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Interviewer: Antibiotics, what do they help, what don't they help, and why should you care? That's next on The Scope.

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Interviewer: Dr. Sara Lamb has a wide range of patient experience from being an internist, a hospitalist, and a pediatrician. So I'm sure you're asked a lot about antibiotics. Do you find that there is still confusion with patients when they should be and shouldn't be used?

Dr. Lamb: Absolutely.

Interviewer: All right. Well, let's clear that up first and then let's talk about why somebody should care about that. So the way I remember it is antibiotic, antibacteria, that's my little . . .

Dr. Lamb: But also antivirus, antifungal, antiparasites.

Interviewer: Also they do . . . I thought it was just antibiotics were just bacteria.

Dr. Lamb: So antibiotics, I think, are a broad sort of category for what we would maybe call antimicrobials.

Interviewer: All right. So then what are the rules when they should be used and when they shouldn't be used? Like for example a cold, antibiotics aren't going to help.

Dr. Lamb: Correct.

Interviewer: Strep throat, antibiotics would help.

Dr. Lamb: I think it depends on, number one, what you think the actual cause of the problem is. Is it a bacteria, is it a fungus, is it a parasite? And then it depends on the host. So the patient in front of you, do they have problems that would put them at risk of having an unnecessarily risky course, a bad outcome if they weren't treated? Or are they an otherwise healthy patient with really a very intact immune system who's likely to be able to fight off this infection without any assistance?

Interviewer: And in the past, I get the feeling that at what point doctors would prescribe or recommend them more often than not?

Dr. Lamb: I think we didn't completely understand what may be the cause of many illnesses that patients presented with and what the likelihood was that they would get better on their own without our intervention with an antibiotic. And you know, since, even since I've been in practice, which was really only about 18 years, we've learned a lot from, you know, evidence-based medicine, from doing population-based studies, looking at outcomes for patients on a very broad scale to be able to have more meaningful, more precise information about who's likely to get better, who's likely to not get better, and who is actually most in need of an antibiotic for a particular condition.

Interviewer: Are we in a bit of a transition where doctors are still prescribing or recommending them when they really shouldn't or they don't need to?

Dr. Lamb: Yes.

Interviewer: So some physicians are on board with kind of what you're talking about, some aren't, why is that?

Dr. Lamb: I think, in part, physicians have a tendency to do what they are most comfortable with, meaning what they have done in the past historically or what they have seen done. And the further we get out from, say, our training experience, in residency or fellowship, the more we rely on our own devices to keep ourselves informed. And one of the most beautiful things about working in an academic center is you're constantly surrounded by medical students, residents, fellows who are constantly asking that question of "Why? Why not?" And that, in and of itself, forces you to stay current with what evolves in the medical literature.

So the further you sort of get away from your training experience and being forced to be kept up to date with the evidence, the medical literature, you can lag in your sort of working knowledge of what is a best practice. We've also seen a great deal of sort of evolution of, you know, clinical practice guidelines that have become more the mainstay of practice for things that we have a lot of evidence for, but that still requires physicians to stay up to date with that information on their own.

Interviewer: So in a lot of ways it brings it back to myself and patients in general that we probably need to educate ourselves a little bit . . .

Dr. Lamb: Absolutely.

Interviewer: About this sort of thing. So I think that transitions into what's the downside of just throwing antibiotics at all sorts of problems? One of which, I think a lot of people have heard about is antibiotic resistance.

Dr. Lamb: Resistance.

Interviewer: Yeah.

Dr. Lamb: Absolutely, without a doubt.

Interviewer: Yeah. So explain briefly what that means.

Dr. Lamb: So antibiotics, when they're given to someone, they will not just take care of the bacteria in your body causing the infection. They will take care of all bacteria that are susceptible to that drug in your body. So that may not affect a few bacteria that would not respond to that antimicrobial. And it sort of disrupts the balance of like the bacteria that are susceptible with the bacteria that are not susceptible.

And then that potentially allows the resistant, unsusceptible organisms to kind of grow out of control. And so those resistant bacteria then proliferate in the system of the person and then they can, they're more likely to be passed on from person to person or from person to door handle which then gets picked up by the next person walking through that hallway.

Interviewer: And that type of anti, maybe it's a different term, but that type of antibiotic resistance is different than kind of what I was thinking of which is these super bugs that are developing.

Dr. Lamb: Well, but that is how super bugs develop.

Interviewer: Okay.

Dr. Lamb: Yeah. So by selecting for bacteria that are in our environment that don't respond to these really big drugs . . .

Interviewer: Oh, I see.

Dr. Lamb: You essentially allow them to propagate and then spread.

Interviewer: And then cause sickness and illness and problems.

Dr. Lamb: Correct.

Interviewer: And then even beyond that, there are some people where the antibiotic can actually mess up your bacteria.

Dr. Lamb: Your own bacteria that are healthy bacteria.

Interviewer: Yeah, in your gut, especially. C. diff comes to mind.

Dr. Lamb: Absolutely.

Interviewer: So how can I be a responsible patient? Should I say no to all antibiotics if I go in for a surgical procedure and they say they want to give me a course of antibiotics as part of that? Should I say no, I'd rather not?

Dr. Lamb: No, I think there's a lot of good evidence to suggest that antibiotics have their place and they have a good role in good medical practice in preserving health, and you know, keeping people without having a complication. So there's lots of good evidence but there's no reason why you can't push your physician, your provider to say, "Well, can you explain that to me? Explain why this is going to be beneficial for me and maybe give me some information about what would happen if I didn't go along with this plan."

Interviewer: And then maybe if the attitude . . . is this a good attitude to have, only use them when you absolutely have to?

Dr. Lamb: Absolutely.

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updated: June 6, 2019
originally published: August 15, 2017