Here’s another pop quiz: Which scenario below requires antibiotics?

• A fever for 3 days
• Cough that turns wet
• A cough that “gets deeper into my chest”
• Runny nose that turns yellow

The oversimplified answer is “none of the above“, at least not without having a doctor check you out first, to decide whether it’s a virus or a bacteria. The above scenarios, while a legitimate problem for patients, are usually caused by viruses and not bacteria — which means the antibiotics are totally unhelpful. In terms of the above scenarios:

• A fever is normal in any virus infection, even over 40 degrees, and can last a few days
• a “wet cough” implying bronchitis still doesn’t mean it’s a bacteria — viruses are the most common cause
• Yellowish/greenish runny nose does not always mean bacteria — it’s simply white cells fighting off your infection, again usually just a virus

This brings up one of my daily jobs in clinic: convincing patients with simple viral infections that they do not need antibiotics.

I discussed this topic yesterday on China Radio International’s Beyond Beijing program, along with three experts from Chinese hospitals and the World Health Organization. Called “The Abuse of Antibiotics”, you can listen to the one hour program by clicking here. The main concern was recent news from China health agencies that the rate of antibiotic use in China (as well as adverse reactions) is very high compared to many countries. Antibiotics are also overused in America, especially for common cold symptoms.

And this well-known international overuse of antibiotics is causing dangerously high resistance rates. In other words, every time your doctor gives you antibiotics for a simple cold or bronchitis, you not only are not treating your likely-viral infection, but you are increasing your risk that next time, when you actually need to fight off a serious bacterial infection, your antibiotic will no longer work on you. Antibiotic abuse is a very real situation which is especially serious in hospitals and ICU wards. For example, many healthy young people are now getting more serious skin infections from the MRSA bacteria (=”Methicillin Resistant Staphylococcus Aureus”), which are much harder to treat now due to increasing resistance.

So What Can We Do?

One of our panel conclusions was that antibiotic abuse is an international issue that transcends borders. The radio panel’s WHO representative mentioned a successful program in Europe which plastered buses and other public spots with a “Not All Bugs Need Drugs” campaign. This started a healthy community discussion which actually did lead to a drop in antibiotic prescriptions.

Every country needs to tackle antibiotic abuse from many angles:

• Doctors have to stop prescribing antibiotics for virus infections
• Docs need to educate their patients much better about the virus/bacteria difference
• Patients need to stop self-treating themselves with antibiotics
• Pharmacies need to stop giving patients antibiotics without prescriptions
• Hospitals need to stop selling antibiotics for a profit
• Animal farms need to stop giving their animals antibiotics simply for growth yields

More Information

The World Health Organization has a program dedicated to decreasing antimicrobial resistance worldwide; you can see their documents and information here. There is also a good website with info geared more for kids and parents; it also has patient handouts in Chinese and other languages. Below is a poster from the Not All Bugs Need Drugs campaign: