There’s something going around

I’m a pharmacist (among other things), and the number one question I get asked at work is “What can I take for that thing that’s going around?”

Here’s what people don’t seem to realize – everything is always “going around.” People are always sick, but not always with the same thing. Just because you have a sore throat and you know someone else who had a sore throat for a few days last month doesn’t mean sore throats are “going around.” Even if you have a bunch of close friends or family who all came down with the same sickness around the same time, it just means that it was “going around” your home or work – it doesn’t mean that your local doctor or pharmacist is going to know anything about your symptoms or what illness you have. So, no. I don’t know what’s going around. Except STDs. Those things are rampant. Did you know that 1 in 4 sexually active young women are currently infected with an STD? Many don’t even know it – they just go around infecting people. But that’s a topic for another day.

That said, if you remember my Christmas post from last month, there definitely WAS a sickness going around that house, and I still have it. My lungs have decided that this is their new normal. Every cough feels like it’s coming from the deepest part of my lungs, and my throat is very displeased with the situation. A normal person might go to the doctor, because 6 weeks of a constant chest cold does not seem normal.

Unfortunately, I’m not going to the doctor because I happen to know that post-viral cough is definitely a thing, and can last for many weeks after recovering from a respiratory infection such as the flu (which I’m 90% sure I had). I also happen to know that the vast majority of doctors would prescribe me antibiotics if I went in, because that’s what the vast majority of doctors do. And here’s the real source of my angst, and the reason I’m writing this:

You probably don’t need antibiotics.

We’ve been trained since the invention of penicillin to believe that illnesses need to be treated. If I’m sick, I need to take something. If I have an infection, I need to take an antibiotic. WRONG.

Currently, it’s estimated that between 30-50% of the antibiotics that are prescribed in America are unnecessary. So if you’ve been given an antibiotic, there’s a reasonable chance that it didn’t do anything (or made things worse). But how can they make things worse?

On the small scale, taking an antibiotic when you really don’t NEED one can cause all sorts of problems. First, it kills off your internal microbiome. We’ve evolved to live in a symbiotic relationship with all sorts of bacteria. The bacteria in our intestines produce essential vitamins that we need to live, assist in digesting our food, and take up all the available space so more nasty infections (such as C. difficile – a bacteria that is very difficult to treat once it takes root) can’t get a foothold and wreak havoc on your innards. In 2017, 223,900 cases of C.diff were reported in hospitalized patients and 12,800 of those patients died. It’s not something you want to mess around with.

Women also have vaginal bacteria that help to regulate pH and keep everything in tip-top shape. Killing off those bacteria is the reason why many women get yeast infections after taking antibiotics. It’s so common that many doctors prescribe antifungals at the same time as antibiotics. So now the one medication you may not have even needed has become two medications. Because you didn’t feel sick enough already, right? But these issues (while very unpleasant for the individual) are small potatoes in the big picture. So what’s the real issue here?

Antibiotic resistance. It’s real, and it’s a problem. More than 2.8 million antibiotic-resistant infections occur in the U.S. every year, killing more than 35,000 people. This is preventable! Antibiotics are meant to save lives (and don’t get me wrong – they definitely save lives), but their overuse is responsible for the deaths of thousands of people every single year.

Antibiotics kill bacteria (they’re anti-biotic — biotic=life — get it?). They don’t treat viruses (which are not actually “alive” – they’re actually a lot like a computer virus – they can’t do anything outside of a computer/cell, but they make that computer/cell do bad things). But antibiotics only kill certain kinds of bacteria. The only way to know which antibiotic will work is to determine which type of bacteria you have and what it’s already resistant to. When’s the last time you went in with a sinus infection or ear infection and they took a swab, waited a few days to culture it, and called you back to say which antibiotic killed the cells in the Petri dish? No. We don’t do that. Even if they do a test (such as a swab for strep), they don’t actually culture it in most cases. They send you on your way with whatever random antibiotic popped into their head first. Each doctor has their own favorite antibiotic that they prescribe to pretty much everybody, and you can almost tell which doctors are staffing the local ER each day with what the most popular meds are for that shift. Sure, there are guidelines, but with most infections there’s no easy way to know what will ACTUALLY work, so they just pick one and see what happens.

So what if they chose wrong, and your bacteria was resistant? What if it was actually viral, and the antibiotic did nothing? Well, usually you get better anyway. Because (get this) most infections clear up on their own. Hear that? I’ll say it again. MOST INFECTIONS CLEAR UP ON THEIR OWN. So why do we treat everything when it’s not necessary? Because it makes us happy to feel like we’re doing something. Nobody wants to get a sinus infection (or a cough that won’t go away – just kill me already) and just sit, waiting for it to go away on its own. We want to take something! We want to be cured! Well, tough noogies, sometimes you just have to wait for your own immune system to step up.

I’m making this sound like I’m anti-antibiotics. I am, but only in the sense that I’m anti-anti-biotics (remember – “biotic” means life!). What I’m trying to say here is that I’m pro-immune system! I’m one of those weird people who thinks that medicines should be saved for the people who actually need them (like people who won’t get better without them). Drug-resistant bacteria are becoming a bigger problem every year, and this over-prescribing trend shows no sign of slowing down in any meaningful way. Doctors are a big part of the problem, but they’re not the only ones. Don’t go to the doctor if you’re not actually seriously ill! This “I’m going to urgent care because I’ve been coughing for a week,” or “I can feel like a sinus infection is starting, so I’m going to call my doctor to ask for the antibiotic I had last time” thing needs to stop. I’m looking at you.

I captured a picture of Emmett sneezing as an infant and saved it for some reason – little did I know at the time, this post was that reason.

https://www.cdc.gov/std/stats18/adolescents.htm
https://www.cdc.gov/features/antibioticuse/index.html
https://www.cdc.gov/HAI/organisms/cdiff/Cdiff_infect.html
https://www.cdc.gov/media/releases/2015/p0225-clostridium-difficile.html
https://www.cdc.gov/drugresistance/biggest-threats.html

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