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Medicine's "magic bullets" sometimes miss the target.

Dr. Paul Ehrlich, who won the Nobel Prize in 1908 for medicine, once referred to antibiotics as the "magic bullets" of medicine. Many World War II veterans owe their lives to the sulfa drugs developed in Germany just before the war, as well as to penicillin, which came into being during the war. In the ensuing half century, antibiotics have saved countless lives and have extended Americans' life spans by an average 10 years.

New and more powerful antibiotics enter the market frequently, yet many infections fail to respond to antibiotic therapy, and many patients experience serious--and sometimes fatal--side effects from them. Like lead bullets, the magic bullets of medicine can save lives when properly used but also can wreak havoc when used carelessly.

Problems with antibiotics may be the fault of the physician, the pharmacist, the patient, or circumstances beyond anyone's control. For example, antibiotics are ineffective against viral infections, but physicians sometimes succumb to a patient's expectations by prescribing them for such things as nonbacterial throat infections. Another problem is that they prescribe an antibiotic that may be incompatible with other medications currently being taken by the patient.

Patients often fail to follow physicians' instructions to the letter. Not taking penicillin or erythromycin for a full 10 days for strep throat, just because a patient feels well after two or three days of therapy, is just one example. Often, neither doctor nor patient can be blamed for gastro-intestinal distress or other side effects normally experienced with some antibiotics.

The most compelling reason for care in using antibiotics is the problem of drug resistance. Nature's genetic changes occur over long periods to help species adjust to environmental changes.

On the other hand, genetic changes in bacteria can occur quickly because bacteria multiply so rapidly. Bacteria may thus learn to adjust to a hostile environment (i.e., an antibiotic) in a period of months. If so, the new strain will no longer respond to that particular antibiotic.

Strep throat will likely recur days or weeks later in the patient who quits taking penicillin after two or three days, because the antibiotic only reduced but did not eliminate the organism. He or she may then use the leftover pills or capsules for another brief period until the symptoms abate.

The antibiotic originally prescribed for 10 days may thus be used to treat as many as two recurrences--by which time the strep bug may have learned to tolerate it. Should the same strain of bacteria later cause a much more serious infection in this or another patient exposed to it, the penicillin will be of no value.

Newer families of antibiotics, such as the quinolones or cephalosporins, are effective against many more different bacteria types than some older drugs, such as penicillin. The broader an antibiotic's range of effect, however, the more likely is the development of resistant strains of bacteria. Use of these more powerful antibiotics should therefore be restricted to the more serious infections, or those that do not respond to the older stand-bys.

Some antibiotics are less effective when taken with food. Others are less likely to cause undesirable side effects if taken with food. Some are less effective when taken concomitantly with other medications, while others may affect the utilization of other medications.

It is important, therefore, that instructions for the use of antibiotics be followed strictly--and that one's physician and pharmacist be made aware of every medication, including over-the-counter preparations being taken by the patient.

The most serious immediate adverse effect of an antibiotic is a severe allergic reaction--anaphylaxis. Allergy to the penicillin family of drugs--penicillin, amoxicillin, ampicillin, dicloxacillin--is the most common. Persons who experience hives or asthma immediately after taking a dose of antibiotics should immediately stop using the drug.

Those who experience swelling of the tongue or adjacent areas should go immediately to the emergency room. Next, they should report the matter to their physician and pharmacist and be sure that they make the information known to all medical personnel in the event of any future treatment.

Such reactions do not necessarily preclude the later use of the antibiotics if skin testing and a careful review of the individual patient's medical history rule out the likelihood of anaphylaxis.
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Title Annotation:antibiotics
Publication:Medical Update
Date:Jul 1, 1993
Previous Article:The battle of the bulge - a new approach.
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