Wednesday, February 18, 2009
A Personal Experience in Antibiotic Resistance
Today I went to Student Health with what I believed to be a sinus infection. The doctor on duty confirmed my hypothesis and proceeded to prescribe me amoxicillin, a derivative of penicillin. He said something along the lines of "it's usually a 7-10 day dosage but you are going to take it for 2 weeks." I didn't say anything at the time, but now that I think about it, why do I need to take the drug for and extra 3-7 days? There is no way the doctor could determine that an extended dosage was necessary in my case from just a basic examination. It seems to me that I would have been just fine if I took the normal ammount of amoxicillin for the normal period of time. Extending the term of medication, although probably easier for the kind people at student who have to deal with thousands of students (especially suring flu season), could lead to increased resistance of the bacteria currently infecting me to amoxicillin. If bacteria can survive the regular doseage period AND a few extra days of exposure to the antibiotics, the bacteria will surely be a very resistant strain. Hopefully there will be no long term consequences for me...
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I think there are several possible reasons for your doctor to make this recommendation. For example he may be making a judgment about how easy to reach your infection is. Or he may have received updated dosage information. Or there may be something in your medical history that caused him to alter the dose. Or maybe there is some mild resistance out there that necessitates a longer course and there has been an advisory on that. It might also be related to the fact that the doctor has probably been seeing many sinus infection cases lately (see Tuesdays Daily Nexus - Germs Infest SB Waters - The stormy weather soaking Santa Barbara County may have brought some nice swell with it, but with the rain comes bacteria-laden run-off and the threat of ocean-borne illnesses.)
In any case, your best course of action is to complete the course as prescribed. Provided the actual prescription is warranted (ie it is a bacterial and not a viral or other infection - and most sinus infections are bacterial) then you are better off taking more, not less antibiotics.
Antibiotics don't actually create resistance, they just kill the bacteria that are present in order from the most susceptible to the least susceptible (ie most resistant). If you stop taking the antibiotic before everything is dead you can end up with a resistant strain when the last few holdouts multiply back up. On the other hand if you take a few extra days treatment you will ensure everything is dead.
So why don't we always take a longer course? Well, we usually do, a typical antibiotic works VERY quickly and will kill most bacteria within the first few doses. The rest are just to clean out the last few holdouts and ensure everything is dead.
So we should reduce unnecessary antibiotic prescriptions, BUT if a prescription is warranted then we should NOT reduce the course of antibiotics we take.
There are even some cases where antibiotics are warranted for a viral infection. Pneumonia is one of these cases. Pneumonia just refers to a lung infection which can actually be bacterial or viral. A deep seated lung infection can be very dangerous as your loungs fill with fluid and pus and pneumonia is a serious concern in the elderly. Your doctor will normally prescribe antibiotics EVEN if the infection seems likely to be viral. This is because of the danger that your overwhelmed immune system will succumb to an additional bacterial infection. So the antibiotics are used prophylactically. In this case, because the risk is rather high, such use is probably warranted.
Antibiotics truly are wonder drugs. You can have a high fever and a raging bacterial infection in the morning and 12 hours later you can be feeling pretty normal. We are starting to take such miraculous recovery for granted but we are going to miss them when when they are all gone.....
Oh, and read the disclaimer about me not being a doctor etc etc.....
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