Christy Feig: New Antibiotic Guidelines

Christy Feig is a CNN Senior Medical Producer.

Q: Why is the American College of Physicians-American Society of Internal Medicine recommending that antibiotics not be used for common respiratory tract infections?

FEIG: The big problem here is antibiotic resistance. It's a growing problem, especially in some upper respiratory infections, and it's caused by using antibiotics when they aren't necessary, as is often the case with upper respiratory infections.

Q: Why is there such concern about antibiotic resistance?

FEIG: Antibiotics are very powerful drugs and they are very good for the most part for stopping bacterial infections. But when bacteria become resistant to this medicine, the medicine is no longer effective. There are already some bacteria that are resistant to almost every antibiotic we have. If we don't pay more attention to this we could one day face a problem that we don't have any antibiotics that work.

The big push is to make sure that doctors only use antibiotics when absolutely necessary. Often doctors will give a patient an antibiotic because the patient is so insistent they get one, but antibiotics don't work on viruses, they only work on bacterial infections, and the vast majority of upper respiratory infections, for example, are viral. Yet, they still account for seventy-five percent of antibiotic prescriptions that are written for adults. So the big push here is to use antibiotics only when necessary. That will keep them effective.

Q: How can you or your doctor tell whether you need an antibiotic or not? What illnesses should be treated by antibiotics?

FEIG: Well with upper respiratory infections, strep throat, pneumonia and whooping cough do need antibiotics because they are bacterial. But most bronchitis, a lot of sinus infections and sore throats are viral and an antibiotic won't do them any good. Now you can expect one of these sicknesses to last a week or two and that's where most people think they need an antibiotic. But studies have shown that these are viral and even giving them an antibiotic won't shorten them.

Sinus infections are particularly difficult because there isn't a test to tell if it is viral or bacterial. What the group is recommending here, as with most of these upper respiratory infections, is to try to treat it at home with over-the-counter remedies for at least a week. If it starts getting better by then that's probably a virus. Viruses get better quicker than bacterial infections. If it is not better by seven to ten days, go see your doctor, because it probably is a bacterial infection.

Q: What sort of over-the-counter medications are available to treat the symptoms for viral infections?

FEIG: The group recommends medications like cough suppressants and decongestants that will treat the symptoms. They won't make you better by making the disease go away, but they will make it easier to wait it out. Most viral infections get better on their own.

Q: How might these new guidelines affect doctor-patient relationships? How should doctors deal with patients who insist on being treated?

FEIG: Doctors are going to have to help educate their patients that antibiotics don't work on viruses, and that antibiotic resistance is a big problem and everybody needs to work together. Some doctors we talked to said stopping to educate patients takes time, and managed care has reduced the amount of time that they have with each patient, so that is hard to do. They also know that if a patient isn't satisfied with the treatment they are giving, meaning if they don't get an antibiotic and want one, a lot of times they will go to another doctor. So it is going to take a little bit of education to help change this with patients. The best thing is for as many doctors to work together on this as possible.

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CDC: Antimicrobial Resistance
MayoClinic.com: Antibiotics
World Health Organization: Anti-infective Drug Resistance
Alliance for the Prudent Use of Antibiotics
CSPI: Antibiotic Resistance Project

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