Antibiotics

Somehow in the past 2 weeks, cough and cold is on the rise. Some blame it on the very unpredictable fluctuation of temperature on daily basis, while others blame it on the haze that hit us several weeks ago.

A young English lady came in for fever and sore throat last week, while I was having my clinic downtown. She had typical symptoms of strep throat, fulfilling centor criteria of tonsillar exudates, cervical lymphadenopathy, and absence of cough.

She would make a lovely candidate to be started on amoxicillin, if she hadn't been allergic to penicillin. Being the typical private practitioner, I did a throat swab on her and gave her Azithromycin instead.

This morning, I came into my office from my trip from Singapore, and found the lab report sitting on my desk. The result showed that the throat culture was Strep alright, but unfortunately, the sensitivity test showed that the strep was resistant to nothing but Azithromycin!!

I quickly contacted the lady, explained the lab result and requested her to come back to get a different antibiotic treatment.. She was happy that I called, but told me that the antibiotics worked like magic for her. Her sore throat went away despite taking the supposingly-no-good-antibiotics that I gave her.

These kind of disparities between the lab results and clinical outcome of the patient is not new to me. Should I have not done the throat swab, I'd probably think that the Zithromax worked. However, the lab result also set me thinking of: Whether the throat swab was necessary? Could the lab results different from what really happen in the host? Should I have not given her any antibiotics, could she have gotten well on her own anyways?

Sometimes patients come in requesting for antibiotics even if they don't need it. Most of the time, even family members and friends around me, would think that their symptoms improved and went away immediately after a dose of antibiotics, even though the symptoms suggested viral etiology. Getting better could be due to the placebo effect, or maybe somehow along the line, antibiotics did something else that made a difference in the disease progression.

Nevertheless, patient education in antibiotic use is very important in promary care settings. We all know if antibiotics were given out without proper selection, we are digging our graves by creating superbugs that will not response to any antiobitics in years to come. Hopefully in the years to come, people will start questioning why the need antibiotics in the first place.