Should You Take Antibiotics?
The editorial mentions two men very important in the history of the discovery of antibiotics, Paul Ehrlich and Alexander Fleming. The first discovered salvarsan, the arsenical drug against syphilis; the second penicillin. Interestingly, the editorial omits a third, equally important name, that of Paul Domagk. It was he who, in 1932, discovered prontosil, the first sulphonamide and the first drug of use in bacterial pneumonia and staphylococcal wound infections. He was awarded the Nobel Prize for his discovery in 1939, but he did not rest on his laurels. He later did some of the research that led to the discovery of isoniazid, one of the first antitubercular drugs. So why is the name of this pupil of Ehrleich’s omitted from the editorial?
He discovered prontosil while working at IG Farben, of subsequent infamy. An aura of Nazism surrounds him: the blurb of a history of the discovery, “The Nazis discovered it. The Allies won the war with it.” The Nazis did not discover it, though it is true that they conducted notorious experiments in the camps with it.
Besides, Domagk was not a Nazi. Indeed, he was arrested and imprisoned briefly by the Gestapo. The Nazis prevented him from collecting his Nobel Prize, and when he did so in 1947 it was too late for him, under the rules, to receive the money. But perhaps the fact that he did not flee Germany during the Nazi era makes him suspect: so best to play safe and not mention him.
The authors of the editorial come to the implicit conclusion that you should take antibiotics when they are needed, but not otherwise: true of all medicines, in fact. The art is in knowing when it is necessary.
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Image and thumbnail courtesy shutterstock / Michal Kowalski
See more on health from Theodore Dalrymple at PJ Lifestyle:
Should You Take Antibiotics?
Me? I don’t know. Do I have a major bacterial infection? If I do, then anti-biotics make sense, and I should do the fully prescribed length of treatment. Otherwise, I don’t need no stinkin’ antibiotics.
Please let me know what you have found out about this “medical condition” of mine that you have alluded to. Thanks!
The problem is not the doctors: it’s the idiots who save some of the prescribed antibiotics for any cold or flue they might contract later on.
OTOH the doctors could be blamed for handing out antibiotics to idiots.
NB: the idiots that I have met include people with PhDs, one of them a PhD in Botany.
Is it possible to get antibiotics for local application without a prescription in the US? if so, that’s more power to the idiots!
The problem is very much not, “the” doctors, but many doctors, who have passed out antibiotics as if they were candy, even for viral infections, and even for trivial issues (head colds), on the specious reasoning that “it can’t do any harm”.
That misuse doesn’t invalidate the proper use of antibiotics, but there IS a large problem with over-prescription, and it is the medical community that bears responsibility for this.
On what are you basing your assertions?
I would echo the complaint that MANY doctors passed out antibiotics for years without good reason. The main reason for the docs giving them seemed most often to be that the patient had arrived with an infection, whether viral or bacterial, an antibiotic was expected and we would not want to offend the patient’s expectation.
In the past couple of years, I have printed out a prescription for an antibiotic, instead of sending it to the drug store (modern computerized medicine, you know) and told the patient if fever or symptoms worsen over the next couple of days—got to the drug store and fill the prescription. Most often this is done on Thursday or Friday with the weekend looming. Early in the week, I tell them to call back in 48 hours if worse.
I base my statement of “MANY doctors” on almost 50 years of experience on the doctor side of the patient-physician relationship.
Oh, maybe the many campaigns in recent years to get doctors to stop abusing antibiotics in exactly the way I’ve described? Or the articles in medical journals to the same effect?
Of course you should take antibiotics if prescribed. What you should not do is insist on a prescription because you think you know better than your doctor/pa/np. When you return a poor Press Gainey survey because you did not get what you wanted know that you have done your part in the over prescription antibiotic resistance situation. Oh by the way, that spider bite you had was not a spider bite. It was an abscess from you picking and squeezing that pimple. I’m just sayin.
As a child, I had strep throat many times. Today, it is no big deal, but had I lived before antibiotics, I’d have almost certainly died of scarlet fever in my childhood.
In 1971 was admitted to the hospital with 106 degree temp and I was eventually diagnosed with strep throat. This was after I had come to the emergency room 3 times previously with a high fever. I thought I was near death then and probably was. The doctors dithered with tests that the ER doctors had already done and it took them several days to determine that antibiotics would be the ticket to my survival. I was sick for weeks after I was released from the hospital but the 500 miligrams of penicillin 3 times a day eventually killed off the infection. This drug saved my life and millions of others from the time of it’s inception. To say that antibiotics are abused is not rational to me. If a patient has a fever due to a bacterial infection, why risk having a them get sicker or perhaps dieing due to witholding the drug because some people are saying antibiotics are over prescribed. How many people have died because Doctors have failed to prescribe antibiotics when they were clearly indicated. Just like everything else that is erroneously set in stone today, some day this bias against prescribing antibiotics will be proven to be a fallacy.
???
So, you’re saying the fact that antibiotics save lives means that they are never abused?
Now THAT is irrational!
Likewise me – with tonsillitis (read that as strep throat with tonsils still in). BUT – the first time I had it they prescribed penicillin – which I’m allergic to -luckily it killed the strep first – that time. The second time I had it was many years later. And the records hadn’t come through – and the penicillin damned near killed me.
So, I take antibiotics with EXTREME caution nowadays. I take the full amount. But I ask the doctors if I can do without.
‘……you should take antibiotics when they are indicated but not otherwise…….’,this is a revelation??
The only thing wrong with this article is it understates the case a bit. Antibiotics are THE most significant advance in the history of medicine. It may not be fully appreciated how dangerous life would be without them. A simple cut could be fatal.
As true as true gets. At the age of 6, my son went climbing up something he was told to stay away from, fell, and landed on a rusty nail. In an earlier era, he’d have been lucky just to lose his leg. Thank you, G-d, for modern medicine, especially antibiotics.
President Coolidge’s son, Calvin Jr., got a mere blister which became infected, and he died only one week later at the age of 16.
http://en.wikipedia.org/wiki/Calvin_Coolidge,_Jr.
Many cases of deafness occurred because of the limited treatment options for ear infections.
It often seems, to doctors at least, as if trust in medicine is inversely proportional to its ability to save lives.
I think it’s much more the case that modern medicine has advanced so far in such a short time that, with all the wonder drugs and new techniques, the average person doesn’t know anybody who died. Oh, there might be the odd car accident here and a case of lead poisoning in a drive-by shooting there but kids don’t die from leukemia, you don’t get polio, a simple cut isn’t fatal and smallpox isn’t mentioned outside of phony history classes. We wiped out malaria, yellow fever and other mosquito borne diseases with DDT (fortunately they’re making a comeback! Go Mosquitoes!! Get your West Nile Virus!!!).
It’s simply unheard of that you’ll die from pneumonia, tuberculosis or some other easily treated disease that would have killed us 75 years ago. Modern medicine removed the rational fear of disease and death leaving a fear vacuum that was filled with irrational fears (global warming, antibiotics, vaccines, the designated hitter, Sarah Palin, etc).
A bit OT, but the article reminded me that one need look no further than Shakespeare to cure most of what ails health care in the US.
“First thing we do is get rid of all the lawyers.”
Dr Dalrymple
Thanks for the pointer to the NEJM article. I generally avoid it because the signal to noise ratio has dropped significantly over time. I actually had Dr Lou Goidman for my pharmacology prof and the triphasic appreciation of any new medication was the first thing he covered in class.
Lou Goodman. Sorry for the typo.
That wasn’t a typo. You just wrote it in Broolynese.
Talk about antibacterial soap.
“Antibacterial” the soap is not the same as “antibiotic” the drug.
“Antibacterial” soap just uses chemicals that kill bacteria. If the bugs become resistant to those chemicals, no biggie, the chemicals aren’t something you could drink to cure an infection, anyway. Resistance would just make the soap stop working; your antibiotics would still be fine.
Plain old soap is a pretty good antibacterial all by itself, anyway, but the antibacterial chemicals give it an extra boost of disinfecting power.
Antibiotic ointment is another matter … I don’t know enough about it to say whether it’s good or bad in the long run.
Antibiotics are a blessing if used correctly. Taking them for a cold is inappropriate. Trying to kill off every bit of bacteria in our environment is inappropriate, and using them to increase the size of livestock is inappropriate. It is this last use that creates the greatest risk, because this is how we get bacteria that are resistant to antibiotics. Nor is it good that we gat a daily dose with our meals when we eat said livestock. The FDA should have banned this use years ago.
This is well known in medical circles and I see less overprescribing than in the past. I have seen this article before here.
Most of the tools in medicine have potential negative consequences. Scalpels, diagnostic radiation, most medicines, interpretation of lab results, to name a few. More complex presentations are beyond this article. These are the sorts of things people go to doctors for in the first place so that people who have expertise can guide the risk/benefit ratio and prescribe treatment.
One important complication not discussed here is the increasing incidence of C. Difficile colitis. Anyway the article is too broad to talk about specifics here. It is a non issue. Like a lot of what our medical expert writes here, I do not get the point.
Antibiotics are a tremendous discovery, but in terms of societal health the biggest gains came before the discovery of antibiotics. Tuberculosis, small pox and most of the endemic diseases that killed off so much of the population in childhood and early adult years were already substantially in decline for several decades before antibiotics were available. By the time antibiotics were available, Tuberculosis rates had declined by 80%, smallpox was no longer a threat, diphtheria, typhoid and numerous other childhood diseases were down by 80-90%. The reasons are:
Access to clean water – cholera and many other intestinal diseases spread from contaminated water.
Less dense and more sanitary living conditions – sunlight kills tuberculosis mycobacterium
Pasteurization of milk – infant mortality dropped rapidly in just a few years when it became policy to pasteurize cow’s milk in the the first decade of the 20th century.
Inoculation wiped out small-pox.
Herd immunity and reduced virulence of infectious agents also has a huge and unrecognized role. In the Middle Ages Leprosy was a common deadly disease. Today, Hansen’s disease (the current name for leprosy) is no longer deadly and does not spread easily. Small pox, syphillis, scarlet fever and diphtheria also became less deadly over time. But there are always new diseases arriving that people have not developed herd immunity and the toxins are at peak virulence.
But God help the poor husband or doctor that tries to deny the modern mommy antibiotics for her brat’s cold!
Dr Dalrymple, a slightly pedantic observation, a little off-topic, but not out of place in a piece about the therapeutic, as opposed to pharmacological, effects of antibiotics. You say that Fleming “discovered” penicillin. Well, he did discover its antibacterial properties in the laboratory, but it was Florey and Chain who take the whole of the credit for developing it into a treatment for infection. They shared the Nobel prize with Fleming, but Fleming was the aggressive self-promoter in later years, attempting to take the credit for the millions of lives saved. Florey was a modest man who would not play that game. It is to him and Chain, but to him in particular, that the credit goes.
fwiw, a medication mistake in 2002 has made it extremely risky for me to take any modern (developed since 1980) med. Dec 18, 2010, at age 58, I developed very acute bronchitis. I used raw garlic every few hours. And was recovered enough to shovel the big snow on Dec 27.
One of the mistakes doctors make is not doing a culture to identify the bacteria, which serves to identify the correct antibiotic for that bacteria.
In 2001, a doctor kept giving me Zithromax for sinusitis. I finally went to my specialist who did a $25 culture, and Ceftin was needed for that resistant-bug. btw, all doctors noted here are top specialists in New York. But only the one who did that culture is what I would call a real doctor.
In later 1970s, my Doc told me no aspirin for a fever as it promotes virus growth (very dangerous) and hobbles the immune system’s work. Instead,
Get a throat culture, what grows will yield the antibiotic which kills it.
Dring huge volumes of liquid (not beer).
Monitor temperature closely, reduce body temperature with drinking cold liquid, use alcohol on torso – externally, do not drink it. The virus will break up in the heat.
Cultures revealed nothing through the years except the one time which grew out pneumonia bacteria and indicated the antibiotic.
I got Bangkok II flu, with two days of agony all over. I closely watched temp and had to use cold water and rubbing alcohol twice or more. Before dawn, the temp dropped to normal. After the drop on the second day, the temp did not rise and the pains disappeared. I went back to work on day 4.
In the 1960s I got Hong Kong flu and was in bed for weeks, nearly a month, taking aspirin.
So many people have been stupid about antibiotics it is no wonder they are questioned. My neighbor, an LPN, used to dose her kids with antibiotics for a couple of days (!) whenever they were getting a cold. Much worse, when my son was small his doctor in charge of his cystic fibrosis management used to push antibiotics on me when he was not sick. In fact, he had no lung involvement at all. So I always refused the antibiotics. In his late thirties the lung involvement began and antibiotics were the answer. Now, at 45 (praise God!) he is in good health because of them. As the article says, the art is in WHEN to take them.
Problems with antibiotics:
- Doctors who prescribe them on patient demand. Sometimes its just easier to give them what the want instead of fighting with them. It’s wrong, but it happens.
- Patients who know exactly what kind of symptoms to present in order to get the antibiotics they want. Don’t fool yourselves, these people are legion.
- Patients who declare themselves “allergic” to an antibiotic because they get mild gastric symptoms. Unfortunately, once they tell you they are allergic, you pretty much need an allergist’s report to prescribe it again. And nobody is going to an allergist for that.
- Patients who don’t take the entire dose, and “save” a few for an emergency. This is extremely common.
- Patients who tell you “that doesn’t work” when you try to prescribe a common antibiotic, insisting on a more exotic one.
- and of course the worst, people who think antibiotics are to be taken as needed, and never get a full does into them.
I could go on, but those are the big ones.
When we were children all the antibiotics we needed were OUTSIDE. We played, we got dirty and we got immunized against the common threats of childhood and later adulthood. The “modern era” Mom and Dad are deathly afraide that their children will get dirty and they constantly do everything to keep them clean including washing their hands with anti-germ solutions of various kinds. This kills bacteria of course but MOSTLY the good bacteria which mankind has lived with for millenia. The results, kids and adults succomb to bacteria which used to protect them.
Norway eliminate ALL antibiotics a number of years ago because of the increasing prevalence of the KILLER MERSA. The “results” is that MERSA has DISAPPEARED in Norway. As Yogi Berra said, “…who woulda thunk it…”.
Norway eliminate ALL antibiotics a number of years ago
Link please?
Norway hasn’t eliminated antibiotic use but they have restricted it severely.
Indeed.
I was just waiting to see what kind of website the poster used for his erroneous information.
As an aside, it isn’t just stricter control of antibiotics that eliminated MRSA from Norway. They are very aggressive at quarantining suspected cases, and are fanatical about cleanliness in their hospitals. Among other things.
I am now an old retired MD. When I was a teenager and expressed an interest in medicine, our GP, in his early 80′s at the time, described his first use of a sulfonamide on a 36 year old man with streptococcal septicemia, a nearly always lethal situation. To this veteran doctor, the result was a miracle. The patient rapidly and completely recovered. Does anyone want to go back to the old pre-antibacterial days?
“a 36 year old man with streptococcal septicemia, a nearly always lethal situation”
He obviously didn’t spend enough time playing in the dirt.
I wonder what these anti-antibiotic people have to say about the high death rate the american indians suffered when they first came into contact Europeans.
Or the appallingly high death rate from infection in any war prior to the development of antibiotics.
The population crash among American Indians was due to viral diseases (smallpox and measles, mainly) not bacterial diseases.
That wasn’t my point.
My point was the “dirt exposure” theory of immunity falls apart when you realize american indians were extremely susceptible to even the most common European disease, viral OR bacterial.
Domagk’s work was more seminal than described. At last count, there are seven therapeutic classes related to the sulfonamides. He is rightly revered as one of the founders of medicinal chemistry.
I’m no longer surprised by NEJM’s political correctness. They’ve lost their integrity in the years since Ingelfinger as they (and other highly visible journals) have sought popular acclaim and influence to the detriment of their reputations. Angell and her successors have much about which to be modest, as an earlier commenter pointed out. Like that commenter, I rarely look at NEJM these days.
I wonder if planting a fear of antibiotics in the general public will INCREASE the development of resistance.
When antibiotics are prescribed, they are always prescribed for a week or two. Often the patient will feel better before the course is finished. But if they stop before the bacteria is utterly defeated, a few bacteria will remain. Those will be the ones most resistant to the drug. That is the most rapid way to build resistance.
Is a large media awareness campaign vaguely warning against dangers of antibiotics more or less likely to lead to people stopping their pills early?
The rule of antibiotics responsibility is this: by all means, avoid using them when practical but if you start, you finish.
“Only those who can relive, either in their memory or imagination (which is much rarer), what it was like to be ill in the pre-antibiotic era can appreciate the rapture with which the development of antibiotics was greeted.”
Here is an anecdote of the pre-antibiotic era, still in living memory for a little while…
My grandfather, who was middle aged at the time, developed appendicitis in 1937. The doctor sent him to the hospital which required a day long journey on the railroad. By the time he was operated on, the appendix had burst and he spent the following 6 weeks in bed with peritonitis.
The bottom of the incision was left open for the infection to drain, and every day when the surgeon made his rounds, he would push his finger into the opening to make sure it didn’t heal closed. There was no anesthetic for that.
During those 6 weeks my Grandmother stayed home on the ranch where her 5th child was born. My father, the oldest child at 16, kept the ranch running in the evenings after school. One of his projects was digging and building a cattle guard with the help of automobile headlights.
Grandfather recovered, and things turned out OK, but it easily could have been a disaster.