We hear it often, especially during cold and flu season. It is the most common reason parents call to talk to our Director. It leads to negative reviews on social media sometimes. It sounds something like this……
Students come in asking for a zpack by name because “that’s the only thing that works”
Parents call and are upset we didn’t “do anything” for their student
“My doctor at home just calls me in an antibiotic”
“Student Health told me I have a cold but I really have an upper respiratory infection!”
“My snot is green so I know it is bacterial”
“You told me I have a virus, but I went to another facility and got an antibiotic”
And finally………………………”Student Health never gives antibiotics!”
SO WHAT’S THE DEAL, STUDENT HEALTH?
Sore throat, cough, nasal congestion/drainage, fever, aches, ear pain, sinus pressure, and headache are some of the most common reasons for visits to Student Health. As you see from the chart, VERY few need antibiotics.
Some important facts to know:
- 90-98% of sinus infections are viral (and even in bacterial cases, antibiotics do not necessarily help)
- 90-95% of sore throats in adults are NOT strep
- over 200 strains of the common cold exist
- bronchitis should not be treated with antibiotics
- most adults experience 2-4 colds annually, each lasting 7-10 days
- colored snot means NOTHING in regards to whether the cause is bacterial or viral
- high fever can be present in either bacterial or viral infections
So how do Providers know whether a patient needs an antibiotic or not?
Providers at Student Health follow national treatment guidelines, which aid diagnosis and treatment planning. The Centers for Disease Control has an excellent chart that you can check out here to see why we make the decisions we do. Part of the diagnosis is on patient reporting of symptoms, duration of illness, etc and the other is based on physical assessment, such as vital sign readings, visual inspection of eyes/throat/nose/ears, and listening to lungs (among other things depending on symptoms).
Do we give antibiotics? Of course we do–when it is the medically appropriate treatment.
Yeah, but wouldn’t an antibiotic help anyway????
NO. Incorrect antibiotic use causes a whole host of problems. People tend to forget that antibiotics can have side effects, some which may even make a patient feel worse than their original illness! Allergic reactions, stomach upset, diarrhea, yeast infections, and rashes are just some of the common side effects people can experience with antibiotics. Another issue is drug resistance–every time you take an antibiotic that you do not need, you are contributing to the fact that the antibiotic is less effective over time to bacteria. Did you know that by taking an antibiotic, you can actually help unleash a dangerous different bacteria into your gut, one that can lead to hospitalization and even death? (Don’t believe me? Check out info on C.Difficile)
Superbugs like MRSA exist now because of incorrect use of antibiotics, and the scary thing is, our ability to fight these super infections is limited or in some cases, there is no way at all to treat them! And what about cost? Prescriptions are not always cheap. Why take a medication that won’t help, may hurt, leads to drug resistance, and costs money?
Health care providers have a duty to prescribe responsibly and to only use antibiotics in acute illness when a patient shows signs that a bacterial infection is present.
So you aren’t going to help.
Here is the part that comes into conversation with a lot of our patient/parent feedback about viral infections: if you are not giving an antibiotic, you are not doing anything to help. The hard truth is this: with most illnesses, including flu, bronchitis, upper respiratory infections, colds, sinus infections and most sore throats, THERE IS NO MAGIC FIX. We always advise patients on the best way to treat their symptoms to hopefully get some relief, but the only thing that cures is TIME. Illnesses can take days or WEEKS to resolve (yes, weeks.) Rest, good nutrition, light exercise, and increasing fluid intake help. We recommend which over the counter medications to take, and provide prescriptions for cough medications or inhalers if warranted; our on site pharmacists are also happy to help patients decide what may help their symptoms. Having a pharmacy right inside Main Campus SHS makes it easy for patients to pick up what they need to start feeling better.
“You told me I have a virus, but I went to another facility and got an antibiotic.”
Our advice to patients would be to always ask why you are, or are not, receiving an antibiotic. Ask what guidelines are being used. Ask why a provider thinks an illness is viral or bacterial. Any high quality provider will be happy to share information and education about their clinical decision.
We hear stories of “urgent care gave me an antibiotic for my bronchitis” (cringe) or “the ED diagnosed an upper respiratory infection and wrote me a zpack” (AKA, you have a COLD. Double cringe) or, possibly the most irresponsible, “I called my doctor at home and he called me in an antibiotic since that always helps” (ugh….)
Some outside facilities may not be willing to practice evidenced based medicine when it comes to antibiotic prescribing because that may mean a patient will be unhappy (and therefore will not pay to come back). We cannot control what other offices do, but we can insist that our facility follows recommendations and best practices. Just because you can walk out of another office with one or more prescriptions does not mean it was the medically sound thing to do.
Possibly the most important part…..that many patients miss…..
While most illnesses are viral in nature, we ALWAYS tell patients that if they are not getting better, something suddenly worsens, or if they have any emergency symptoms such as difficulty breathing, inability to put their chin to their chest, severe headache, chest pain, high fever that does not respond to medication, or prolonged vomiting, THEY NEED TO BE RE-EVALUATED. Infections that start out as viral, or appear early on as viral, can lead to bacterial infections that do need antibiotics or other treatments. Most patients will recover from viral illnesses on their own, but if that is not the case, we will always be glad to see patients for follow up appointments. The great thing about Student Health is that if you pay fees with your tuition, you do not have to pay to be seen and evaluated….so never hesitate to come back with any new concerns, symptoms that are not improving, or other questions about your care.
Our goal is help the ECU campus community be as healthy as possible. By communicating how we form diagnoses and treatment plans, we hope patients and others will feel more educated and confident that safe and appropriate antibiotic prescribing is a important part of the care we provide at Student Health Services. As always, feel free to drop us a line at firstname.lastname@example.org with your health or service related questions.
Stay well, ECU!
Antibiotics Aren’t Always the Answer https://www.cdc.gov/features/antibioticuse/infographic2.html
Appropriate Antibiotic Use https://www.cdc.gov/antibiotic-use/
CDC Treatment Guidelines https://www.cdc.gov/antibiotic-use/community/for-hcp/outpatient-hcp/adult-treatment-rec.html