The Antibiotic Reflex

Lost in the numerous daily stories about Ebola is this gem: When Thomas Duncan, the first Ebola patient to enter the U.S. undetected, first presented himself to a hospital in Dallas, he and his fiancée told staff more than once that he had been to Liberia. And even though his presenting symptoms were consistent with Ebola, that disease was never considered. Instead, he was diagnosed with a low-grade viral infection, given a prescription and sent home. Three days later he returned to the hospital in worse shape and was diagnosed with Ebola virus disease. The following week Thomas Duncan died.

Subsequent news stories about Mr. Duncan focused largely on two things: How on Earth did hospital workers not consider Ebola when he first appeared there (his family is understandably angry about this). And did he infect other people during that 3 days before he went back to the hospital and was finally admitted (so far, no).

But let’s back up. That prescription he was sent home with when he first went to the hospital – it was for an antibiotic. Never mind that they fumbled the Ebola ball, they also prescribed an antibiotic because they thought he had a low-grade viral infection. Which is like giving a fishing rod to a deer hunter: antibiotics treat bacterial-based infections only, not viral-based ones – so what were they thinking when they prescribed an antibiotic for a viral problem?

Thomas Duncan had the Ebola virus. But he was sent home from the hospital with an antibiotic.

Here’s the thing. Wrongly prescribing antibiotics happens far too often – about 40% of the time according to the US Centers for Disease Control: when presented with illness, the reflex to both seek and prescribe an antibiotic is common to both patient and doctor.

More often than not when you or your child have an ear ache, a sore throat, or cold, flu, or bronchitis-like symptoms, it is some virus that’s doing it to you. Nevertheless, people reflexively seek, and receive, antibiotics.

The physician reflex to over-prescribe is due to patient pressure, the fear patients will go elsewhere, not wanting to bother with lab tests, fear of being sued in the event that an antibiotic should indeed have been described, and, the big catch-all – even if antibiotics aren’t warranted, at least they’ll do no harm.

The assumption of no harm, however, has proven flat-out wrong. Because when you’re improperly prescribed an antibiotic two things happen: your bugs, not wanting to die, fight back and evolve into “superbugs” that are able to resist antibiotics in the future. So the next time you get a bacterial infection and really do need that prescription it won’t help you. Second, you don’t keep those superbugs to yourself. Instead, you spread them to the people closest to you, like family and friends. And like you – and because of you – should these people eventually need an antibiotic the chance of it not working has now increased.

We don’t know whether or not Mr. Duncan asked for an antibiotic. What we do know is that when he first went to the hospital the world in general and health care workers in particular were on notice (2d para below the Gov. Perry video) that a deadly viral outbreak in West Africa was just one flight away from our doorstep. Despite that, and despite having all the evidence it needed to treat Mr. Duncan as a possible Ebola case, the Dallas hospital antibiotic reflex sprang into action with dire consequences: Thomas Duncan died, his family are mourning, the hospital staff who got it wrong are surely not feeling good about themselves, and the nation is scared.
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