Antibiotics rarely make sense



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Antibiotics can save lives, there is no question about that. However, due to the almost inflationary use, the antibiotic drugs often no longer work. "When in doubt prescribe antibiotics," was the motto of family doctors for a long time. The agents do not help at all in the case of viral infectious diseases, for example. Many patients are unsettled and still require an antibiotic to only get well in the wrong belief.

The fact is, for example, patients suffering from bacterial pneumonia or sepsis (blood poisoning) can save antibiotics. In addition, antibiotic drugs can alleviate the symptoms of an infectious disease caused by bacteria and accelerate the healing process. However, because antibiotics are also regarded as a “panacea” by doctors, the drugs are taken much more often than the medical benefits suggest.

Bacteria are very adaptable
Word has got around in the meantime, but the number of regulations is not in proportion to the benefits. So-called antibiotic resistance threatens with each administration because many strains of bacteria are very adaptable. Changes can be made by mutations. The result: the bacteria become virtually immune to the active substances and form real resistances. After that, the medicines no longer work. If infected bacteria are passed on to others, they spread. Epidemics are threatened by antibiotic-resistant bacteria.

The President of the German Society for General Medicine and Family Medicine, Prof. Dr. Ferdinand Gerlach emphasized: “Our goal must be to use antibiotics as specifically as possible and as little as possible and as much as necessary. The appeal is not only aimed at doctors but also patients. Because many patients ask the doctor for antibiotics because they believe that this will help them recover faster. Professor Markus Dettenkofer from the Institute for Environmental Medicine and Hospital Hygiene at the University Hospital Freiburg / Breisgau confirms this. There are patients "who ask the doctor for antibiotic treatment". Often it is parents who ask for an antibiotic out of concern for their children or workers who want to be able to get back to work quickly. Because the doctor then puts himself under pressure see, the preparation is often prescribed hastily and unnecessarily, although the doctor actually knows that long-term use of unnecessarily used antibiotics is not only dangerous for the patient but also for society as a whole.

Patients know too little about the possible consequences
"Many patients think that taking antibiotics is the ultimate," says Dr. Carsten Matthias, general practitioner from Hamburg. Many also know too little about possible consequences and side effects. The medicines for fungi or viruses are without any mechanism of action. However, in order to differentiate specifically whether the disease was caused by a virus or a bacterium, the family doctor would have to take a saliva sample or a urine test and have it examined in the laboratory. However, such a diagnosis takes a few days and is usually not related to the infection. In many cases, patients also do not want to wait so long or the effort seems too high for the doctor. Therefore, in addition to patient pressure, doctors are tempted to prescribe an antibiotic.

Antibiotic ineffective in flu
Helmut Schröder from the AOK Scientific Institute in Berlin emphasizes: "A classic flu is usually caused by viruses". However, evaluations by the health insurance company have shown that with increasing numbers of patients with viral infections in winter, prescriptions for antibiotics also increase, although these remedies do not help at all in the case of flu. But Schröder does not want to be misunderstood: "Quite indisputably, antibiotics have to be used for pneumonia, if Lyme disease is suspected after a tick bite and for urinary tract infections." However, antibiotics can be useful if there is bacterial inflammation in addition to the flu. Because the body is severely weakened in the event of an infection, so that bacteria have an easy time entering the organism.

Different mechanisms of action of antibiotics
Antibiotics are not all antibiotics. The composition of the drugs either inhibits the growth of the bacteria or kills them entirely. While some active substances specifically target specific strains, broad-spectrum antibiotics such as penicillin or tetracycline act against several types of bacteria. If pathogens can be localized, then treatment can be targeted. If there is no evidence of the pathogen because there is an emergency, therapies are preferred as a trial. "You will first use a broad-spectrum antibiotic and carry out diagnostics in the laboratory at the same time," explains the doctor. If the results are available from the laboratory or the previous antibiotic therapy is not working, the treatment will be adjusted.

Antibiotics are not always useful for bacterial infections
Not every bacterial infection has to be treated with antibiotics. Many ear, nose and throat specialists have changed their treatment strategy for otitis media. Because in acute otitis media, the course of the disease with and without antibiotics is very similar. "We therefore recommend the following strategy: Four out of five children no longer have pain after 24 hours if they are given pain relievers such as juices," says Schröder. It is very important to protect the patient physically and to ensure that they are adequately hydrated if the symptoms last longer than two to three days, a doctor should be consulted, who then decides whether antibiotic therapy is suitable. Home remedies for middle ear infections can also be helpful. Children in particular receive antibiotics too often.

It is Friday afternoon and all the doctors have already closed, but the child is crying with an earache. At best, doctors in the emergency clinic provide an antibiotic prescription that can be used after 48 hours if the symptoms still persist. This way, the parents feel reassured, "reports Gerlach. In most cases, the prescription is not redeemed because the pain is gone even without an antibiotic.

Antibiotics have numerous side effects
What many do not know: Every antibiotic drug therapy has consequences for the body. "Antibiotics have numerous side effects such as nausea, diarrhea or vomiting," emphasizes Gerlach. Some patients also have an allergic reaction. In addition, the intestinal flora is disturbed, as a recent study by Stanford University (Palo Alto, California) found. Therefore, naturopaths and naturopathic doctors recommend antibiotic therapy for intestinal rehabilitation in order to rebuild the intestinal flora.

It is now undisputed that bacteria learn to adapt after a short time. They form defense mechanisms or change their genome sustainably. Therefore, the funds should not be discontinued until the end when the state of health has improved.

It is not only subsequent therapies that are made more difficult. Infants, patients with a weakened immune system or hospital patients can be at acute risk of death. If patients are seriously injured or major operations are carried out, there is always a risk of bacterial infection or sepsis. For this reason, risk patients are always first tested for germs in the laboratory before admission to the hospital. (sb)

Read on:
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Image: Rainer Sturm / pixelio.de

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