Many people seem to believe that the Z-pack possesses magical qualities. Patients come in requesting it for the common cold, because it worked for them in the past. Not only do many believe it cures the common cold, but they think it can treat any infection. Have a urinary tract infection? Just ask your doctor to prescribe a Z-pack! Sniffles got you under the weather? Do the same!
Anyone who believes these myths is setting themselves up for bigger problems down the road. A common cold is caused by a virus, typically a rhinovirus, that is not treated with antibiotics. In fact antibiotics have no powers over any viruses, mythical or otherwise. The best treatment for viruses is best-rest, fluids, and symptomatic care. It will get better in 2-3 days whether or not a patient takes antibiotics or not. The Z-pack is not the best antibiotic for all bacterial infections. It may have worked great for your ear infection but will not do much for a urinary tract infection because this is caused by different types of bacteria. The choice of antibiotic should be targeted at the specific kind of bacteria causing an infection.
Why should we care if someone takes a Z-pack if they don’t really need it?
- Side effects: all medications have side effects. Some of them can be quite benign but some can lead to lethal consequences.
- Bacterial resistance: bacteria can build resistance to antibiotics if they are used too often. Over time, those antibiotics stop working against those bacteria and stronger ones (which often have stronger side effects) are needed. Sometimes, patients need multiple medications thereby raising the chance of side effects as well as resistance to multiple antibiotics. If a patient takes antibiotics too often, they are more difficult to treat. We should reserve antibiotics for when they are needed.
- The rise of super-bugs: the more we use antibiotics, bacteria mutate themselves to survive the attack. As they evolve, they become immune to treatment and we are left with bacteria that are difficult, or even impossible, to treat.
- Costs: antibiotics can be quite expensive. Money spent on these medications when they are not needed are just a waste, for both patients and insurance companies. When insurance companies pay more for patients care, they turn around and raise the price of premiums and deductibles so we could argue that patients are the ones truly footing the bill when these medications are used needlessly.
- Complications: certain other infections can arise due to the use of antibiotics. For example, C. diff., a bacteria that can cause deadly diarrhea results when an antibiotic wipes out normal gut flora and allows dangerous bacteria to take over.
Many patients come to me requesting a Z-pack. When it is indicated, I prescribe it. But, sometimes I know it is unnecessary because they have a viral infection or other reasons. If I explain my reasoning well, patients accept my decision. Some will be convinced that they need that Z-pack and get angry. Some will leave my office and go down the road to the urgent care center and be given a prescription for a Z-pack.
The problem we face is that there is poor communication. Patients sometimes don’t understand the difference between viral and bacterial infections and we need to spend the time educating them. Many patients do understand the difference and we need to strive to help all patients understand. Physicians are under a great deal of pressure and often cave in when they know, for example, a Z-pack is not really needed because they want to make the patient happy. Yes, it is important to keep our patients satisfied, but not at the risk of causing them unneeded complications. Both doctors and patients need to work better to address treatment goals and understanding disease processes. Doctors need to open their ears and hear what their patients are telling them. Likewise, patients should listen to what their doctors are telling them and consider the explanation before dismissing them as not caring. Only when we work together can we tackle the increasing problem of antibiotic resistance and the rise of super bugs.
Copyright secured by Digiprove © 2018 Linda Girgis, MD, FAAFP
The placebo effect and power of the mind to cure should not be underrated, not that we should be prescribing unnecessary antibiotics but in some instances it may be helpful even when we “believe” it is viral not bacterial.
Oh, puleeze. You want to cut down on overuse of antibiotics? The experts tell us 60% of the antibiotic usage in the US is in animal feed. Let’s stop that first. i would gladly pay 50 cents more a pound for chicken or beef if we could do that. Then, let’s talk about the insane overuse of abs in the hospitals and the much overused diagnosis of sepsis. Did you know that sepsis adds $5000 to the hospitals’ reimbursement from Medicare? No wonder everybody and his or her mother is diagnosed with sepsis. Then let’s talk about the appropriate usage and prescribing of antibiotics in the office setting.
HUZZAH!!!
Let it be know throughout the land:
Just because you have “a swollen gland”
or because your throat is sore
we prescribe antibiotics, nevermore!
I opened my office in 1977 and this problem was ongoing then although the antibiotics were different. I doubt if it is ever going to be solved and it will probably get worse since physicians have markedly less time to talk with patients now and it is less time consuming to throw a drug at every complaint.
How about that pt satisfaction, didn’t get what I want.
The common cold does not get better in 2 to 3 days but can take up to 10 to 14 days. It is still a virus and needs symptomatic treatment with fluids, Vit C, saline flushes, nasal decongestant sprays and may be an antihistamine for excessive drainage.
“Patients sometimes don’t understand the difference between viral and bacterial infections”. My response to this is, do doctors understand the difference?? No, we don’t. If our job is to distinguish between infections that require Abx and those that don’t, tell me how to distinguish between a cold and a sinus infection. because the symptoms are essentially the same. Rather, we ask pts to be sick for at least 7 days before our conscience feels better about prescribing an Abx, has nothing to do w the fact that the pt may have had a bacterial infection all along. So who did we help in this case? No one.
Pretty much any guideline on sinus infection spells out the difference. 7 days has little to do with it, in fact some ENT guidelines suggest four weeks from urti to sinus infection. Either way we know much better than the patients who somoften say,”but I know my body.” BS. We know their bodies way better than they do.
I work in urgent care and they will not get a Zpak here by just demanding it either.