PUTTING A CHILL ON IMPORTANT PILLS ANTIBIOTICS CAN'T CURE COLDS AND FLUS - AND OVERUSE PUTS ALL OF US AT RISK.

Byline: Mariko Thompson Staff Writer

Faced with the threat of powerful drug-resistant bacteria, public health and medical organizations have launched campaigns in recent years warning against the overuse of antibiotics. Now advocates in California are preparing to take the message into immigrant communities, where the mistaken belief that antibiotics are an effective remedy against colds and flus still prevails.

Despite the warnings, nearly one-third of Californians remain unaware that antibiotics are useless against viral infections such as colds and flus. The figure jumps among immigrants - 59 percent of Latino immigrants and 54 percent of Korean immigrants say that colds and flus can be treated with antibiotics, said Elissa Maas, vice president for community health at the California Medical Association Foundation's Alliance Working for Antibiotic Resistance Education (AWARE).

``We need to make sure the campaigns we use reach the immigrant communities and not wait until they go to the doctor or clinic,'' Maas said. ``The right drug for the right bug - that's our mantra. These medications may not be with us if we don't use them the right way.''

Because of widespread misuse of antibiotics, bacteria are outsmarting medications faster than new drugs can be invented. Antibiotics are designed to combat bacterial infections, from certain ear infections and strep throat to more serious illnesses such as meningitis and some pneumonias. Bacteria's increasing resistance to antibiotics has frightening ramifications. Not only do infections with drug-resistant strains translate into longer hospital stays, they also require stronger antibiotics that may produce serious side effects. Without effective antibiotics, more people will die of once-treatable diseases, doctors said.

Bacterial vs. viral

One of the challenges that educational campaigns have encountered is making the distinction between bacterial and viral infections clear to the general public. Most people aren't going to remember that sinusitis is bacterial and bronchitis often is viral. That's why the AWARE project simplified its message to target the worst offenders, colds and flus.

``If you've got a cold or flu, antibiotics aren't going to help,'' Maas said. ``That accounts for most viral-type infections.''

When a person suffering from a cold takes an antibiotic, the drug instead attacks common bacteria that live in the body, said Dr. Irving Steinberg, associate professor of pediatrics and clinical pharmacy at the University of Southern California Keck School of Medicine.

``I've coined this as the innocent bystander concept,'' Steinberg said. ``They get exposed to that antibiotic and develop mechanisms of resistance.''

Resistance also occurs when people fail to take the full course of their prescribed antibiotic. Patients often begin to feel better and stop taking the pills even though the bacterial infection has not been eradicated, Maas said.

``You've killed the weak bacteria but left the strong ones,'' she said.

Of the 235 million doses of antibiotics taken each year, health officials estimate that up to 50 percent are not necessary. While trend reports show antibiotics usage has decreased over the last decade, resistance rates have not dropped, said Dr. Rita Mangione-Smith, assistant professor of pediatrics at UCLA Mattel Children's Hospital. In California, about one-third of bacterial infections are resistant to penicillin-type antibiotics, according to AWARE.

``That's why (the campaigns) are going out there gangbusters,'' Mangione-Smith said.

The doc stops here

So why don't doctors just stop writing unnecessary prescriptions? Why appeal to the public at all? Part of the problem is that some illnesses, such as bronchitis, can be viral or bacterial, Maas said. Doctors might err on the side of caution and prescribe an antibiotic, she said.

The greater problem has to do with pressure. Doctors who perceive that a parent expects antibiotics for a sick child are more likely to write the prescription, Mangione-Smith said.

In a 2002 study, Mangione-Smith found doctors prescribed antibiotics 65 percent of the time if they thought the parents expected them. In cases where doctors believed the parent did not expect antibiotics, the rate fell to 12 percent.

The UCLA study found expectations were significantly higher in minority communities. Latino parents were 2.5 times more likely and Asian parents 3.5 times more likely to expect antibiotics than white parents.

``In Mexico, antibiotics are sold over the counter - and they're used to treat everything,'' Mangione-Smith said. ``It's accepted as a reasonable medication for a cold. That's an established belief in that culture. To reverse that with a public health campaign is going to be tough. The message is going to have to be tailored to address the issues of that group.''

To reach these communities, AWARE plans to team up with Latino and Asian doctors and launch an educational campaign through ethnic media outlets. Steinberg of USC said media campaigns can make the doctor's job easier. Doctors can use the awareness as a launching point to provide more detailed information during routine office visits. The worst time to try to educate patients is when they're sick, Steinberg said.

``Then it sounds like a temperance lecture - thou shalt not use antibiotics,'' he said. ``When publicity efforts are made and deal with rational use, patients latch on to that.''

Juana Davila, a registered nurse and pediatrics supervisor at Valley Community Clinic in North Hollywood, said she would like to see an awareness campaign targeted at the Latino community.

``I have not seen any campaign toward them, and I watch a lot of Spanish-language TV,'' Davila said. ``You can't always make them believe that they don't need antibiotics. Their child is sick - and they want something right now.''

Mariko Thompson, [phone]

mariko.thompson(at)dailynews.com

Antibiotic facts

--Antibiotics can be used to treat bacterial infections, unless the bacteria have become resistant. Bacterial infections include strep throat, urinary tract infections, most ear infections and some sinus infections.

--Antibiotics are not effective against viral infections, which include colds, flus, most coughs and most sore throats.

--More than 160 million antibiotic prescriptions are written each year in the United States. Health officials estimate that anywhere from 20 to 50 percent of antibiotic use is unnecessary.

--In California, about one-third of bacterial infections are resistant to penicillin-type antibiotics.

--The Streptococcus pneumoniae bacteria cause an estimated 700,000 to 1 million middle-ear infections in children, 50,000 cases of pneumonia, hundreds of cases of meningitis and blood stream infections, and 4,000 deaths each year.

--A person who becomes infected with a drug-resistant strain of bacteria is likely to spend more time in the hospital and require treatment with stronger antibiotics that may have serious side effects.

Source: California Medical Association Foundation Alliance Working for Antibiotic Resistance Education (AWARE) project. For more information, visit www.aware.md.

CAPTION(S):

3 photos, box

Photo:

(1 -- cover -- color) `The right drug for the right bug'

Antibiotic awareness campaigns strive to educate public about overuse

On the cover: Dr. Nina Maisterra listens to Marlene Reyna's heart during her exam.

(2) Leo Razuri, 11, gets his throat checked while younger brother Sebastian, 3, watches at North Hollywood's Valley Community Clinic, where medical personnel aim to stem the flow of unnecessarily prescribed antibiotics.

(3) Marlene Reyna, 5, gets her temperature taken at Valley Community Clinic.

Tina Burch/Staff Photographer

Box:

Antibiotic facts (see text)