The flu: Will antibiotics work?

The flu season is upon us. People will flock to their doctors complaining of fever, body aches, cough and stuffy nose. Some will demand antibiotics to soothe their symptoms, and many will get them. That’s not a good thing. Antibiotics are effective against infections caused by bacteria. The flu is caused by a virus and does not respond to antibiotics.

Although the symptoms may be similar, the afflicting organisms are actually quite different. Bacteria are self-sufficient cells that are capable of multiplying on their own. Antibiotics kill the cells or inhibit their growth. Viruses, on the other hand, require a host — like you — to survive. Once inside they hijack their host’s cell mechanism, which allows them to make replicas of themselves. In other words, they use you to survive and multiply.

The introduction of penicillin in the 1940s, which began the era of antibiotics, has been recognized as one of the greatest advances in medical history. However, their overuse and misuse contribute to the emergence of so-called “superbugs.” Bacteria are hearty organisms that can learn to resist drugs, making many currently available medications ineffective against them.

The Centers for Disease Control and Prevention have found that the emergence of these antibiotic-resistant bacteria has resulted in 23,000 deaths a year. C. difficile, a serious diarrheal infection, is an example of a superbug that alone causes 14,000 deaths a year, according to the CDC.

Yet, many providers continue to prescribe antibiotics for the flu. A study published in the journal Clinical Infectious Diseases noted that in a study population of 7,000 patients, 30 percent of those diagnosed with the flu were prescribed antibiotics.

That does not mean that people suffering with the flu have no recourse. Antiviral medications are available that limit the flu’s ability to reproduce, thereby reducing the severity and length of time of the illness. In the cited study, however, only 15 percent of those eligible for antivirals received them.

Actually, the best treatment for a virus is to prevent it altogether. That’s the role of immunizations. The US health care system now touts inoculations for several viruses, including measles, mumps and polio.

Bacteria and viruses differ in other ways as well. Not all bacteria are bad. Some aid food digestion, while others help repair stomach ulcers, for example. In contrast, viruses usually cause illness, which can range from the nuisance of the common cold to cancer. Human papillomavirus, or HPV, causes virtually all cases of cervical cancer, and is responsible for some cases of anal and oral cancers. Human immunodeficiency virus, or HIV, can result in AIDS.

Even more confusing is that some infections can be caused by either bacteria or viruses. Examples are pneumonia, meningitis and diarrhea. A physical exam and culture sample will confirm the organism.

In 2012 the American Board of Internal Medicine Foundation launched a program called Choosing Wisely, whose goal is to encourage a dialogue among providers nationwide on ways to avoid wasteful and unnecessary medical tests, treatments and procedures. The treatment of upper respiratory infections caused by viruses was among those listed.

Consumers can also do their fair share by not demanding antibiotics. There is a comfort level of walking out of a doctor’s office with a prescription in hand that will make you feel better. Patient demand is a large factor in overuse. Many doctors acquiesce to their patients’ request, while others may lack awareness of the increase in antibiotic resistance.

For a list of resources on appropriate testing and treatment reviewed by the ABIMF, visit their website at www.choosingwisely.org/doctor-patient-lists/.