November 21, 2019, MORRIS, IL – Antibiotics are one of the most useful medicines available, but they might not be for long if not used properly.
That’s what Morris Hospital Infectious Disease Specialist Dr. John Bolden stresses heading into the winter, when cases of flu, colds, bronchitis, pneumonia, ear infections and other such illness most frequently occur.
“Antibiotics aren’t always needed, ” said Dr. Bolden, who also serves as chair of the infection control committee at Morris Hospital & Healthcare Centers. “Thirty to 50 percent of antibiotics prescribed are unnecessary or inappropriate.”
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Why is this important? The more antibiotics we take, the more likely it is for bacteria to become resistant to those antibiotics. Which means, the next time you come down with an infection, antibiotics might not kill it.
The Centers for Disease Control and Infection (CDC) reports that each year in the United States, at least two million people get infected with antibiotic-resistant bacteria, and at least 23, 000 people die as a result. Some strains of bacteria have become resistant to several kinds of antibiotics. And they can even share their resistant genes with other germs, making them antibiotic-resistant, as well.
“The cases of multi-resistant bacteria are going up, ” Dr. Bolden said. “The problem is getting worse. Most hospitals today, including Morris Hospital, have an antibiotic stewardship program that promotes appropriate antibody use.”
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Some of the cases of antibiotic-resistant infections Dr. Bolden sees in his practice are classified as urgent threats. They include MRSA (methicillin-resistant Staphylococcus aureus), C. diff (Clostridium difficile) and drug-resistant gonorrhea.
He has also seen cases of ESBL (Extended Spectrum Beta Lactamase) Resistance, a family of germs that includes antibiotic-resistant E. coli. This family of bacteria is resistant to penicillins and cepholosporins.
To help keep bacteria from developing a resistance to antibiotics, Dr. Bolden advises listening to your physician when he or she has determined that antibiotics will not cure a particular ailment.
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“Viruses are not killed by antibiotics, ” Dr. Bolden said. “If you have a cold, the flu, or some types of bronchitis, ear infections or pneumonia, antibiotics might not do any good at all, or they might harm you through side effects.”
Most viral infections get better on their own in four or five days, Dr. Bolden said. There are also swabs and other tests doctors can do to determine if your infection is viral or bacterial.
Dr. Bolden said good ways to steer clear of contracting infections are to get recommended vaccinations; take antibiotics as prescribed; wash your hands properly; eat and sleep well; protect yourself against sexually-transmitted diseases; prepare food safely; consider taking probiotics, especially when on antibiotics; and tell your doctor if you have an infection, especially if it’s not getting better or is getting worse.
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Dr. Bolden sees patients at the Morris Hospital Infectious Disease Specialists office at 425 E. U.S. Route 6 in Morris. For more information or to make an appointment, contact Dr. Bolden at 815-513-3074 or visit /infectiousdisease.Almost a half of adults in the UK take at least one prescribed drug and a quarter take at least three. Photograph: Getty
W hen former airline pilot Tony Royle came to see me last year to seek reassurance that it was OK to participate in an Ironman event, having stopped all his medications 18 months after suffering a heart attack, I was initially a little alarmed.
But after talking to him, I realised he had made an informed decision to stop the medication after suffering side effects, and instead had opted for a diet and lifestyle approach to manage his heart disease.
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His case is a great example of how evidence-based medicine should be practised. This is the integration of clinical expertise, the best available evidence and – most importantly – taking patients’ preferences and values into consideration.
But our healthcare system has failed to keep to this gold standard of clinical practice for the most important goal of improving patient health outcomes.
The consequences have been devastating. Modern medicine, through over prescription, represents a major threat to public health. Peter Gøtzsche, co–founder of the reputed Cochrane Collaboration, estimates that prescribed medication is the third most common cause of death globally after heart disease and cancer.
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In the UK, use of prescription drugs is at an all-time high, with almost half of adults on at least one drug and a quarter on at least three – an increase of 47% in the past decade. It’s instructive to note that life expectancy in the UK has stalled since 2010, the slowdown being one of the most significant in the world’s leading economies.
Contrary to popular belief, the cost of an ageing population in itself is not a threat to the welfare system – an unhealthy ageing population is. A Lancet analysis revealed that if rising life expectancy means years in good health, then health expenditure is expected to increase by only 0.7% of GDP by 2060.
The greatest stress on the NHS comes from managing almost entirely preventable chronic conditions such as heart disease, high blood pressure and type 2 diabetes. Type 2 diabetes alone (demonstrated to be reversible in up to 60% of patients) takes up approximately 10% of the NHS budget. A disturbing report from the British Heart Foundation suggests that heart attacks and strokes are set to “surge” in England over the next 20 years as the prevalence of diabetes continues to increase.
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Yet rather than address the root cause of these conditions through lifestyle changes, we prioritise drugs that give – at best – only a marginal chance of long-term benefit for individuals, most of whom will derive no health outcome improvement. The reality is that lifestyle changes not only reduce the risk of future disease, their positive effects on quality of life happen within days to weeks. However, those patients unlucky enough to suffer side effects from prescribed medicines may find their quality of life will deteriorate in order to enjoy small longer term benefits from the medication.
Of course patients may need to use both, but what’s important is that information is presented in a transparent way to encourage shared decision making. The Academy of Medical Royal Colleges’ Choosing Wisely campaign encourages patients to ask their doctor whether they really need a medication, test or procedure.
Prof Luis Correia, director of the Centre of Evidence Based Medicine in Brazil, says if a clinical decision is not in keeping with the patient’s individual preferences and values, “it will not work”.
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A report commissioned by thinktank the King’s Fund in 2012 recommended putting patient preferences at the heart of decision making in medicine, suggesting it would not just be a victory for ethics and policy but for finance, too, as the data shows patients given all the information choose fewer treatments. But more than saving money, it will be about redistributing resources within the system to where they are needed most, in acute and social care.
This solution to the NHS financial crisis and giving patients the very best chance of improving their health will require a national public health campaign to reduce the amount of medications the population takes, improving lifestyle and adhering to the true principles of evidence-based medicine that make shared decision making the priority in clinical practice.
A few weeks ago, four years after his heart attack and two years after coming off all medications and dramatically changing his diet, Tony completed his first Ironman at the age of 58, revealing it’s never too late to improve fitness. But the most important message remains clear: you can’t drug people into being healthier.The Academy says scientific advances mean in future there will be more opportunities to intervene with treatment before there are any symptoms.
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It argues developments in genetics present a great opportunity to develop highly effective targeted therapies, with a clear idea of who will benefit and who will not.
I think it's unarguable that prevention is better than cure, and if you wait until the patient presents with signs or symptoms of kidney disease, liver disease, heart disease, very often most of the damage is done and can't actually be recovered.
So if it were possible to take steps while still in health to prevent or delay the onset of disease that seems to make very good sense.
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Sir Robert says he does not just envisage drug interventions for pre-emptive treatment - but his comments have raised renewed concerns about people being over-medicated.
This issue has already provoked fierce debate over the use of statins for people at low risk of heart attack and stroke.
Professor Carl Heneghan from the Oxford University Centre for Evidence-Based Medicine, says the focus with disease prevention should be on issues such as physical activity, smoking and diet.
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What we have to do is look at clear lifestyle risk factors. The future of healthcare is a healthier lifestyle. Only in certain diseases such as cancer will we find personalised treatments are effective.
The fact that prescription drugs are the third most common cause of death after heart disease and cancer should make policy makers wake up.
Having a real impact on reducing demand and improving quality of care in the NHS will only happen when the root
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