QUESTION:
Hi -
It's me, and I'm back with another question for you.
This time I'm writing about my family in the Philippines. My wife is
Filipina and her brother and his family live near Manila along with her Dad. Anyway, I was
talking to R (her brother) the other day and he mentioned that F (one of my nieces)
was feverish and "not feeling well" (which probably means she was not as
active) and that he had given her some antibiotics. I asked about the antibiotics. He said
he gave her Bactrim (trimethoprim/sulfamethoxazole). I asked him where he got it and he
said "at the drug store." I asked him if he got a prescription from a doctor for
it and he said "no" and that they could just purchase antibiotics OTC. He
further stated that they "usually give that for a few days when people are
sick."
I know in this country we "try" not to give antibiotics to people unless we
believe they might benefit from it, and that we are trying to cut down on
indiscriminate use of antibiotics because it promotes the evolution of
antibiotic-resistant strains of bacteria. I also know that taking antibiotics for a
couple of days and then stopping is not good because it promotes the growth of
antibiotic-resistant bacteria in the body (and I explained that to R).
My question to you is this. Considering the relative ease with which antibiotics are
obtained in the Philippines, what should I tell R about when is the appropriate time to
take them? How does one tell, generally, if an illness would benefit from antibiotic
treatment? Are there some basic rules of thumb for when to and when not to take them (kind
of like "starve a fever, feed a cold", except for antibiotics)?
I discussed with R the possibility of never giving antibiotics to his family unless he was
prescribed to do so by a physician. However, R said physicians almost always give
antibiotics to anyone who isn't feeling well (great!). I know that many US physicians also
do that to make it look like they're trying to help a patient (present company excepted,
I'm sure), even though it's not helping at all, so I can only imagine that the trend is
worse over there where the medical expertise is at a lower standard.
Any guidance would be greatly appreciated.
ANSWER:
Apologize for taking somewhat longer to answer this for you, but I was
detained by a lovely 7#14oz baby girl coming into the world yesterday. I'm
sure you'll understand! Welcome back - again with another good question. You have
hit on a problem that illustrates our global culture and the difficulties it presents.
Even in the U.S. we are overusing antibiotics, partially due to laziness on the
part of providers and largely due to insistent demand on the part of consumer/patients.
The Center for Disease Control is making an effort to stop the trend, but of course
they only reach a part of the population and have very little effect on the people in
other countries.
You are quite right in your assumptions and your concerns. Bactrim, otherwise known
as Septra, is a basic and very good antibiotic. I can not say the the
over-the-counter type they sell in other countries is pure or standardized for
effectiveness but giving it in the way you describe is definitely NOT a good idea. The
body, repeatedly exposed to the Septra,will develop within its immune system adjustments
that will make it less effective when it is truly needed. In addition, a true
infection only partially treated with antibiotics often recurs - but resistent to the
initial antibiotic. People are also somewhat more likely to develop allergic
reactions or intolerance to specific antibiotics, not a small
thing with Bactrim! The allergic reaction to Bactrim can be life threatening. But I
tell you what you already know.....
Antibiotics, like any powerful ally in health care, should be used with great respect for
their power. How to tell when to use them? As a doctor, I use all my
diagnostic skills and scopes to make that decision. A large part of it is my ability
to tell after all these years who is really sick and needs the big guns. It's
an observation skill..... However, I know many mothers who are quite skilled at
knowing when their family members are truly sick and they don't even ask for antibiotics
until it is appropriate. After awhile I trust these parents and when they call me
and describe the problem, I believe them when they say they need antibiotic help.
In answer to your question: No, there is not a rule of thumb that is simple for this
one. But there is a valuable guideline: Do NOT use antibiotics unless the
person is obviously toxic (persistent fever, actual pus seen somewhere) or unless their
own immune system has not been able to win the fight after two weeks of trying.
Seeing pus behind the ear drum, hearing congestion within the lungs, seeing an
infected skin lesion, or having a positive strep culture from the throat are all worth
antibiotics. But a thoughtful provider has to make that call, usually. Viruses can
cause very high fevers, can cause white spots on the tonsils, and can make a person look
sicker than a bacterial infection. Viruses are not touched by antibiotics.
Again, I give you some internet resources here that are appropriate. Try
this link to the CDC's site:
http://www.cdc.gov/drugresistance/community/
and then you can try their 'FAQ' page:
http://www.cdc.gov/drugresistance/community/
Good luck trying to convince your family in the Philippines to avoid antibiotics unless
really needed! I know from experience that re-educating ourselves about this is
difficult and it is hard to watch your children feel bad if you think there might be an
easy solution. I encourage people to honor their own powerful immune system and
allow it to do its job, but they don't always like to hear it.
Best Wishes,
Dr. Kerr