Maggie McKay (Host): Welcome to the Kirby Connections Health Podcast, where we help you nourish your wellness journey with Kirby Medical Center. I'm Maggie McKay. On this episode, we'll talk about using antibiotics appropriately with Primary Care Medical Officer and KMG Medical Director, Dr. Lauren Fore. Thank you for being here, Dr. Fore. It's so good to have you.

Lauren Fore, MD: Yes. Thank you for having me.

Host: I can't wait to learn more about this topic because I have to tell you, there have been so many times that I've thought, "Ugh, do you use antibiotics? Do you not? Is this a virus? Is it not?"-- especially as a parent, when my son was younger. My husband and I are like, "I don't know." So, how do you differentiate between a bacterial and a viral infection when you're deciding on antibiotic treatment?

Lauren Fore, MD: So, viruses and bacterial infections, they can often present very similarly. So, some of those common symptoms that we see with either viral infections or bacterial can be a fever, a cough, sore throat, runny nose, body aches, but there are a couple of key differences. Usually, that's in like how long the symptoms are going on.

So typically, viruses are self-limited, which means that they're going to resolve on their own. Usually within five to seven days, someone's going to start feeling better from a virus. Bacterial infections tend to last a bit longer, and usually need an antibiotic to help them get over that.

Usually, when someone's coming in to see me, there's a couple of key things that I will do. So, I'll take a thorough history, ask them how long things have been going on, what all their symptoms are, and also do a thorough physical exam. But we're also lucky in that we have some tests that are available to us too that help us differentiate between the two. So, some tests that we have would be a strep swab that helps us determine if someone has strep, which is a bacterial infection that would require an antibiotic. We have COVID, flu, RSV, swabs. Those are viruses. We can do a chest x-ray that helps us see if there's any pneumonia. Sometimes that can be caused by a bacteria and would require an antibiotic. We can even do urine tests to look for bacteria in the urine.

Some common bacterial infections that we see would be strep, like I mentioned, or cellulitis, that's an infection in the skin. Like I said, pneumonia, urinary tract infections, those are all typically caused by a bacteria, and then those would need antibiotics. And some common viral illnesses that we see would be flu, COVID, RSV in the common cold. So, they can present pretty similarly, but there's also a couple key differences that we look for when we're determining if someone has a bacterial versus a viral infection.

Host: So, when would you not want to take an antibiotic?

Lauren Fore, MD: So, antibiotics, they don't work against viral infections. So if someone has an infection from a virus, we wouldn't want to prescribe an antibiotic in that case. So with any medication, there are the potential for having side effects. So, we always want to weigh the risks versus the benefit when we're taking a medication.

So in a bacterial infection, antibiotics work really well in these situations. So there is some risk with an antibiotic. But in a bacterial infection, that benefit outweighs the risk of taking the medicine. But since antibiotics don't work against viruses, there's really no benefit in taking an antibiotic in that case. So, the risk outweighs that benefit, and we won't want to take an antibiotic in that situation.

I've often had people come in, they'll say, "Oh, I always get this illness every year. I have this cough, runny nose. This has been going on for three to four days. And they'll say, "I always get a Z-Pak, that's an antibiotic. It always helps me feel better." Usually in those situations, it's probably a virus that was causing their symptoms. Their body probably would've fought that off on their own, but they happen to get an antibiotic. So, they're getting better, which they would've done without it, but they're attributing it to the antibiotic. So, sometimes it's nice to kind of let things run their course. But ultimately, illnesses, they can be from bacteria or from viruses, but the antibiotics only work against the bacteria.

Host: You mentioned risks. What are the risks of taking an antibiotic when you don't need one, like you said?

Lauren Fore, MD: The overuse or the misuse of antibiotics can lead to the development of antibiotic-resistant bacteria. So, when antibiotics are used unnecessarily or for too long, bacteria have more opportunities to develop resistance and resistant bacteria can then spread to others. So, it's also important to take antibiotics as prescribed. Because if you don't, if you're not completing a course of antibiotics, we're running the risk of partially killing off the bacteria that's present and then that bacteria can develop resistance to the antibiotic.

So, a lot of times in, urinary tract infections or ear infections, people will tend to feel better within a couple of days of starting that medicine, but it's important to complete the whole course because if they're not, the bacteria is just getting a taste of that antibiotic and then it can develop mechanisms to help be resistant to the antibiotic in the future.

Host: So true. I remember I only needed to do it once and I learned my lesson. I took maybe three days of something and I thought, "Oh, I'm fine." And I didn't finish. And sure enough, it came back probably even worse. So, why is antibiotic resistance a major public health concern?

Lauren Fore, MD: Yeah. So, antibiotic resistance is a top public health threat according to the WHO. And antibiotic-resistant bacteria have been seen in every U.S. state and in every country. So, everyone can potentially encounter this. In the U.S. over 2.8 million antibiotic-resistant infections occur each year, and over 35,000 people in the U.S. die each year from infections from antibiotic-resistant bacteria. Antibiotic-resistant bacteria, they make it harder to treat these infections. It also makes some medical treatments and procedures like surgery or chemotherapy riskier to do. And actually, the bacteria are developing resistance to the antibiotics more quickly than we're developing new antibiotics. So, it could get to a point where we run out of antibiotics to treat these bacterial infections.

So in addition to taking antibiotics appropriately, there's a couple other key steps that we can take to help prevent the development of these antibiotic-resistant bacteria along with preventing spread of infection. Some of these things can be like proper hygiene, washing our hands frequently, covering our coughs, and just being aware that when we're sick, that we do have ability to spread our illness and taking some precautions to help prevent that spread.

There's also some vaccines that are available too. A lot of vaccines we have are against viruses, but we have some that are against bacteria too. So by getting vaccinated, we're preventing us from getting that infection and which means we're preventing the spread of it too.

And along with it being a health concern, there's also some economic costs to antibiotic-resistant bacteria. The World Bank, they estimate that antibiotic-resistant bacteria could lead to $1 trillion in additional healthcare costs by 2050. And in the U.S., it's estimated that the treatment of these antibiotic-resistant infections costs over $4.6 billion per year. So, it's definitely a healthcare concern, but also an economical concern.

Host: Wow. I had no idea that those are some huge numbers and consequences. You mentioned earlier, someone comes in and says, "Oh, I had a Z-Pak for this, but it was for the wrong thing." How do you address patients who ask you for an antibiotic for a viral illness?

Lauren Fore, MD: In those situations, I really try to use it as a big educational opportunity. So, nobody likes to feel sick, everyone wants to feel better quickly. But I think it's also important to know that, as your healthcare provider, like we don't want You to feel sick either. We also want you to feel better, and we want to do whatever we can to help you do that.

Unfortunately, antibiotics just don't work against viruses. So if we're telling you that we don't think an antibiotic is warranted, it's not because we're trying to withhold treatment, it's because we're trying to do the best thing for you without causing any harm. So, I just take that opportunity to educate and counsel on the difference between bacterial and viral infections.

Usually, I'll say something like, "My exam and the testing we performed didn't find a source of a bacterial infection today." Your symptoms are likely due to a virus, and antibiotics don't work against viruses, so we're going to treat you symptomatically. Then, I'll give them some suggestions on treatment and things that we can do to help relieve their symptoms while their body fights off that viral infection, really just taking the time to have that discussion on why the antibiotic isn't warranted In that case, while we're also discussing reasons a person should follow up or they might need a change in their treatment because things do evolve. So, I always give them some signs to look out for. You know, if these things change, follow up with this, because maybe an antibiotic wasn't warranted in the beginning. But because things can change, sometimes we do see superimposed bacterial infections on top of a virus, and we may need to adjust our treatment as things evolve. But all in all, we just want to help people and we don't want to cause any harm. And that's why these conversations are so important.

Host: You have to listen to your doctor. They know best. I am totally guilty of it. I have had the same doctor for, I don't know, 30 years, and I like begged him to give something, because I had to be somewhere, maybe a trip, I can't remember. And he's like, "I'm telling you, you have got to let it run its course. There's nothing I can give you." And I'm like, "There's got to be something." So, you're right, you're the doctor. Why would we call you? You're the one who knows. We don't. So, listen to your doctor when they give you advice. Thank you so much for sharing your expertise. This has been so educational and perfect time of year for it.

Lauren Fore, MD: Yes. Thank you. I appreciate your time.

Host: Again, that's Dr. Lauren Fore. And if you'd like to learn more, please go to kirbyhealth.org/about-us/community-outreach-services or kirbyhealth.org. And if you found this podcast helpful, please share it on your social channels and check out our entire podcast library for topics of interest to you. Thanks for listening to Kirby Connections Health Podcast.