Joey Wahler (Host): They're frequently prescribed, but sometimes misunderstood. So, we're discussing antibiotics. Our guest is Dr. Mahendra Poudel. He's an Infectious Disease specialist. This is the Salinas Valley Health Ask the Experts Podcast. Thanks for joining us. I am Joey Wahler. Hi, Dr. Poudel. Welcome.

Mahendra Poudel, MD: Thank you for having me.

Host: Great to have you aboard. We appreciate the time. First, it's interesting, isn't it? So many of us have been prescribed antibiotics, but we probably don't usually think much about this. What exactly are they and what type of infections do they treat?

Mahendra Poudel, MD: Antibiotics are powerful medications that fight bacterial infections. It is important to recognize that they only treat a bacterial infection and do not treat viral or fungal or parasitic infections. They are used to treat a wide range of bacterial illness, simple like strep throat, bladder infection to more serious life-threatening conditions like pneumonia, meningitis, sepsis, bloodstream infection, and a variety of other infections.

Host: Gotcha. And so, how do doctors decide when antibiotics are truly necessary? I guess they've got to fall into those categories, right?

Mahendra Poudel, MD: That is true. So, doctors and medical practitioners go through a very careful process to determine if antibiotics are really necessary. First, they would take a thorough history, do a physical exam, and then run certain tests that's available to them, and confirm that what's going on is a bacterial infection and kind of weigh the risk and benefit and make sure antibiotics are really indicated. So, the goal is to prescribe antibiotics only when there is a clear bacterial infection and benefit the patients without doing unnecessary harm.

Host: Gotcha. Now, I know that some often wonder can antibiotics cure viral infections like the flu or a cold?

Mahendra Poudel, MD: Absolutely not. It is very important to understand that antibiotics only treat bacterial infections as I mentioned above, and they do not treat and are completely ineffective against viral, fungal, or parasitic infection. Taking antibiotics for a viral infection is not going to make you feel better or make you recover quicker, but instead it may harm you by side effects and contributing to antibiotic resistance.

Host: Why is it, Doctor, so important to take antibiotics exactly as they're prescribed? Typically, it might be a five-day run, et cetera. Why is it so important to stick to that?

Mahendra Poudel, MD: The duration of antibiotics is formulated based on clinical studies in terms of how long you need to take it for the optimal outcome. There is also an effective level of the antibiotics in the body that you have to maintain in order to kill these bacteria effectively. And taking the prescribed course or completing it will help to eliminate all bacteria so that the infection doesn't come back again.

Host: Speaking of which, it leads me perfectly into my next question, what could happen if you skip doses or don't finish the full course of the antibiotics?

Mahendra Poudel, MD: Well, if you skip doses or don't complete the course of the antibiotic, obviously, there's a high chance that the infection may come back. And often, it may come back stronger than previously, because you're often leading to antibiotic resistance. So, it's very important not to skip any doses.

Host: Because if you feel better after, let's say a couple of days and you're supposed to be taking it for five, you may think you're in the clear, but not necessarily so, right?

Mahendra Poudel, MD: That is absolutely true.

Host: So, how about the risks of taking antibiotics when they're not needed? Overmedicating, as it's called.

Mahendra Poudel, MD: Antibiotics are very important medicine, and they're often life-threatening. But if you take them when they're not needed or indicated, there can be a variety of side effects. Often, like nausea, vomiting, diarrhea, rash, it may affect the kidney. So, there's all these side effects that you see. And also, it could lead to a specific infection called C. difficile, which basically these antibiotics are killing the good bacteria in the gut and then letting these bad diarrhea-causing bacteria to grow because these antibiotics don't treat the C. difficile cause of bacteria. And the C. difficile infection is becoming more and more severe. It's complicating healthcare, making patients very sick. Not only side effects like what we talked earlier, but also if you take antibiotics when they're not indicated, you are increasing and contributing to antibiotic resistance. Because every time you expose these bacteria to antibiotics, it's basically also trying to survive and becoming more and more resistant that next time the same antibiotics may be ineffective and you have to give more or stronger antibiotics.

Host: Interesting. So, it's almost like the less they're used on a given person, the more effective they are.

Mahendra Poudel, MD: Absolutely. So, there's a saying these days in Infectious Medicine that less is more when it comes to antibiotics.

Host: Okay. Switching gears a bit, Doctor, how about the dangers of a growing problem, not just in California but elsewhere? Namely people buying illegal antibiotics from, say, local mom and pop stores, as if they're aspirin, and as we alluded to, self-medicating?

Mahendra Poudel, MD: That is a very concerning trend these days that we're seeing locally as well as nationally, and especially in other countries because you can buy antibiotics over-the-counter and don't need prescription from a medical provider. But fortunately, that's at least not the case in the United States because you need a prescription to get antibiotics. But a lot of our patients are traveling, and we see a lot of Hispanic patients in our community who travel to Mexico where you can buy antibiotics over-the-counter. So, this is definitely concerning because it often leads to incorrect diagnosis because these people are diagnosing themselves and treating, thinking that what they have is a bacterial infection when they might just have a cold or a flu. And without testing and running the test, often these antibiotics may be wrong, even if they have a bacterial infections. The dose and duration and frequency of the antibiotics may not be accurate. Often, it can lead to multiple allergic reactions, life-threatening side effects. And if you are taking all the medications, there could be a lot of like drug interactions.

 And I think the most important thing is this could lead to antibiotic resistance, and make future treating of infections very complicated because of multi-drug resistant bacterias, which are called superbugs.

Host: Right. And you covered that a moment ago. Couple of other things. From your experience to your knowledge, how big a problem is that of counterfeit drugs being sold in this country, especially antibiotics?

Mahendra Poudel, MD: we haven't really seen that much of counterfeit antibiotic, but it's definitely of a concern because we're not sure how these are studied. What's the ingredient in there? Are there any harmful chemicals? Since there's no quality control or randomized trials that are done, like the prescription-based antibiotics. So, it's really hard to know what's really inside that medicine, and it's really concerning that way too.

Host: Why do you suppose this is happening? Is it a cultural thing where often it's in poorer areas where people might not be as educated or knowledgeable about taking medication properly and/or they don't have proper or perhaps any insurance?

Mahendra Poudel, MD: Yeah, I think that's a good question. I mean, there probably are more than one factor to it. Things like lack of access to appropriate healthcare, because if you're uninsured or you don't have access to affordable healthcare, or a nearby clinic or hospital. Also, there is this mistrust in medical system, when it comes to certain populations.

Obviously, healthcare education, awareness and IQ may be not as high as we want to be. And oftentimes, there is this family and peer pressure that, "Oh, you know, my grandma has this antibiotic. She takes it when she gets a cold. So, you have a cold, might as well want to take it." And often, this perception of antibiotic cures everything may be going on in these communities.

Host: Final question about that. Anything you think that can be done to address the issue besides just getting the word out about the cautions or the dangers associated with it as we've discussed?

Mahendra Poudel, MD: I think it's very important to realize that antibiotics only treat bacterial infections and do not treat viral, fungal or parasitic infections. And these are powerful medications that are life-saving at times, but if you take it unnecessarily, they may be really harmful to you and may develop, drug resistance, which is going to be a problem down the road when you really get sick and need those antibiotics.

Host: And so, having said that, Doctor, in summary here, finally, what's your main overall message to those joining us regarding the taking of antibiotics, and particularly the importance of doing so only under professional supervision?

Mahendra Poudel, MD: Antibiotics can save lives. But at the same time with inappropriate consumption can lead to a whole range of problems such as side effects and development of drug resistance. So, I think, as a community, we have a role to play in preserving the effectiveness of these life-saving medications. So, it's about protecting this vital resource. So, I'd really like to urge people to really think if they really need antibiotics and not try to self-consume or take them as a cure for all.

Host: Great advice indeed. Folks, we trust you are now more familiar with proper use of antibiotics. Dr. Poudel, keep up all your great work, and thanks so much again.

Mahendra Poudel, MD: Thank you, Joey, and thanks for having me.

Host: Absolutely. And to listen to our podcast library, please remember to visit salinasvalleyhealth.com/podcasts. If you found this episode helpful, please do share it on your social media. I'm Joey Wahler. And thanks again for being part of the Salinas Valley Health Ask the Experts Podcast.