Dear Editor,

With any luck the recent snow will soon be replaced by warmer temperatures, but respiratory viral season is still in full swing. As an Assistant Professor and pharmacist at Butler University and at Riley Hospital for Children, I am no stranger to the negative impact of respiratory viruses. Relief from the symptoms of respiratory viral infections, including nasal congestion or runny nose, cough, headache, fever, and sore throat, is of particularly high priority for college students with busy academic and extracurricular schedules. Unsurprisingly then, it is common for students (and everyone else) to seek antibiotics when they become ill.

The reason I am writing this letter is to raise awareness that most common respiratory infections are caused by viruses, against which antibiotics are totally useless. Although antibiotics are highly effective against bacteria, they do not kill viruses, which are differently structured germs. Why does it matter, you ask, if someone else is taking an unnecessary medication? The reason is, aside from the increased risk of side effects such as diarrhea, antibiotic overuse accelerates the development of resistance in bacteria. We are all fortunate in that our bodies exist in harmony with more bacteria than human cells – our microbiota. However, exposing our beneficial and protective microbiota to antibiotics, allows the bacteria to develop ways to outsmart the antibiotics, and therefore become resistant. The newly resistant bacteria can easily be passed between individuals, therefore contributing to the rapid spread of antibiotic resistance.

Many may argue that the antibiotics they receive for their sinus infections or cold symptoms are effective in curing their illnesses. Azithromycin, or a “Z pak”, is often erroneously prescribed for sinus infections or cold symptoms, which are usually caused by viruses. The 5-day treatment duration for a Z pak matches up well with the 5-7 days it normally takes for viral infections to naturally resolve, and people attribute their increased health to the antibiotic they receive. Unfortunately, Z paks increases the development of resistance.  Some sinus infections are caused by bacteria, such as those lasting for more than 10 days or those where an initial illness that appeared to be improving suddenly worsens.  In these cases, antibiotics other than Z paks are recommended.

The discovery and therapeutic use of antibiotics revolutionized medicine and now facilitates survival for medically complex individuals, such as those who receive chemotherapy. Resistance has been reported soon after every new antibiotic has been introduced, and increased use of antibiotics accelerates the development of resistance. Individuals who develop antibiotic-resistant infections are more likely to have a higher severity of illness, higher healthcare costs, increased hospital stays, require additional doctor visits and procedures, and are more likely to die of their infections. One seemingly simple solution would be to create new antibiotics, but this is difficult and few antibiotics are in development. Even then, newer antibiotics may be more expensive, and associated with less experience and more severe side effects. Our nation is in the grips of a public health crisis related to antibiotic overuse and it will take a concerted effort at all levels of antibiotic use to prevent a catastrophe. I implore readers to listen to the advice of medical professionals and only use antibiotics when necessary for the treatment of bacterial infections.

Sincerely,

Kristen Nichols, PharmD, BCPS

Kristen Nichols