A Difficult Case of C. Difficile

I took care of a teenager this past year who suffered from too many antibiotics.  Her doctor originally thought she had a skin infection and put her on the first antibiotic course.  The skin did not improve, so he put her on a second course.  When the skin was still no better, he sent her to the Emergency Department.  Here she was put on a third, even more powerful antibiotic.  Her skin still did not improve, but she developed diarrhea, fever, loss of appetite, and terrible cramps.  Her diarrhea and cramps lasted almost three weeks before we figured out that she had a bowel infection called "C. Difficile."  C. Difficile is a bacteria that lives in your colon, in harmony with the other kinds of bacteria there.  If you get too many antibiotics though, the antibiotics wipe out many of the other bacteria that compete with C. Difficile, and the C. Difficile takes over.  When it takes over, you get the painful and unpleasant symptoms of our teen above.  After two more rounds of antibiotics aimed at the C. Difficile, the girl finally got better.  Except for her skin, which probably wasn't infected in the first place.  Antibiotic overuse is a big problem in modern medicine.  Antibiotics are prescribed too often for conditions they can't help.  People are most often infected by viruses, which antibiotics do not kill.  Viruses cause the vast majority of coughs and runny noses, fevers, sore throats, and even most sinus and ear infections.  There is no cure for viruses except for time; waiting the three or four days it will take for the patient's immune system to clean out the virus.  However, patients or patients' families often pressure doctors to prescribe the unnecessary antibiotics: "You've got to do something!"  In turn, doctors feel that pressure and write the prescription.  What can it hurt?, we think.  What if it really is a bacterial infection, which antibiotics do cure, and we are late in prescribing the antibiotic and the patient gets sicker?  This is what we doctors often say to ourselves to make it easier on our consciences when we over-prescribe antibiotics.  So how can antibiotics be bad?  Just ask our teenager in the case I just described.  Antibiotics are drugs, just like adrenalin or steroids or heart medicines.  They can be helpful when used properly, but they also have side effects.  People develop allergic reactions to antibiotics, occasionally severe and life-threatening reactions.  Antibiotics can also change the healthy balance of bacteria in a person's bowels (like our teenager), or in the mouth, leading to painful consequences.  Even worse, too many antibiotics in a person, or in the environment as a whole, lead to bacteria developing resistance to the antibiotics.  Bacteria are living things, and their populations are constantly evolving.  One of their evolutionary abilities is to develop and share resistance to chemicals that can harm them, like antibiotics.  Some bacteria populations, like Enterococcus or Staph Aureus, have developed resistance to so many antibiotics that people infected with them have a hard time being cured.  There are only a few antibiotics left that can wipe out those bugs, and those antibiotics are so strong that they really have some nasty side effects, and can only be given in the hospital through an IV catheter in a vein.  Doctors and scientists worry that there might come a day when all bacteria become resistant to all antibiotics, and we will be back to the days before antibiotics.  In those olden days, people died of pneumonia and strep throat.  Ear and sinus infections sometimes caused terrible complications where the infections ate into the brain cavity.  Just about all doctors' professional organizations, like the American Academy of Pediatrics, have campaigns to encourage doctors and patients to be more judicious in their use of antibiotics, so that antibiotic resistance does not get out of control.  So join doctors and scientists in advocating the proper use of antibiotics.  Do your part to prevent antibiotic resistance by not insisting on an antibiotic if your doctor says it is not necessary.  That is not only better for us all in the long run, it is just plain better medicine.