection. A lot of patients don't realize that. It's something that I see in the emergency room. Patients come in and they think they have an infection, and they tell me that they've been taking antibiotics that they had leftover, which we would never use for said infection if it is bacterial. So, that's the other thing. Don't take anything you have leftover. See your doctor, do any tests that need to be done. If they do prescribe antibiotics, finish them to completion. If they don't and you're concerned, have that talk with them, and there are very legitimate reasons when we don't use them.
Melanie: Thank you so much. It’s really great information, Ken. Thanks for being with us today. You're listening to Lourdes Health Talk, and for more information you can go to www.lourdesnet.org. That's www.lourdesnet.org. This is Melanie Cole. Thanks so much for listening.
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