Ask the Pharmacist

Q: Antibiotics have been readily prescribed for many years. Is there anything new to say about them these days?

A: Antibiotics are among the most-commonly prescribed drugs in Canada, particularly during the fall and winter, and yet we rarely hear them discussed relative to some of the other drug classes, such as the opioids or statins. Despite their lack of glitz, there are some exciting new developments in the use of antibiotics that are worth sharing.

The first is that there is an emerging trend that shorter courses (i.e. the number of days you must take an antibiotic for an infection) are better for a number of reasons. Number one is obviously financial. Fewer days equals fewer pills which equates to less money spent by the individual/insurance company/government.

But more importantly, from a medical standpoint, shorter courses of therapy seem to reduce the risk of bacterial resistance. This term refers to the ability of bacteria to change so that our drugs are no longer able to kill it or control its spread. This goes against the conventional wisdom which traditionally felt that shorter courses of treatment might, in fact, promote resistance.

To the contrary, however, every study that has looked at this issue has found that fewer days of antibiotic use equates to a lower risk of resistance developing. This seems to be the case regardless of the type of antibiotic used or infection treated. It has also been found that for most infections, short courses work just as well as longer durations and provide less chance of side effects. such as c. Difficile, yeast infections and a number of others.

The rationale is that with continued exposure to antibiotics, the normal flora which includes “good” bacteria in our body is killed off along with some of the bad bacteria we are trying to get rid of, such as strep. This good bacteria, in the absence of antibiotics, normally competes with bad bacteria for survival and in doing so, suppresses the bad guys. Unfortunately, when our normal flora’s levels get reduced by antibiotics, it allows the resistant germs to grow more readily.

So, the key is to use antibiotics only when necessary (i.e. not for viruses) and for the optimum length of therapy. The new recommendations are as follows.

For an acute, uncomplicated sinus infection (note most of these are viral in nature), a suitable course would be five to seven days (as opposed to the traditional seven- to 10-day routine). Children or more complicated infections, should stay at a 10- to 14-day course.

The new guidelines for community-acquired pneumonia are suggesting a minimum of five days with the suggestion of stopping anytime after the fever has been gone for two to three days and no other related symptoms ongoing.

Ear infections (which are also predominantly viral) should be treated when needed for 10 days in children less than two, and for three to seven days in those older, depending on a number of criteria.

Recommendations for bladder infections continue to suggest three days for most patients, with longer durations for those who are elderly or pregnant.

Interestingly, strep throat has not had its duration altered one iota even though many consider it to be as blasé as infections get. Treatment should be kept at 10 days as the full course is needed to eradicate the bug and prevent the potential of rheumatic fever.

Now, the obvious caveat to all of these recommendations is that prescribing is not, and never should be, a one-size-fits all endeavour. The choice of which antibiotic to use, the severity of the infection and, of course, the characteristics of the patient being treated (age, general health status, kidney function, and other drugs being consumed), all play large modifying roles on the number of days treatment should be maintained. The point, however is, that giving 10 to 14 days of antibiotics to otherwise healthy individuals, “just to be sure," should be gone forever.

The other new antibiotic development that will affect many people is that the decade-or-so-long conflict between the dentists and the orthopedic surgeons has finally been resolved. For years, those patients who have had total joint replacement surgery were told that they needed to take a single large dose of an antibiotic an hour before their appointment in order to prevent the possibility of mouth bacteria getting into and infecting their artificial joint.

The dental profession has long been questioning the need for this preventative measure while the ortho’s have continued pushing its importance as a safety precaution. This is rather ironic since it is generally the dentists who have to actually prescribe the treatment because surgeons have moved on to other patients after their routine follow-ups. And, as always, patients have been caught in the middle not knowing whose advice to follow.

Now, after a more than two-year joint study, both groups of professionals have agreed that antibiotic prophylaxis (our fancy word for preventative measures) is generally unnecessary for patients with total joint replacements and those with orthopedic pins, plates and screws.

Those with a history of complications associated with their joint replacement, who are undergoing more than a routine cleaning, may still need the antibiotic depending upon the opinions of both the dentist and the surgeon, as will those who take them in order to prevent endocarditis (an infection of the lining of the heart) from occurring.

For more information about this or any other health-related questions, contact the pharmacists at Gordon Pharmasave, Your Health and Wellness Destination. Also check the website at www.gordon-pharmasave.com/ and the Facebook page at www.facebook.com/GordonPharmasave/?fref=ts