I have to thank my husband for using our
awesome telemedicine option for a weekend appointment, so we didn’t have to go
track down an urgent care center… actually we had to track one down anyways but
thanks for the first attempt. Also have to thank him for testing something I’ve
been SO excited to see implemented across the nation- unfortunately our
experience with telemedicine this time was less than ideal and has made me a
bit skeptical. But that’s a story for another post.
So my husband caught the dreaded stomach bug that has been
shutting down daycares, schools, offices, etc. It came on suddenly and hit him
like a freight train, following a large wedding we attended and a training day
where facemasks and gloves that have likely never experienced Lysol spray were
used. Not surprisingly he was knocked on his bottom and suffering as many
Americans have over this winter.
To get a little background, stomach bugs like Norovirus have absolutely been on fire this year. We hear all the time from friends who have received notices that their child’s school is closing for a day or two, or that some kid in a daycare classroom has noro and to be on the lookout. Few things compare with those 48 hours of hawking your child for any sign of gastric self-destruction. Unfortunately children can be infected multiple times in the first five years of life, and milestone infections spread like wildfire in adult populations[i].
To get a little background, stomach bugs like Norovirus have absolutely been on fire this year. We hear all the time from friends who have received notices that their child’s school is closing for a day or two, or that some kid in a daycare classroom has noro and to be on the lookout. Few things compare with those 48 hours of hawking your child for any sign of gastric self-destruction. Unfortunately children can be infected multiple times in the first five years of life, and milestone infections spread like wildfire in adult populations[i].
Norovirus is a rapidly evolving virus, keyword virus. The RNA code (rather than DNA)
can replicate rapidly and function with mutations and mistakes in the coding.
This leads to what I’ll call milestone viruses. According to Parra et al, six
global epidemics have occurred when the virus mutates significantly and then
and spreads rapidly. For example, the 2009 virus emerged as a mutation of the
2006 virus, co-infecting until it became a fully independent strain. The 2012
strain of norovirus wrecked havoc across the United States East Coast in
particular, and the same situation has been seen in the 2016-2017 winter as the
newest strain mutates and becomes independent.
Why did I go into this background on norovirus? Because
viruses mutate faster than any other microorganism currently known to us.
Viruses come on suddenly, hit us with an explosive rush to count tiles in our
bathrooms. It comes on suddenly but it also depart suddenly. Norovirus averages
48-72 hours in a typical, healthy person. But by day 3 many of us are done. We
are exhausted and dehydrated from spending so much time going between the
bathroom and bed. We just want to eat something. My husband talked almost
exclusively about big macs during his most recent bout with the virus. The
treatment plan for norovirus is typically rest and rehydration. Unfortunately
we don’t have drugs that can stop noro in its tracks. However, many doctors
still want to send you home with antibiotics.
“99.9% of the cases that present with your symptoms are viral. But I’m going to prescribe an antibiotic anyways. Just in case.” --My husband's telemedicine doctor
“99.9% of the cases that present with your symptoms are viral. But I’m going to prescribe an antibiotic anyways. Just in case.” --My husband's telemedicine doctor
Antibiotics, treat bio-organisms such as bacteria- which has
an operating system written in DNA, not RNA. Norovirus does not react to antibiotics, lets try to be very clear
about that. So why did the physician who treated my husband call in an
antibiotic?
A 2007 study conducted by Oxford investigated this exact
issue- physicians prescribing antibiotics under pressure. Patients come in to
clinics with an acute viral infection, feeling miserable, exhausted, and burnt
out from the symptoms lasting a few days. They want a quick fix to feel better,
so despite the drugs being ineffective, physicians send them home with a
prescription for an antibiotic[ii].
The mindset could be that it won’t hurt anything to treat with an antibiotic-
symptoms should clear up by the end of the 10 day course anyways, so the
patient will feel better.
Unfortunately, this mindset is detrimental to our functional
antibiotic supply. Antibiotic resistance leads to multi-drug resistant strains
of bacteria, which leads to increasing numbers of deaths from previously treatable
infections. What makes over-prescribing unethical is that as we overuse
antibiotics and increase microbial resistance, we are seeing more deaths. We
are putting individuals at risk of death and serious illness because we want a
patient to have a feel-good feeling when they leave the office. That their
doctors visit meant something.
It is the responsibility of the physician to educate the
patient on the differences in infections. It is the responsibility of the
patient to listen. It is the responsibility of humans collectively to ensure
that our antibiotic supply remains as functional as possible in order to
prevent deaths from treatable diseases. A new mindset is necessary, otherwise
we are all at fault for increasing resistance and ultimately mortality rates
due to the misuse of antibiotics.
No more “Take this antibiotic… just in case”.
After Dr. Misuse called in the prescription for antibiotics,
my husband looked at me and said “this doesn’t make sense.”, I guess that’s
kind of the product of have a wife with a MPH. We went for another office
visit- this time in person at urgent care rather than via telemedicine. The
physician actually impressed my husband with explaining specifically that he
would not prescribe antibiotics for this case and why (I guess it helped that
my husband explained his skepticism of the antibiotics as well). After five
days of symptoms, they created a treatment plan of clear fluids, pedialyte, and
expletives- finally my husband was starting to feel better.
As usual, I’m not a medical doctor. But I’ve been trained to
investigate research and data and raise eyebrows at things that just don’t make
sense. This misuse of antibiotics has got to stop before they are completely
ineffective.
[i] Parra, G. I., Squires, R. B., Karangwa, C. K.,
Johnson, J. A., Lepore, C. J., Sosnovtsev, S. V., & Green, K. Y. (2017).
Static and evolving norovirus genotypes: Implications for epidemiology and
immunity. PLoS Pathogens, 13(1), e1006136. doi:10.1371/journal.ppat.1006136
[ii] Stivers, T. (2007). Oxford Studies in
Sociolinguistics : Prescribing under Pressure : Parent-Physician Conversations
and Antibiotics. New York, US: Oxford University Press. Retrieved from
http://www.ebrary.com.proxygw.wrlc.org
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