August 23, 2008

Pill Overkill Breeds Drug Resistance

By Prithvijit Mitra

Kolkata: Does your doctor prescribe antibiotics every time you have a bout of sinusitis? Beware, you may be headed for deep trouble. Most doctors in the city ignore warnings by the World Health Organization (WHO) and ask patients to pop high power antibiotics even in the case of viral sinusitis, where these pills are useless.

Forty-year-old Anjan Das learnt this reality the hard way. He was given antibiotics whenever he had sinusitis. Two years ago, the engineer suddenly started having chronic breathing problems. It refused to go away despite treatment. Das no longer has sinus attacks but has been forced to turn to inhalers. He was shocked when told that antibiotic overuse - avoidable, since he was a short- term sinus patient - had made him resistant to a variety of drugs. It could also have induced his breathing problem.

There are scores of others like Das in Kolkata who are suffering from myriad disorders and have become resistant to drugs - thanks to the sinus overkill. A substantial number of them, according to a study conducted by preventive medicine experts in Kolkata, are sinus patients who were wrongly prescribed antibiotics.

"The majority of sinus patients do not need antibiotics at all because they have short-term viral infections. Antibiotics don't help them, just make them resistant to drugs," said Debashish Basu, preventive medicine expert.

Last year, the American Academy of Otolaryngology (AAO), which represents ear, nose and throat specialists , issued new guidelines for treating sinusitis, recommending that doctors wait for 10 days before even considering an antibiotic. If the patient gets better by then, the bug is almost surely a virus, and antibiotics would be of no use. But if the problem lasts longer, chances are that it is bacterial. The AAO guidelines leave it to the doctor to decide whether to prescribe an antibiotic or monitor the patient another week.

These guidelines have been endorsed by WHO but in Kolkata, these caution is thrown to the wind, admit doctors . "I have come across scores of short-term patients who have been prescribed antibiotics and they continue to buy them over the counter. It wrecks their system but doesn't help to control the sinus. We need to follow the new guidelines and adapt a more patient approach," said tropical medicine expert Tomonash Bhattacharya.

Medical experts around the world are pushing for a less- aggressive approach. Around 21% of antibiotic prescriptions for adults in the US are for sinusitis, even though studies show the drugs do little or no good. In India, it is believed to be at least 10%.

Short-term sinusitis can be caused by either a bacterial infection, which may respond to treatment with antibiotics , or a viral infection, which doesn't . Doctors believe the overwhelming majority of cases begin as viral infections, and less than 2% turn into bacterial infections.

Doctors, on their part, blame patients for insisting on antibiotics. Many pop antibiotics without waiting for the doctor's advice, they claim. "One of my patients would take antibiotics whenever he caught a cold. He is not a long-term sinus patient but he just refuses to see reason. He has developed multiple illnesses over the years," said Basu.

The AAO has recommended non-antibiotic treatments that may ease sinus symptoms. These include decongestant sprays, saline irrigation, topical steroids and over-the-counter pain medicines.


Headache when you wake up in the morning is typical of a sinus problem Pain when your forehead is touched Heaviness & pain in the head while bending Pain in upper jaw and teeth Cheeks tender to the touch Related symptoms may include fever, weakness, fatigue, cough that gets severe at night, runny nose or nasal congestion


l The most common culprit is the common cold virus. It usually goes away without treatment in two weeks. l In few cases, bacteria like Haemophilus influenzae, Streptococcus pneumoniae, Moraxella catarrhalis and Staphylococcus aureus cause serious infections


l Antibiotics not necessary in most cases since they are viral attacks. Pain relieving medication, anti-hestamines and decongesants are prescribed. Chicken soup is also beneficial l Antibiotics should be prescribed only when the sinusitis persists for more than two weeks

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