BUGS BATTLE ANTIBIOTICS

There used to be an old saying in the health-care field that "a shot of penicillin is good for what ails you."

But that kind of philosophy is quickly going by the wayside, because some organisms are becoming immune from certain antibiotics, causing physicians to use them more sparingly.

"The bugs are becoming resistant to the antibiotic," said Dr. John Russell, a Cape Girardeau internist and pediatrician. "It is not an uncommon problem. A lot of our older antibiotics don't work like they used to, because organisms have developed patterns of resistance to certain ones."

Russell explained that once older antibiotics fail to work, there is a need to use new generation antibiotics that are more expensive. And, because there is always a danger that eventually those won't work as well, the trend now is toward being conservative.

In the past, Russell said antibiotics have been prescribed routinely for infections that probably would have cleared up over time. That isn't the case any longer.

For example, Russell said, once it was common to treat non-infective fluid behind the ear drum with antibiotics, but now, unless there is a sign of infection, they aren't used.

Once certain drugs lose their effectiveness, it often takes time to find something that works, which only prolongs the cure, leads to other side effects, and adds to the expense.

"There certainly needs to be consideration that particular antibiotics work for particular kinds of infections," Russell said. "By taking care in choosing an antibiotic that has the highest likelihood of success, we can oftentimes reduce the number of treatment failures and prolonged exposures to antibiotics."

Nancy Mosley, a pediatric nurse practitioner with the Cape Girardeau County Health Department, said her department tries to avoid using antibiotics when possible, but many times it is difficult to persuade parents a prescription isn't always necessary.

Mosley said if a child comes in that is feverish, has a cold and may have a history of recurring problems, they may decide it is a virus and not to give the child anything.

"Sometimes it is a hard decision because the parent generally wants antibiotics," she said.

Russell agrees that it is a problem, and that doctors need to help educate parents that every illness shouldn't be treated with antibiotics.

Both also agree that cost of antibiotics are a factor.

"Cost-effectiveness is always forefront in choosing antibiotics," Mosley said. "You have to ask is a parent going to be able to get this if you prescribe it? I assume a lot of physicians consider that also. Just because a person has insurance does not mean it covers medicine."

Jim Tilghman of the Medical Arts Pharmacy said the reason newer antibiotics are more expensive is because they are still under patent, which gives a company a 17-year exclusive right. Once it is off patent, as the older antibiotics are, other companies can make it and cheaper, generic equivalents are available.

He noted that a 10-day course of Amoxicillin runs $10 to $12. But a newer antibiotic that is patented could cost $80 to $90 for the same treatment.

"New antibiotics are coming down all the time that are still under patent," Tilghman said. "About 10 percent of new drugs on the market are in the antibiotic field. That is a very lucrative field for manufacturers because over the years some become less effective so they try hard to develop new ones."

Russell said the problem isn't related to age, except that children and pediatric patients are more likely to have bacterial infections.

Russell explained that if an organism can be cultured, doctors can tell whether an antibiotic will work.

"But if the infection is someplace where we cannot culture it, we are kind of on a best-guess basis," he said.

In most cases, they have an idea what caused the infections and have a list of antibiotics that generally work. But if there is a treatment failure, it means another trip to the doctor and another round of medication, which is generally more expensive.

"The pendulum has swung back and forth," Russell said. "As antibiotics became more widely available and cheaper, they were used more.

"It is becoming harder and harder to come up with antibiotics that are effective against a wide range of organisms, because of developing patterns of resistance."