Many people seem to believe that the Z-pak possesses magical qualities. Patients come in requesting it for the common cold, because it worked for them in the past. Not only do many believe it cures the common cold, but they think it can treat any infection. Have a urinary tract infection? Just ask your doctor to prescribe a Z-pak! Sniffles got you under the weather? Do the same!

Anyone who believes these myths is setting themselves up for bigger problems down the road. A common cold is caused by a virus, typically a rhinovirus, that is not treated with antibiotics. In fact, antibiotics have no powers over any viruses, mythical or otherwise. The best treatment for viruses is best-rest, fluids, and symptomatic care. It will get better in 2-3 days whether or not a patient takes antibiotics or not. The Z-pak is not the best antibiotic for all bacterial infections. It may have worked great for your ear infection but will not do much for a urinary tract infection because this is caused by different types of bacteria. The choice of antibiotic should be targeted at the specific kind of bacteria causing an infection.

Why should we care if someone takes a Z-pak if they don’t really need it?

Side effects. All medications have side effects. Some of them can be quite benign but some can lead to lethal consequences.

Bacterial resistance. Bacteria can build resistance to antibiotics if they are used too often. Over time, those antibiotics stop working against those bacteria and stronger ones (which often have stronger side effects) are needed. Sometimes, patients need multiple medications thereby raising the chance of side effects as well as resistance to multiple antibiotics. If a patient takes antibiotics too often, they are more difficult to treat. We should reserve antibiotics for when they are needed.

The rise of superbugs. The more we use antibiotics, bacteria mutate themselves to survive the attack. As they evolve, they become immune to treatment and we are left with bacteria that are difficult, or even impossible, to treat.

Costs. Antibiotics can be quite expensive. Money spent on these medications when they are not needed are just a waste, for both patients and insurance companies. When insurance companies pay more for patients care, they turn around and raise the price of premiums and deductibles so we could argue that patients are the ones truly footing the bill when these medications are used needlessly.

Complications. Certain other infections can arise due to the use of antibiotics. For example, C. diff., a bacteria that can cause deadly diarrhea results when an antibiotic wipes out normal gut flora and allows dangerous bacteria to take over.

Many patients come to me requesting a Z-pak. When it is indicated, I prescribe it. But, sometimes I know it is unnecessary because they have a viral infection or other reasons. If I explain my reasoning well, patients accept my decision. Some will be convinced that they need that Z-pak and get angry. Some will leave my office and go down the road to the urgent care center and be given a prescription for a Z-pak.

The problem we face is that there is poor communication. Patients sometimes don’t understand the difference between viral and bacterial infections and we need to spend the time educating them. Many patients do understand the difference and we need to strive to help all patients understand. Physicians are under a great deal of pressure and often cave in when they know, for example, a Z-pak is not really needed because they want to make the patient happy. Yes, it is important to keep our patients satisfied, but not at the risk of causing them unneeded complications. Both doctors and patients need to work better to address treatment goals and understanding disease processes.

Doctors need to open their ears and hear what their patients are telling them. Likewise, patients should listen to what their doctors are telling them and consider the explanation before dismissing them as not caring. Only when we work together can we tackle the increasing problem of antibiotic resistance and the rise of superbugs.

Linda Girgis is a family physician who blogs at Dr. Linda.

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