Melanie Cole (Host): Antibiotic resistance is a growing problem both in the United States and across the world. The main driving factors behind antibiotic resistance are the overuse and misuse of antibiotics. It can be confusing to know when antibiotics are truly needed for common infections. My guest today is Dr. Andrew Dean. He’s an emergency room physician with Stoughton Hospital. Welcome to the show Dr. Dean. So, let's talk about antibiotics and really what are they used for? What are the most important reasons to use an antibiotic?

Dr. Andrew Dean, MD (Guest): Well, thanks for having me. The most important reason to give antibiotics is to fight a bacterial infection. That’s where they are effective. They are not effective against viruses and other infections like that, which is the big problem we have in the emergency department – is treating people with likely viral infections with antibiotics.

Melanie: So, certain infections people hear about – strep throat, ear infections – there's so many childhood infections that we hear about, and people sometimes just want an antibiotic because they think. So, let's bust up a few myths before we talk about some of the resistance that’s developing. If someone sees green mucus, does that mean they need an antibiotic?

Dr. Dean: It does not. Green mucus is seen in many viral infections. The color of the mucus is not a reason to give an antibiotic. We base our decision to give antibiotics based on other things, such as seeing an obvious pneumonia on an x-ray or a positive strep throat culture.

Melanie: Sore throats, coughs, bronchitis – these are all things that people come up with and right away they think, okay, I'm going to need an antibiotic. Which of those do they need one for?

Dr. Dean: Sure, antibiotics are needed for a bacterial pneumonia or a bacterial strep pharyngitis – strep throat infection. The vast majority of upper respiratory infections – colds, even earaches – are viruses. They’re caused by viruses – they will get better on their own, and they will not respond to antibiotics.

Melanie: Well, I'm glad you brought up ear infections and sinus infections as well. So, do we watch and wait with some of these because sometimes parents are hesitant – especially with ear infections because over the years you’ve heard it could affect your child’s hearing and such like that. What do you do as far as talking to your pediatrician or your physician about antibiotics for ear infections or sinus infections or colds?

Dr. Dean: The vast majority of ear infections and sinus infections and colds are caused by viruses. They will get better on their own, and they require symptomatic treatment only. So we treat the fevers with ibuprofen and Tylenol. We can treat sinus congestion with decongestants or steroid nasal sprays. The vast majority of the time with sinusitis or ear infections we will wait likely seven to ten days before initiating antibiotic treatment as most of those infections will get better on their own without antibiotics and without risking some of the harmful side effects of antibiotics.

Melanie: So, what is antibiotic resistance, and why do you think, in your opinion, that you're starting to see this as an emergency room physician for things that might even come in – MRSA or God forbid, sepsis – any of these things that might need an antibiotic where maybe it's not working quite as well as it should?

Dr. Dean: Right. What we're seeing now is that bacteria are evolving, and they have essentially developed ways of resisting our normal antibiotics and as such what we have traditionally used to treat these infections no longer work, and when we're just talking about a basic sinus infection, that’s not the end of the world. When someone does develop a more severe infection, as you mentioned, like a sepsis which is a disseminated infection of the bloodstream and the whole body – when antibiotics don’t work against those situations that becomes life-threatening and can be extremely difficult to control. We like to reserve our antibiotics for true documented bacterial infections, and that way, the hope is they will remain effective against the more serious infections, and that’s why we tend not to want to use them in these more, ultimately, minor situations.

Melanie: So, Dr. Dean, is there a crossover? We hear about antibiotics in our food or in our milk or in acne medication and these kinds of things — is there a crossover with this resistance being caused by an overuse in some other ways besides just getting it as a prescription?

Dr. Dean: There is some thought that antibiotic resistance can come from, for example, some of the meat that we eat. Poultry can be treated with antibiotics. Some other meat products are treated as they're growing with antibiotics both to prevent infection and to actually help increase their size, but having the antibiotics distributed in the food system does also create these super bacteria that are resistant. So, that’s definitely an issue. You also mentioned topical medications. Another issue is anti-bacterial soaps and detergents. Those are another thing that can increase antibiotic resistance, and it's something that quite frankly is not needed – plain old soap and water will be sufficient to clean up most household issues without the need to use an antibacterial soap or detergent.

Melanie: Do probiotics have a role in helping to reduce some of this resistance that we're seeing?

Dr. Dean: Probiotics don’t necessarily affect resistance, but they can help reduce the side effects that people have when they do need to take an antibiotic. Specifically, one of the most common side effects of antibiotic treatment is GI discomfort, either nausea or diarrhea. By taking a probiotic, it helps maintain your normal gut flora and can help reduce those side effects.

Melanie: Dr. Dean, the Centers for Disease Control and Prevention are calling this a critical mission to prevent this resistance from becoming worse. What would you first like to say to healthcare providers about what they can do to help with this mission?

Dr. Dean: I think when we talk to other providers, what we want to remind them is to really make sure that what they are treating with antibiotics is indeed the bacterial infection. The vast majority of things that we give antibiotics for – in the emergency department and emergency departments around the country – are likely viruses. And, we're not doing anybody any favors by doing that. We are certainly encouraging long-term resistance and putting our patients at risk for side effects. It certainly starts with us having these conversations with parents and patients because oftentimes people think because they have an infection, they need antibiotics and even though it's likely not a bacteria.

Melanie: And what about for patients? What would you like them to know when they come in and they're asking for an antibiotic and even, you know, practicing good hygiene, getting their recommended vaccines, those kinds of things. What can we as patients do to help thwart this resistance?

Dr. Dean: Well, certainly trying to avoid getting infections in the first place is always a great step. So, like you said, hand hygiene is by far the most important thing. Getting vaccinations that will prevent infections is also incredibly important. What I would tell patients is that when they come and see their doctor, and their doctor doesn’t prescribe an antibiotic, it's likely a well thought out decision by them, and they're not doing it just to kind of push the patient’s care under the rug. We know what we're doing. We think about this a lot and see it a lot. It’s fair to ask them why you're not getting an antibiotic, but also realize that there is some very good science and very significant reasons behind not treating your everyday URI infection or cold infection with antibiotics.

Melanie: And what about if we do have to have them? Give us some of your instructions for healthy and safe antibiotic use.

Dr. Dean: The big thing is to take them as prescribed. So, if you're prescribed to take it twice a day, take it twice a day and always take the full course. If for some reason, you do not end up taking your full course, and your symptoms resolve that’s great – please throw away the rest of the medication. It should not be kept around just in case you get symptoms again. I commonly hear patients tell me that they started to feel sick, so they started an antibiotic. You certainly don’t ever want to start an old antibiotic just because you don’t feel well. Not all antibiotics treat the same thing. Antibiotics can have expiration issues, so certainly take your antibiotic in full, and any leftover antibiotic should be thrown away.

Melanie: Then wrap it up for us, Dr. Dean. It’s really – it’s great information, and it's so important for both healthcare providers and for the common patient to hear about this critical mission that the CDC and healthcare providers are trying to thwart so that we don’t develop a resistance so that these bugs can’t kind of take over – give us your best advice.

Dr. Dean: My best advice would be to be sure to discuss all your symptoms with your doctor and have a good conversation. At the end of that conversation – your doctor does not feel that antibiotics are warranted, I would trust them, and I would go along with that and realize that the vast majority of infections that we have are viral. They will resolve on their own with symptomatic control and time. That being said, we need to make sure we have our antibiotics available to be effective against more serious infections when they do rear their heads and prevent possible life-threatening situations.

Melanie: Thank you so much, Dr. Dean for being with us today. You're listening to Stoughton Hospital Health Talk, and for more information, you can go to stoughtonhospital.com. That's stoughtonhospital.com. This is Melanie Cole. Thanks so much for listening.