With the flu season underway and viral respiratory infections becoming more prevalent, Florida Lung, Asthma and Sleep specialists thought this would be the perfect time
to acquaint you with recent findings regarding the treatment of viral respiratory infections with antibiotics.
A Mini Case Study: Laura, a 37 year old working mother of 3, had an ARTI. This is the acronym for an Acute Respiratory Tract Infection. In fact, Laura had an acute viral respiratory tract infection.
She rushed to her nearest walk-in clinic where she was given an azithromycin prescription. In two days she thought she felt better.
Then less than 10 days later, she went to her primary care doctor with a strong cough. You might have guessed her diagnosis: she had contracted a bacterial RTI, which had become very resistent to antibiotics.
Question: Did the azithromycin help her in the first place?
The short answer is, “No. The azithromycin did not help her. In fact, Laura’s emergency doctor’s prescription could lead “to unintentional adverse consequences.”
To understand why, let’s take a look at this case in the light of a significant study, “Antibiotic Use for Viral Acute Respiratory Tract Infections Remains Common.” Mark H. Ebell, MD, MS, of the UGA Health Sciences Campus, in Athens, Georgia, and Taylor Radke, MPH, conducted the research.
You are probably aware that more and more recent studies have alerted all physicians to “the use of inappropriate antibiotic prescriptions.” The Ebell-Radke research included 54,656 encounters of viral ARTI. Their research, published in The American Journal of Managed Care, focuses on clinicians’ and patients’ use of antibiotics in cases of Viral Acute Respiratory Tract Infections. Let’s look at a little background:
1. Acute viral (upper) respiratory tract infections (ARTIs) happen to be “one of the most frequent reasons for a healthcare encounter in the United States, with estimates of over 43 million ambulatory visits per year for cough or sore throat and many days of lost productivity. With a cough as the main symptom, these infections are typically named “acute bronchitis.”
2. Viruses are the common cause and if you are generally healthy, you can control the infection without a visit to your doctor or a prescription medication. You know the drill: stay in bed. Drink liquids. Get plenty of rest. 
3. Sadly, the old fashioned, common treatment of these viral infections with antibiotics increases the likelihood of a second episode of respiratory tract infection.
4. In the recent past, the problem used to be even more evident. It has been known for some time that this treatment can lead to more antibiotic resistance. “Previous studies have shown that over 60% of adults with ARTI received an antibiotic normally with progressively more broad-spectrum.”
5. By the way, there have been several “clinical trials that have shown that azithromycin, amoxicillin, and amoxicillin-clavulanate do not improve outcomes for patients with acute bronchitis…”
Likewise, such treatment has been proven to “lead to important consequences such as antibiotic resistance, with high economical impact on the US economy.”
Why Antibiotics Do Not Help a Viral ARTI
Put simply, when you take an antibiotic while actually having a viral infection, that antibiotic continues “attacking bacteria in your body — bacteria that are either beneficial or at least not causing disease. This misdirected treatment can then promote antibiotic-resistant properties in harmless bacteria that can be shared with other bacteria.”
It stands to reason then that the antibiotic will do you no good when you subsequently contract a bacterial infection because it is now an antibiotic resistant bacteria.
The Ebell-Radke research investigated the type and number of antibiotic prescriptions filled in the 28 days following an index visit for acute respiratory tract infections (ARTIs) generally of viral origin. They observed that, in spite of the fact that, in such cases, antibiotics have not demonstrated effectiveness on evidence-based practice guidelines, many patients, like Laura above, were given antibiotics. They wanted to know the numbers behind the overuse of antibiotics in ARTIs.
They discovered, “Prescriptions are particularly high when the clinical diagnosis is acute bronchitis, when patients are seen by a clinician in an urgent care setting or when they are seen by a nurse practitioner or physician assistant.”
Bacterial Vs. Viral ARTIs
The Mayo Clinic stated a simple comparison, that helps demonstrate the highstakes of antibiotic mistreatment. “For example, an antibiotic is an appropriate treatment for strep throat, which is caused by the bacterium Streptococcus pyogenes. It’s not, however, the right treatment for most sore throats which are caused by viruses.”
Ebell-Radke Research Results
The Ebell-Radke study demonstrated that “Within 28 days of an encounter for a presumed viral upper respiratory tract infection, 49.4% of patients filled an initial antibiotic 
prescription: 4.8% received a prescription for an anti-influenza drug and 1.2% received both. A second antibiotic prescription was filled after the initial prescription by 8.9% of patients and a third by 0.7%.” You can visit more statistical results of the Ebell-Radke study at the reliable online resource for the Journal of Managed Care.
They saw that the prescriptions were very often given to older patients, whereas pediatricians prescribed antibiotics the least often.
Especially alarming was that “8.9% of patients received a second antibiotic and 0.7% received a third during the 28 days following the index encounter.” In the final analysis, the research scientists expressed deep concern over the continued use of antibiotics for acute bronchitis and other viral ARTIs.
The Ebell-Redke study concluded with:
- An urgent plea for more public health messages for the community.
- Secondly they highly recommended more in-service training for doctors.
- Thirdly, they accentuated the necessity that doctors must educate their patients concerning viral ARTIs.
In short, both patients and physicians need to realize antibiotics just are not an effective treatment in such cases.
So How is This Happening?
At FLASS, we have been aware of the growth of antibiotic resistance in recent years. It has been in mainstream data, so why are we still seeing this problem in studies and statistics?
We agree with four major reasons provided by the Mayo Clinic.
1. Healthcare providers may prescribe antibiotics before getting test results from the lab.
2. Some patients insist on a fast fix for their infection and pressure their doctors into writing antibiotic prescriptions.
3. Antibiotics are readily available online and patients are self-diagnosing illnesses to get them.
4. Patients can’t feel the difference between an invasion of bacteria or a virus. Therefore they take antibiotics left over from a previous infection, which might be the wrong thing to do.
The Florida Lung, Asthma and Sleep Specialists go on record as highly discouraging these four patient behaviors. Such behaviors won’t help the patient’s and add to the dangers of antibiotic resistance.
You might also like to know that these behaviors needlessly increase the health care expenses of the patient.