Why Not To Demand Antibiotics For Your Post-Christmas Crud


You drag into your doctor’s office for help after a week of a ruthless, chest-ripping cough. “Doc, I think it’s lung cancer,” you say.

“Okay,” your doctor says. “I’ll write you out a prescription for the chemo drug methotrexate.”

Not exactly a realistic scenario, is it? So then why, when you’ve got garden-variety winter phlegm, might you push your doctor to do your bidding and write you an order for antibiotics?

That’s a point paraphrased from a recent talk by Dr. John Powers, a physician and researcher at the George Washington University School of Medicine, and formerly the lead medical officer for antimicrobial drug development and resistance initiatives at the FDA.

I share it now because it’s the season of bugs and crud, and chances are you’ve been kissing and hugging a lot of people who were sharing their germs along with their cheer. That means you may soon be tempted to demand a nice little course of a “-cillin” or a “-mycin” from your doctor — but hold on a minute:

Antibiotics remain tremendously valuable treatments when prescribed appropriately for bacterial infections, but the reasons to avoid using them unnecessarily have been multiplying of late, and the information below might tip you a bit toward restraint.

‘Up to about 10% of antibiotic prescriptions can cause some adverse effects.’

Personally, I just got over a cough so violent that each spasm threw me backward like the recoil of a rifle. Friends told me to get a lung X-ray and to ask for antibiotics, but under the influence of Dr. Powers and others like him, I decided to just wait and see. The message had finally started to penetrate that if an upper respiratory infection is likely to be a virus — and yes, my children had just been through one — time might be the best cure. (It was.)

No question, antibiotics can work wonders. But they’re also hugely over-used, particularly for coughs. A study last month in the journal “Pediatrics” found that American pediatricians order unnecessary antibiotics at least 10 million times a year, for conditions the drugs do not affect such as asthma and flu.

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Health authorities say that what doctors and patients alike need to aim for is the sweet spot known as “judicious use” of antibiotics. But where is it? And how do we get there when we tend to focus on the wonder-drug aspects of antibiotics rather than the downsides?

I asked Dr. Ben Kruskal, director of infection control at Harvard Vanguard Medical Associates and director of infectious disease at Atrius Health, who has worked on “judicious use” campaigns both within Harvard Vanguard and as part of a statewide project. (The CDC works on the issue at the federal level; its”Get Smart” materials are here.) Continue reading