Transcription:
Antibiotics: When You Need Them And When You Don't

Melanie Cole (Host):  There’s been a lot of discussion lately about whether and when antibiotics should be used. My guest today is Dr. Amanda Everhart. She’s a family medicine physician at the Allina Health Farmington Clinic. Welcome to the show, Dr. Everhart. What are antibiotics? 

Dr. Amanda Everhart (Guest): Hello, Melanie. This is Dr. Everhart, as you mentioned. Antibiotics are medications that help to treat bacterial infection. We’ve all heard of them. They’re things like penicillin, amoxicillin, and Z-Pak. That’s another common example that we seek frequently. 

Melanie:  What kinds of infections do antibiotic -- I know people get confused and viruses are different than bacteria. So what kind of infections do they work for? 

Dr. Everhart:  Antibiotics are good for bacterial infections. They don’t work against viral infections, which is, as you say, a common misperception. People often think that, “Oh, I’m sick. I need an antibiotic.” Well, an antibiotic can only help us if you’ve got an infection with a bacteria, not with a virus. They also don’t work against things like fungal infections or yeast infections. Those types of infections are often not susceptible to antibiotic.  

Melanie:  Something like a bladder infection or strep throat, are those bacterial infections? 

Dr. Everhart:  Those are. Those are almost always bacterial infections, whereas things like the common cold are usually viral infection. Bronchitis is usually a viral infection. Sinus infections are often usually viral as well. And I know a lot of people come in to the doctor to get treatment for those common colds, bronchitis, sinus infections, a lot of times, people come in expecting an antibiotic, but that’s not necessarily the correct treatment if their illness is indeed caused by a viral ailment.  

Melanie:  Dr. Everhart, with so many patients I’m sure coming to you and insisting on antibiotics even when they don’t need them, can we become resistant to the actions of antibiotics, and what are the complications from that? 

Dr. Everhart:  Yeah, that’s a great question and definitely a big concern for us in healthcare today. Antibiotic resistance is very real and a very big deal. Basically, what that means is the bacteria no longer are susceptible to the antibiotics that they used to be susceptible for. For example, for a very long time, we were able to use certain antibiotics for bladder infections, and the bacteria kind of wised up. The bacteria that usually caused bladder infections have kind of wised up, so there’s a lot of antibiotics we’re not able to use for bladder infections anymore that we were able to use back in the day before the resistance occurred. Resistance is usually a problem because if we’re using antibiotics when they don’t need to be used, the bacteria are becoming either exposed to these antibiotics—they kind of learn what the antibiotic’s tricks are, if you think of it that way—and they could come up with their own defenses against the antibiotics. So, it’s important to only use the antibiotics when it’s appropriate and when it’s going to be actually effective for the disease.

Melanie:  And as much as we want our antibiotics to work for us, there are times when they can have some negative consequences when we use those antibiotics. Tell us about those. 

Dr. Everhart:  Definitely. Just like with any medication, antibiotics are not without side effects. On a small scale, they often will cause stomach upset, possibly nausea, often cause diarrhea. They can also cause vaginal yeast infections in women. On a more severe degree, we can also develop infection like something called like C. diff. C. diff is an infection in the intestine that causes severe, severe diarrhea and dehydration. It’s very difficult to treat and can be life-threatening, especially to the elderly, to frail individuals with a lot of medical complications, and to the very young. 

Melanie:  How would someone know if they need or if a family member needs an antibiotic versus just kind of riding up the virus? 

Dr. Everhart:  Yeah. So lots of different criteria for that. It totally depends on the type of infection too. If you’ve got bladder symptoms, urgency, it burns when you use the bathroom, quite possibly that’s a bladder infection, and I’d recommend coming in right away, because like I’d mentioned before, those are almost always bacterial and almost always require antibiotics. Strep throat is kind of the same way. So if you feel like you might have strep throat, severe sore throat, fevers, headaches, and really not a whole lot of other symptoms, I’d recommend going in to the doctor sooner than later. For the common cold, however, that’s usually not a bacterial infection. And I recommend giving it a little more time. If you have moderate symptoms, moderate cold symptoms, congestion, a little bit of a cough, even if you’re coughing stuff up, maybe some low-grade fever, those are generally—and again, this is generally—suggestive of a viral infection, and I’d recommend giving it about 10-14 days before coming in to the doctor to be seen. That said, if you’ve got severe symptoms—it’s the worst cold you’ve ever had, symptoms are just intolerable, you’re not able to sleep or function, you’ve got high fevers—then I’d recommend being seen sooner than later. And in general, if you have any questions about it or you’re on the fence about, “Well,do I need to go in? Do I not to get in?” we are always, in the medical profession, happy to see you, and we’re very easily able to kind of sort things and figure out is this something where antibiotics would be appropriate or not based on your medical health, your history, your current symptoms, your physical exam, and a lot of other criteria. 

Melanie:  Dr. Everhart, if someone does have to be on antibiotics, do you recommend that they do things like eat yogurt while they’re on that to maintain any of that good, healthy bacteria, or not so much? 

Dr. Everhart:  Yeah. No, I’m a big fan of -- you’re talking kind of the probiotics. We find probiotics in yogurts. You can also get probiotic capsules and pills. I’m a huge fan of probiotics. I think they can be very effective, very helpful. As you mentioned, the gut, our intestines have good bacteria in them that help to keep everything working the way it’s supposed to. And when we take antibiotics, that not only kills off bad bacteria, but it also kills off all that good bacteria as well. And so, that’s where a lot of these intestinal side effects can come from. At least one yogurt a day while you’re taking antibiotics is going to be helpful. I’d also recommend considering taking probiotics that’s appropriate for you, again, with your medical history and your medical condition. 

Melanie:  And what should you do if a family member is sick? How do you respond if they do have to be on antibiotics? Does that right away make them not contagious?  

Dr. Everhart:  Again, it kind of depends. For example, with strep throat, usually people need to be on antibiotics for 24 hours before they’re considered to be non-contagious. Was it ear infection? That’s likely to be contagious. And so, if I see a child with an ear infection, I put them on antibiotics. They can go back to daycare, for example, even later that day if they’re not in a fever and they’re feeling well enough to go back. So it really kind of depends on the antibiotic and the condition and lots of other factors. 

Melanie:  We have antibiotics in food, in milk. There’s a lot these days. Is that contributing to this resistance, or are they two separate things? 

Dr. Everhart:  I think it is contributing. I don’t have the data. I haven’t read any studies recently about that, but just my own sense of it is that it’s certainly not helping. But a lot of the antibiotics resistance that we’re seeing, I think a much bigger piece to all of that is the overuse of antibiotics, especially like the common cold. In the medical profession, we owe it to society to be good stewards of the resources that we have, the antibiotics that we have, and make sure that we’re using them appropriately and not adding to this epidemic.

Melanie:  Dr. Everhart, speak about the use of antibiotics specifically. We always say take the whole bottle; make sure you don’t stop halfway. People do that all the time, don’t they? 

Dr. Everhart:  Right.Yes, they do. 

Melanie:  What happens if you don’t take that whole prescribed dose? 

Dr. Everhart:  In certain situations, we recommend you take the whole prescribed dose because the studies have shown that you need to be on the antibiotic for that long in order to fully treat the infection. So for example, for strep, we put you on a prescription for penicillin, we recommend the full 10 days of antibiotics to make sure that we’re fully treating the strep, even though you’re going to start feeling better after a day or two on the antibiotics. In other cases, we recommend you take the full course just to make sure that the bacteria is gone and we’re not developing resistance. If a bacteria gets exposed to antibiotics, like I said, it kind of picks up some of those tricks that the antibiotic uses to take care of it. And then, we don’t a hundred percent get rid of all those bacteria, then I always think about those bacteria are a little smarter. And if they kind of slip through the cracks, then they’re going to be the ones that will contribute more strongly to the antibiotic resistance. 

Melanie:  In just the last minute or so, Dr. Everhart, tell the listeners your best advice about the use or misuse of antibiotics and why they should come to Allina Health for their care. 

Dr. Everhart: I think the best advice I can give people is don’t come right in. If you get the sniffles, don’t come in on the first day. Give it a little bit of time. Trust your body to do its job. Our bodies have been taking care of infections for millions of years before we came up with any of these antibiotics. We do have the capability to heal ourself, and I encourage to fully give our bodies a chance to do that. That said, if you feel like your symptoms are severe, if you feel like this is much worse than you normally would experience with a common cold, for example, or if you’re just worried, please feel free to come in, see your physician, and let us take a look and determine what’s going to be the best course for you. Allina Health, I think, is a great option for healthcare. We have openings even for same-day appointments every day, which is very important if you’re looking at something like a common cold or something that’s a little bit more of an acute problem. 

Melanie:  Thank you so much. You’re listening to The Wellcast with Allina Health. And for more information, you can go to allinahealth.org. This is Melanie Cole. Thanks for listening.