Fighting colds and flus

Antibiotics do not work against viruses, and their overuse is creating the spread of superbugs, writes Mags Gargan

We’ve all been there – runny nose, congestion, sore throat, cough, fever, muscle aches – every year winter bugs do the rounds making their way through homes, schools and workplaces, and making us all feel miserable. However, another thing all these symptoms have in common is that antibiotics will not cure them.

Most common infections like colds and flus are caused by viruses and antibiotics do not work against viruses. Yet every year people fill GP waiting rooms with an expectation of receiving a prescription, leading to an unnecessary purchase of antibiotics. This in turn is helping to develop a worldwide problem of evolving antibiotic resistant bacteria.

The HSE, Irish Pharmacy Union and the Irish College of General Practitioners are currently running an information campaign to explain why there is no point taking antibiotics for colds and flus.

As part of ongoing efforts to tackle the global health risk posed by antibiotic resistance, leading Irish health experts recently discussed bugs, infections and antibiotics at a free public meeting in the Irish College of General Practitioners in Dublin.

Precious resource

Speaking in advance of the conference Dr Nuala O’Connor, Irish College of General Practitioners, said antibiotics are a precious resource and she would not like face into a morning’s work without their availability.

“Before antibiotics were invented what I think people forget is that it was very common for at least one child to die in each family from infections that we now treat with antibiotics, such as meningitis and chest infections. Each year it is estimated that 25,000 people in Europe die from multi-drug resistant bacteria or these superbugs.

“World experts believe that the current antibiotics that we have are the ones we are going to need for the future. We are not going to have any major advances in terms of antibiotics. It’s important for all of us to preserve our current antibiotics for the future, so it’s something that patients need to be aware of, doctors need to be aware of, the Government needs to be aware of, and we all need to support the initiatives that are being put in place for drug resistance so we can preserve the effectiveness of antibiotics for future generations,” she said.

Prof. Edmond Smyth, Consultant Microbiologist in Beaumont Hospital, said as a microbiologist his real concern is that “so much of what we do in modern medicine is dependent on having antibiotics available to us”.

“The treatment of cancer, the management of trauma, major surgery, the treatment of all these vasculitic diseases, treatment of meningitis and so forth, are all dependent on us having antibiotics at our disposal. Without antibiotics, we can’t actually do the majority of what we do, so the whole extraordinary edifice of modern medicine is under threat,” he said.

“It is not going to happen overnight, but piecemeal. If resistance continues to emerge at the rate at which it is developing, and we don’t do something significant about it, we are going to be in the position where we have to stop doing many of these interventions because we won’t be able to manage the outcomes.”

Antiseptic surgery

Prof. Smyth said this is what prevented surgery before Sir Joseph Lister, the British pioneer of antiseptic surgery, revolutionised medicine. “It was the risk of infection that prevented them from [surgery] – they were able to do many of these things; they could anaesthetise patients, quite crudely, and they had the techniques but they couldn’t prevent the infections that killed over half of the patients.”

One by one antibiotics are succumbing to resistant bacteria, making their power relatively shortlived. Prof. Smyth said that bacteria has evolved more in the last 70 years than the billions of years before antibiotics, and once resistance has emerged, it seems to be permanent.

He said these resistant bacteria can currently be found in Ireland. “We have a particular problem with a bug called VRE 9 (vancomycin-resistant enterococci) – a common organism in all our bowels. We are finding now that many of our hospitalised patients, our sickest patients, have this organism on board and they are getting a serious life threatening infection caused by this VRE. In fact the rate of serious infection caused by VRE in this country is the highest in Europe.”

The value of antibiotics to the US economy is estimated to be 300 trillion dollars. 51 tonnes of antibiotics are used in USA every day and 50 million prescriptions are written in Britain each year. Animal use accounts for 50% of antibiotic use, mainly to reduce the price of food and promote growth, while therapeutic use only makes up 20%. Prof. Smyth says we need to control the use of antibiotics. It is about stewardship – not wasting them unnecessarily.

Dr O’Connor said that doctors through educational resources are being made more aware of the scale of the problem we are facing. “We now have clinical guidelines about antibiotic prescribing and these guidelines are trying to get us to prescribe more narrow spectrum antibiotics rather than broad spectrum antibiotics. The way I often describe it to people is why use [bleach] when washing up liquid will do. There are different types of antibiotics out there. There are narrow spectrum antibiotics which will kill most of the common infections that we see,” she said.

“GPs also need to take time to explain to a patient what is the difference between the virus and the bacteria – tell patients how long it will take them to get better. A lot of people don’t realise that you could cough for up to three weeks after a viral infection and most sore throats are going to take up seven days to get better. So a lot of education needs to be done on both sides. But really keeping antibiotics effective is everyone’s responsibility and that is the key message of this campaign.”

Prescription

Kathy Maher, vice president of Irish Pharmacy Union urged people to go to the pharmacy first to check if they need to go to their GP or if they can use medicines without the need for prescription. “Most coughs, colds and flus are caused by viruses so antibiotics are not the answer and they won’t provide relief for any of the symptoms.

“There is no set way to combat colds and viruses but you can limit the spread by educating children to wash their hands after the cough or sneeze and make sure you ‘catch it, bin it, kill it’ as the HSE message would have said. Also if you are in one of the ‘at risk groups’ (children, elderly and sick) go to you pharmacy or GP to have your seasonal influenza vaccination,” she said.

To avoid spreading bugs the panel of speakers advised that you wash your hands regularly and keep them away from your face and mouth. Sneeze into you elbow not your hand, as this will spread bacteria to everything you touch. Shaking hands, including at the sign of peace in Mass, is not an issue, just make sure to wash your hands regularly and thoroughly.

If you’re suffering one of these bugs it is difficult to hear that something like the common cold is self-limiting. However, taking antibiotics is a waste and means that they won’t work when you really need them for a serious infection. All you can do is manage the symptoms and you will get better in time.