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Vital Signs

Fall 2004

Take Antibiotics Only When Appropriate

Overuse of antibiotics in both children and adults has become a serious public health problem. “For more than 50 years, we’ve had an array of powerful antibiotics, and doctors have felt that if there was even a small chance that they could help the patient, we ought to use them,” says Michael Herbst, M.D., family practitioner at Santa Monica- UCLA Medical Center. “The problem is that we aren’t developing new antibiotics as quickly as germs are developing resistance to the old ones. As a result, our antibiotics are not working as well as they used to, so we’re seeing more patients with infections that can’t easily be treated, if at all.”

Germs become ever more stubborn against antibiotic treatment due to the Darwinian concept of natural selection. “The bacteria that survive to reproduce are the ones that are resistant to the antibiotics,” says Dr. Herbst.

“It’s survival of the fittest.” Unnecessary use of antibiotics can also increase the risk of harm to the user, he notes. For several weeks to several months after taking antibiotics, patients are likely to carry resistant germs, rendering another infection during that period more difficult to fight. In the past, some doctors have succumbed to patients’ demands by over-prescribing the drugs, with one study finding that a majority of persons receiving medical care for the common cold were given prescriptions for an unnecessary antibiotic. “People have thought that a visit to the doctor wasn’t complete unless they got a prescription,” says Dennis Woo, M.D., pediatrician at Mattel Children’s Hospital at UCLA. “We need to adjust patients’ expectations so they realize that most of the time children are sick, they don’t need antibiotics. And doctors need to draw the line and use antibiotics appropriately, even though it might be easier to just write a prescription.” Most colds and respiratory infections are viral and therefore do not respond to antibiotics.

“When patients feel sick, their physician can help them make the judgment,” says Dr. Herbst. “But patients need to understand that there are situations in which antibiotics are a wonderful thing and other situations where they’re completely useless, and even dangerous.”

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