(February 4, 1999, Gazette)
Most of us have already spent part of this winter coughing, sneezing, wheezing and feeling really miserable. Flu and cold germs are everywhere, and doctors are deluged by patients looking for relief.
But for too many, that relief takes the form of a prescription for antibiotics. Often it's unnecessary, because antibiotics are ineffective against viral infections such as colds, flus and the majority of sore throats and bronchitis. But it's more than just a problem of waste because the overuse of antibiotics worldwide has resulted in bacteria developing resistance.
Dr. Jim Hutchinson, Medicine, is taking action to reduce antibiotic use in this province. As medical director of infection control with the Health Care Corporation of St. John's, he's aware of how widely these powerful drugs are prescribed, and the global implications of their misuse. So he started the Newfoundland Optimal Antibiotic Project together with the Newfoundland and Labrador Medical Association, the Newfoundland Pharmacy Association, the Department of Health and the Pharmaceutical Manufacturers of Canada in conjunction with Abbott Laboratories.
The first phase of the project surveyed the diagnosis and treatment of infections in general practice. It found that about 15 per cent of patients end up with an antibiotic prescription, largely for respiratory tract infections.
"The number of prescriptions cannot be justified by the number of bacterial respiratory tract infections that should be present," said Dr. Hutchinson. "For example, most pharyngitis (inflammation of the throat) is treated as if it's streptococcal pharyngitis, a bacterial infection which is fairly rare in adults. But we found that 20 per cent of adult women in the St. John's/Mount Pearl areas were treated for this - I can't believe that many women really have strep throat every year."
The statistics are even higher for children. Among the 7,000 children under the age of six in St. John's and Mount Pearl, the study estimates there were 5,300 cases of otitis media (inflammation of the middle ear) diagnosed last year.
"There should certainly be less than that," said Dr. Hutchinson.
That means that a lot of patients went to the doctor with a sore throat or earache, and came away with an unnecessary prescription. It was their own immune system, not the antibiotics, that successfully fought the virus that was likely making them sick.
Dr. Hutchinson's main concern about the misuse of antibiotics is global in nature. The more antibiotics are used, the more bacteria develop a resistance to them. And that's bad for everyone.
"We all share our collective bacteria, and when those bacteria become resistant we all stand the chance of suffering."
On an individual level, there is also a danger in using antibiotics when they aren't necessary.
"I see cases of allergic reaction such as severe colitis, which can kill you, or inflammation where the skin comes off like you've had a bad burn. Even though these reactions are rare, there's still a small number of people who have very bad outcomes from using antibiotics and if those antibiotics weren't necessary it's not a trivial matter."
Dr. Hutchinson is getting his message out in every way possible. He's adapted a series of posters that warn about the improper use of antibiotics and call for a stop to their misuse; these have been distributed to doctors' offices and pharmacies throughout the province. Individuals are advised to yield to their doctor's advice - in other words, if the doctor says you don't need antibiotics, don't insist on a prescription.
"When people go to the doctor with a cold, they expect to be treated and that expectation is antibiotics. The problem has been that people want them very much and doctors prescribe them very readily. Physicians have been desensitized to the problem over time, so now I'm resensitizing them."
So far the campaign is working. Antibiotic prescriptions in the province were down about 12 per cent for the year ending September 1998 compared to the previous year, and that was prior to the major intervention now being taken by the Optimal Antibiotic Project. The national goal adopted by Health Canada is to reduce overall antibiotic prescription in the country by 25 per cent, and Dr. Hutchinson is certain that this goal will be easily achieved in Newfoundland and Labrador. The response to his campaign, which included a fall speaking tour on the Burin Peninsula and in Central Newfoundland, has been very positive.
"What I say rings true with people, even those who take their kids to the doctor for antibiotics all the time. People recognize that using less is better."
So next time the flu strikes hard, what should you do?
"If you have a really high fever or you just can't function normally, then see a doctor," advised Dr. Hutchinson. "But even if you do have a bacterial infection that is not severe, there is an advantage to fighting it yourself. Most people will recover in time and they will be in a better position to fight the next bug because they have had a successful immunologic response."
What about turning to herbal remedies, such as the very popular echinacea? Dr. Hutchinson admits he's no expert on that product, but he says there is reasonable evidence that it helps the common cold.
"I favour using herbal remedies versus antibiotics because there is a smaller danger to the global community."