LETTERS: ANTIBIOTICS OVERUSED

To the editor:

There was discussion in the newspaper concerning funds that were misspent by Dr. Coleen Kivlahan, director of the Missouri Department of Health. Given the amount of funds and the total lack of explanation, most -- if not all -- managers in private enterprise would have been fired immediately.

Interestingly, Kivlahan not only has received no reprimand but is still in her job. Actually nothing has been done to reflect on her mismanagement. This represents a total dereliction of duty on the part of Gov. Mel Carnahan. While everyone makes mistakes, mistakes of this magnitude should not be tolerated nor permitted.

To allow Kivlahan to continue with her obvious incompetence in management is inexcusable and intolerable. I am totally mystified why Governor Carnahan tolerates such poor performance from his appointees. If he expects those of us in the health-care profession to respect him and his appointments, then he must demand a high level of performance from those same appointees. Yes, we all make mistakes. But some mistakes simply cannot be overlooked.

GERALD L. NICHOLSON

Cape Girardeau

To the editor:

Is the development of new, more powerful antibiotics the solution to the serious problem of antibiotic-resistant bacterial germs? Your recently published article on this topic overlooked another simpler measure to which most of us can personally contribute. That measure is to avoid misuse of currently available antibiotics. Numerous medical studies have shown that antibiotics (such as penicillin) are prescribed in tremendous amounts in doctors' offices, clinics and hospital emergency rooms in our country. Many of these prescriptions are inappropriate and even harmful.

This is the time of year for colds (upper respiratory infections). These illnesses, although they make us feel very bad, are not severe and will usually be overcome by our body's own immune system in a few days. Such infections are usually caused by viruses. Science shows us that antibiotics can kill various types of bacteria but do not kill viruses and thus are of no real help in getting over colds. Disappointing, perhaps, but these are the facts. Yet in a society always looking for fast solutions to problems, what we want is to feel instantaneously better. No one wants to feel bad, and we need to get on with our busy lives. Anything for a quick cure.

Thus many patients, thinking they might get better faster, will request that their doctors prescribe an antibiotic for their cold. And, wishing to please although knowing better scientifically, the doctor often agrees. Not surprisingly, two to three days after starting penicillin (or whatever antibiotic was used), the cold sufferer feels better. What this individual doesn't realize is that he or she would have felt better in two to three days without penicillin. It didn't really help the natural healing process. Nonetheless, the patient feels that he or she has benefited from the antibiotic, and so this antibiotic-seeking behavior is psychologically reinforced for the next cold to come along. And on and on it goes.

Meanwhile, in addition to the risk of unpleasant side effect or allergic reaction to the antibiotic (quite common), this inappropriate use of medication has given the bacteria we all normally carry in the back of our noses and throats "exposure time." This helps them, so to speak, work out ways to deactivate the antibiotic to which they are exposed and other drugs with similar chemical structures. Given multiplied thousands of antibiotic exposures year after year in this country, bacteria once susceptible to drugs such as penicillin begin to emerge as supergerms. Then when truly serious infections caused by these bacteria come along, they become harder and harder to treat. In essence, we have unwittingly engineered the bacteria to be very hard to kill. If we would reduce the number of inappropriate uses of antibiotics, their killing potency would be better preserved.

So the next time you've just gotten those mild-sore-throat, achy, runny-nose, congested (commonly referred to as "sinus"), little-bit-of-cough, no-fever feelings, if you go to a doctor, you might consider asking him or her: Is this just a virus cold? Do I really need an antibiotic? Aren't the odds great that I'll get better on my own in a few days without an antibiotic? You'll be doing yourself and all of us a favor. The favor costs nothing, and the development of a new superpotency antibiotic is a very expensive and time-consuming process. Besides, new drugs developed will also ultimately become useless if current patterns of antibiotic misuse continues.

DR. JAMES L. FLETCHER JR.

Cape Girardeau