November 2019- United States Antibiotic Awareness Week

A note from the author--- Happy November NCP friends! Within the last few weeks, the national flu campaign has been in full swing, urging everyone to get their flu shots and focusing on preventing the spread of illness. At this time of year, it is incredibly important to wash your hands and cover your mouth when you cough/sneeze to prevent disease from spreading, whether it is bacterial or viral in nature. As the cold, wet weather begins, doctors see an influx in visits for everything from coughing, sneezing, and sore throats, to vomiting, GI distress, and fevers. However, a hot topic is often raised when people are going to their primary doctors with complaints of illness: to prescribe antibiotics, or not? November 18-24, 2019 is the United States Antibiotic Awareness Week. Let’s celebrate this week together by learning more about antibiotics below!

What is United States Antibiotic Awareness Week? Antibiotics are essential for survival. Throughout Antibiotic Awareness Week, there will be a lot of attention placed on the proper and improper use of antibiotics. It is an issue that needs to be addressed and public education is essential. While everyone can contract a bacterial infection and suffer serious consequences if they aren’t treated, there are many who are at higher risk, such as those undergoing cancer treatment, who have surgery or invasive procedures, or have chronic diseases that affect their immune system. Everyone can play a role in helping reduce the risk of antibiotic resistance, aside from debating how antibiotics should be used in sepsis treatment:

Don’t demand antibiotics if your doctor or nurse practitioner says you do not have a bacterial infection.

Do not take antibiotics prescribed for anyone else. Do not take leftover antibiotics, even if they were prescribed for you. Finish your full course of antibiotics, even if you feel better and it seems like the infection

has gone away. Follow the instructions on the prescription regarding how often to take the medication

and the dosage. Speak with your doctor or nurse practitioner if you have side effects from the antibiotics. Ask your doctor or nurse practitioner how long it should take before you start to see or

feel improvements. Contact them if you do not feel better by that time.

Antibiotics: The Past, Present, and Future Penicillin was discovered in 1928 and with this new antibiotic, a new world in medicine began. Common infections could now be treated, saving many lives. But unlike the welcome news of penicillin’s discovery, today’s antibiotic news is sobering. The antibiotics we have today aren’t as effective at treating some types of infections as they used to be. Latest statistics show that each year, at least 2 million people in the United States contract an antibiotic-resistant infection and at least 23,000 die. Bacteria are living microorganisms that can mutate over time to protect themselves from the effects of antibiotics. The best-known example is Methicillin-resistant Staphylococcus aureus or MRSA, a staph infection that has become immune to many types of antibiotics. This is concerning because an untreated infection can lead to sepsis, a serious and often deadly response to an infection. The Importance of Antibiotics, the Threat of Resistance Antibiotics save lives and are critical tools for treating a number of common and more serious infections, like those that can lead to sepsis. However, at least 30% of the antibiotics in U.S. outpatient settings are prescribed unnecessarily. Any time antibiotics are used, they can cause side effects and lead to antibiotic resistance, one of the most urgent threats to the public’s health. Antibiotics save lives but any time antibiotics are used, they can cause side effects and can lead to antibiotic resistance. Antibiotic resistance is one of the most urgent threats to the public’s health. Antibiotic resistance happens when bacteria develop the ability to defeat the drugs designed to kill them. When bacteria become resistant, antibiotics cannot fight them, and the bacteria multiply. Some resistant bacteria can be hard or impossible to treat and can spread to other people.

The Impact of Improper Antibiotic Use Overuse and improper use of antibiotics are the main causes of antibiotic-resistant bacteria. According to the Centers for Disease Control and Prevention (CDC), at least 30% of antibiotics prescribed in the U.S. are unnecessary – either prescribed for a non-bacterial infection or for a bacterial infection that likely would have cleared up on its own. Improper use of antibiotics includes people using antibiotics prescribed for others, using saved and/or expired antibiotics from previous treatments, stopping treatment before the full infection is cleared up, and not taking the right dose at the right times. All of these expose bacteria to antibiotics, which enables them to mutate so they become invulnerable to the antibiotics later on. Each year in the United States, at least 2 million people become infected with bacteria that are resistant to antibiotics and at least 23,000 people die as a direct result. Many more die from complications from antibiotic-resistant infections.

The Key to Appropriate Antibiotic Use Seek advice from a qualified healthcare professional before taking antibiotics. Antibiotics are a precious resource, so it is important to get the right advice before taking them. This not only ensures you and your family get the best treatment, responsible use of antibiotics will also help reduce the threat of antibiotic resistance. Improving the way healthcare professionals prescribe antibiotics, and the way we take antibiotics, helps keep us healthy now, helps fight antibiotic resistance, and ensures that these lifesaving drugs will be available for future generations. CDC’s educational effort, Be Antibiotics Aware: Smart Use, Best Care, is the year-round effort to improve antibiotic prescribing and use and combat antibiotic resistance.

The CDC’s Messages to the Public about Antibiotics Antibiotics save lives. When a patient needs antibiotics, the benefits outweigh the risks

of side effects and antibiotic resistance. Antibiotics aren’t always the answer. Everyone can help improve antibiotic prescribing

and use. Improving the way healthcare professionals prescribe antibiotics, and the way we take antibiotics, helps keep us healthy now, helps fight antibiotic resistance, and ensures that these lifesaving antibiotics will be available for future generations.

Antibiotics do not work on viruses, such as those that cause colds, flu, bronchitis, or runny noses, even if the mucus is thick, yellow, or green.

Antibiotics are only needed for treating infections caused by bacteria, but even some bacterial infections get better without antibiotics. Antibiotics aren’t needed for many sinus infections and some ear infections.

An antibiotic will not make you feel better if you have a virus. Respiratory viruses usually go away in a week or two without treatment. Ask your healthcare professional about the best way to feel better while your body fights off the virus.

When antibiotics aren’t needed, they won’t help you, and the side effects could still cause harm. Side effects range from minor to very severe health problems. When you need antibiotics for a bacterial infection, then the benefits usually outweigh the risk of side effects.

Taking antibiotics can lead to antibiotic resistance. Antibiotic resistance occurs when bacteria develop the ability to defeat the drugs designed to kill them.

If you need antibiotics, take them exactly as prescribed. Talk with your doctor if you have any questions about your antibiotics.

Talk with your doctor if you develop any side effects, especially severe diarrhea, since that could be a Clostridioides difficile (C. difficile or C. diff) infection, which needs to be treated.

Do your best to stay healthy and keep others healthy by cleaning hands, covering coughs, staying home when sick, and getting recommended vaccines, such as the flu vaccine.

Presidential Message on Antibiotic Awareness Week, 2017 During Antibiotic Awareness Week, we recognize the often-underappreciated threat that resistance to antibiotics poses to our Nation’s health. We remind our Nation’s medical professionals, veterinarians, and researchers to learn about the appropriate prescribing and use of antibiotics, and remind them of their role in helping patients use antibiotics appropriately so that we can better combat this emerging health concern. Since they were first marketed in the 1940s, antibiotics have helped to revolutionize modern healthcare, offering cures to previously untreatable infections. Millions of people owe their health to the healing power of antibiotics. Antibiotic resistance, however, limits—and can even eliminate—the power of antibiotics, putting individuals and communities at greater health risk. Antibiotic resistance arises when bacteria survive despite encountering antibiotic medicines designed to kill them. As a result, many infections have become increasingly difficult to cure—making millions of Americans sick and causing tens of thousands of deaths in the United States each year. My Administration is, therefore, committed to implementing the National Action Plan for Combating Antibiotic-Resistant Bacteria. This plan provides a roadmap to identify instances of antibiotic resistance, stop the spread of resistance, and improve the prescribing and use of antibiotics. We will strengthen our collaboration with international partners and empower our Nation’s greatest minds to develop new vaccines, diagnostic tests, and medications to prevent, diagnose, and treat infections. While these efforts will surely be fruitful, the best way for us to combat the public health threats from bacterial infections is for patients and doctors alike to do their part and prescribe and use antibiotics only when needed and only as directed. This week, I encourage Americans to learn more about antibiotic resistance and what each of us can do to confront this increasingly important public health issue. Together, we will slow the spread antibiotic resistance and preserve the effectiveness of antibiotics for future generations.

The Treatment for Sepsis Treatment for sepsis is basic. The standard of care following the Surviving Sepsis Campaign guidelines includes providing intravenous (IV) fluids and rapid administration of antibiotics within an hour of triaging the patients, for both sepsis and septic shock. Some physicians are questioning this approach. In an editorial published last month in the Journal of the American Medical Association, three physicians from the U.S., Switzerland, and the U.K., wrote that they believed antibiotics should not be automatically given to patients suspected of sepsis, but they should be saved for patients diagnosed with septic shock. Acknowledging that patients with known bacterial infections should receive antibiotics at any stage, they offered three reasons not to have a blanket approach to the prescription:

1. Diagnosing sepsis and septic shock can be challenging, and sepsis may be assumed when the problem has some other cause;

2. Unnecessary antibiotic use can have serious consequences, ranging from antibiotic-resistance to effects from the drugs themselves, such as Clostridium difficile infection;

3. Combining sepsis and septic shock into one treatment plan is, in their opinion, a mistake.

The Ongoing Debate Between Sepsis Experts Many physicians who regularly treat septic patients disagree. Sepsis Alliance board member Jim O’Brien, MD, director of quality and patient safety at OhioHealth in Columbus, says that antibiotics for septic patients are still the right approach. In an article published in HealthLeaders, O’Brien said, “The data supports that the sicker a patient is—and septic shock is probably the best example—the more likely they are to benefit from antibiotics. But there is evidence of patients with sepsis without shock who also benefit.” O’Brien qualifies this, pointing out that physicians have to take into consideration the patient’s risk and severity of illness, as well as any possible alternative diagnosis other than sepsis or septic shock. However, if a patient has signs of infection and is presenting with signs of sepsis, using antibiotics would reduce the chances of the patient progressing to septic shock, increasing their mortality risk. A study published in early 2017, coauthored by Sepsis Alliance Chief Medical Officer, Steven Q. Simpson, MD, Professor of Medicine and Acting Director of the Division of Pulmonary and Critical Care Medicine at the University of Kansas, agreed: “Longer time to initial antimicrobial administration is associated with increased progression of severe sepsis to septic shock and increased mortality,” the authors wrote.

Q & A for parents

My child has a really bad cold. Why won’t the doctor prescribe an antibiotic?

Colds are caused by viruses. Antibiotics are used specifically for infections caused by

bacteria. In general, most common cold symptoms—such as runny nose, cough, and

congestion—are mild and your child will get better without using any medicines.

Don’t some colds turn into bacterial infections? So why wait to start an antibiotic?

In most cases, bacterial infections do not follow viral infections. Using antibiotics to treat

viral infections may instead lead to an infection caused by resistant bacteria. Also, your

child may develop diarrhea or other side effects. If your child develops watery diarrhea,

diarrhea with blood in it, or other side effects while taking an antibiotic, call your child’s

doctor.

Isn’t a nose draining yellow or green mucus a sign of a bacterial infection?

During a common cold, it is normal for mucus from the nose to get thick and to change from

clear to yellow or green. Symptoms often last for 10 days. Sinusitis is a term that means

inflammation of the lining of the nose and sinuses. A virus or allergy can cause sinusitis and

in some cases, bacteria can be the cause.

There are certain signs that bacteria may be involved in your child’s respiratory illness. If

your child has a common cold with cough and green mucus that lasts longer than 10 days,

or if your child has thick yellow or green mucus and a feverhigher than 102°F (39°C) for at

least 3 or 4 days, this may be a sign of bacterial sinusitis. If your child has developed

bacterial sinusitis (which is uncommon), an antibiotic may be needed. Before an antibiotic

is prescribed, your child’s doctor will ask about other signs and examine your child to make

sure an antibiotic is the right medicine.

Aren’t antibiotics supposed to treat ear infections?

Not all ear infections are treated with antibiotics. At least half of all ear infections go away

without antibiotics. If your child does not have a high fever or severe ear pain, your child’s

doctor may recommend observation initially. Because pain is often the first and most

uncomfortable symptom of ear infection, your child’s doctor will suggest pain medicine to

ease your child’s pain. Acetaminophen and ibuprofen are over-the-counter pain medicines

that may help lessen much of the pain. Be sure to use the right dose for your child’s age and

size. In most cases, pain and fever will improve within the first 1 to 2 days.

There are also ear drops that may help ear pain for a short time. You can ask your child’s

doctor if your child should use these drops. Over-the-counter cold medicines

(decongestants and antihistamines) don’t help clear up ear infections and are not

recommended for young children. Your child’s doctor may prescribe antibiotics if your child

has fever that is increasing, more severe ear pain, and infection in both eardrums.

Aren’t antibiotics used to treat all sore throats?

No. More than 80% of sore throats are caused by a virus. If your child has sore throat, runny

nose, and a barky cough, a virus is the likely cause and a test for “strep” is not needed and

should not be performed. Antibiotics should only be used to treat sore throats caused by

group A streptococci. Infection caused by this type of bacteria is called “strep throat.” Strep

throat generally affects school-aged children and not children younger than 3 years. If your

child’s doctor suspects strep throat based on your child’s symptoms, a strep test should

always be performed. If the test is positive, antibiotics will be prescribed.

Resources https://www.cdc.gov/antibiotic-use/week/index.html https://www.cdc.gov/antibiotic-use/week/get-involved.html https://www.cdc.gov/antibiotic-use/week/toolkit.html https://www.whitehouse.gov/briefings-statements/presidential-message-antibiotic-awareness-week-2017/ http://www.thepediablog.com/2017/11/17/u-s-antibiotic-awareness-week/ https://www.testtargettreat.com/en/home/rapid-diagnostics.html?utm_source=bing&utm_medium=cpc&utm_campaign=Industry%20Keywords&utm_term=%2Bantibiotics%20%2Bweek&utm_content=Antibiotc%20Awareness%20Week https://www.who.int/campaigns/world-antibiotic-awareness-week/2017/event/en/ https://www.sepsis.org/news/the-antibiotic-dilemma-u-s-antibiotic-awareness-week-nov-12-18/