Tuesday, October 25, 2011

No, you can't have that.

A case tonight reminded me of a constant battle between me and some of my clients --

A couple presented tonight with their kitty for a primary complaint of sneezing.  He is otherwise young and healthy, eating and drinking normally, with a normal temperature.  On physical exam, he has no nasal discharge, no ocular discharge, and no evidence of substantial illness.

His most likely diagnosis is a viral upper respiratory tract infection.  Similar to the common cold in humans (although caused by different viruses), a viral URI will NOT respond to antibiotics.  Antibiotics only kill bacteria, and do nothing to affect viruses.  Most mild viral URIs will resolve without any treatment.  Some do progress to involve bacteria; these patients usually have yellow milky nasal discharge, fevers, and are not eating.  Bacterial URI does require antibiotics, however viral DOES NOT.

Most clients walk in expecting to leave with a prescription, so when I diagnose their cat with a suspected viral URI, and give them the above information, they get very angry.  "Can't you just prescribe him antibiotics or something?" They say. "It will make me feel better to give him antibiotics..." and "Please, doc, it can't hurt anything, right?" 

Wrong.  Prescirbing antibiotics in this situation (or many others where they aren't indicated) only results in development of antibiotic resistance, as well as side effects on the patient from the antibiotics (typically vomiting or diarrhea), and does nothing to hasten recovery.

Antibiotic resistance is a real concern that affects each and every one of us - since the invention of penicillin in the 1950's, increasing numbers of bacteria have developed the ability to survive its use, resulting in the formulation of more and more classes of antibiotics (cephalosporins, fluoroquinolones, tetracyclines, aminoglycosides,etc).  The reason for the development of resistance is quite simple -- evolution.  The lifespan of bacteria is in the realm of minutes; with each generation they undergo natural selection, and evolutionary pressures result in replication of ONLY the surviving population.  Simply stated: if a population of bacteria is exposed to an antibiotic, only those who are resistant will survive.  Only those who survive are able to reproduce (the resistant population) and we are left with clones of those bacteria carrying the ability to resist antibiotics. (Obviously the actual mechanisms are much more complicated than this, however that level of detail is not needed in this discussion.) 

Each and every time antibiotics are used, the likelihood of a resistant strain emerging increases.  Of course, antibiotics SHOULD be prescribed for conditions that they are needed for  - bacterial infections.  Pneumonia, urinary tract infections, bite wound/skin infections, just to name a few appropriate uses. 

Prescribing an antibiotic for conditions that they do not treat, however, is an inappropriate use of a very important class of medications.  It takes me about 3 times longer to explain to my clients why I am NOT prescribing antibiotics; honestly, it'd be easier for me to just cave in and give them the pills. 

In the words of my mother -- "just because it's the easier choice doesn't make it the right choice." Responsible antibiotic use is a ethical obligation of the prescribing community, both veterinary and human.

1 comment:

  1. I'm so glad you brought this up! It is a huge pet-peeve of mine... and it seems like people outside of the science/medical community just don't understand the impact of throwing antibiotics around all willy-nilly at any ailment! It is especially astonishing how many medical professionals are guilty of such irresponsible use of the drugs. Thanks for spreading the word!