'Get Smart' About Antibiotics

Most people know that antibiotics are used to fight infections. Millions of lives have been saved by their ability to combat bacterial infections.  Many people are unaware, however, that antibiotics are not effective for all types of infections, specifically those due to viruses.  Inappropriate use of antibiotics has led to the new problem of antibiotic resistance. One of the best known examples of antibiotic resistance involves bacteria known as MRSA, which stands for methicillin-resistant Staph aureus. Let's look at when it is appropriate to use antibiotics and learn about the "ugly side" of indiscriminate antibiotic use-----antibiotic resistance.

Antibiotic resistance is the ability of bacteria to resist the effects of drugs.  It is considered to be one of the world's most pressing public health problems. The number of bacteria resistant to antibiotics has increased in the last decade, in large part because of inappropriate antibiotic usage. Every time a person takes antibiotics, sensitive bacteria are killed, but resistant germs may be left to grow and multiply. Drug-resistant bacteria do not respond to more common and less expensive antibiotics, and in some cases may not respond to any antibiotic currently available. This can lead to serious infections that require more powerful (and expensive) antibiotics, hospitalizations, and sometimes surgical procedures. There are also many instances in which resistant bacterial infections have caused deaths. There is the potential for antibiotic resistance to develop anytime an antibiotic is used, so it is important that they be given only when absolutely necessary.

In September, 2003, the Centers for Disease Control (CDC) launched their 'Get Smart' campaign to reduce the incidence of antimicrobial-resistant disease by "knowing when antibiotics work."  Along with the CDC, health care providers and patients also play an important role in improving the appropriateness of antibiotic use.

Recommendations for health care providers:

• Only prescribe antibiotic therapy when likely to be beneficial to the patient
• Use an agent that targets the specific organism responsible for the infection
• Prescribe the antibiotic for the appropriate dose and duration

In a nutshell, this means that doctors should only prescribe antibiotics when a bacterial (rather than viral) infection is suspected, and should chose the antibiotic that is most likely to be effective for the specific bacteria responsible for that infection.  Colds, flu and most cases of sore throat or runny nose do not need antibiotics. They are caused by viruses and in most instances the body is able to combat the infection on its own.

Advice for patients:  The CDC has offered the following recommendations to encourage appropriate antibiotic usage and prevent the development of resistant bacteria.

• Tell your healthcare professional you are concerned about antibiotic resistance.
• Ask your healthcare professional if there are steps you can take to feel better and get symptomatic relief without using antibiotics.
• Take the prescribed antibiotic exactly as your healthcare professional tells you.
• Discard any leftover medication.
• Ask your healthcare professional about vaccines recommended for you and your family to prevent infections that may require an antibiotic.
• Never skip doses or stop taking an antibiotic early unless your healthcare professional tells you to do so.
• Never take an antibiotic for a viral infection like a cold or the flu.
• Never pressure your healthcare professional to prescribe an antibiotic.
• Never save antibiotics for the next time you get sick.
• Never take antibiotics prescribed for someone else.

For more information on appropriate antibiotic use see the "Get Smart" pages on the CDC's website.

If you have any questions about antibiotics, please log into your account and send us your question. We are here to help.

Swollen lymph 'nodes' — When should you be concerned?

Lymph nodes, sometimes referred to as lymph 'glands', are part of the body's lymphatic system.  The lymphatic system consists of a system of conduits and organized collections of lymphoid tissue that include nodes, the tonsils, and the spleen.  Coursing through these channels is liquid called lymph that eventually drains into the bloodstream near the heart, but along the way, it is "filtered" by the lymph nodes. Within these lymph nodes are high concentrations of disease fighting cells, particularly lymphocytes. While performing their intended function of fighting infection, lymph nodes typically become enlarged. In fact, infection is most common reason for lymph nodes enlargement. 

Lymph nodes are found throughout the body, but when enlarged, are usually noticed in characteristic locations, particularly the neck, groin and armpit regions.  Lymph node enlargement can be localized to one group of lymph nodes or can be generalized (involving several sites of lymph nodes).  For example, enlarged lymph nodes localized to the arm pit could occur as a result of a bacterial infection in a hand wound.

Generalized lymph node swelling, on the other hand, could be seen in a systemic illness such as viral mononucleosis.  In addition to viral and bacterial infections, other causes for enlarged lymph nodes include immune disorders (lupus, rheumatoid arthritis, etc.), cancers affecting the lymphatic system (leukemia, lymphoma, Hodgkin's disease), and cancers that have spread (metastasized) from some other part of the body to the lymphatic system.

The discovery of enlarged lymph nodes often causes concern because many people are aware that lymph node enlargement can be an early sign of cancer. Certain features, however, can help to distinguish between those lymph nodes that are enlarged because they are doing their intended job of fighting infection versus those that are enlarged for more ominous reasons.

When infection is responsible for enlarged lymph nodes, symptoms such as sore throat, fever, runny nose, or in the case of a skin infection, redness or swelling are usually present. Another sign that indicates a normal physiologic response is enlargement less than one centimeter (roughly ½ inch).  An even more reassuring sign is the gradual shrinking in size following the infection or inciting event.

The following features of enlarged lymph nodes may be associated with problems other than infection and should be evaluated by a physician:

• The lymph nodes do not get smaller after several weeks or continue to get larger.
• Redness and swelling of the overlying skin develops, suggestive of a secondary infection within the lymph nodes.
• The lymph nodes are hard, irregular, or fixed in place, features suggestive of malignancy.
• Fever, night sweats, or unexplained weight loss accompanies the lymph node enlargement.
• The lymph nodes are larger than 1 centimeter in diameter.
• The nodes are found in certain locations, such as just above the collar bone (supraclavicular lymph nodes). These are sometimes seen with tumors in the areas of the lungs, breasts, neck, or abdomen.

Most often, enlarged lymph nodes are a sign that the body's immune system working as it should.  When enlarged lymph nodes are discovered, they should be carefully monitored to make sure that the enlargement resolves.  If not, a visit to the doctor is warranted.

If you have any questions about lymph nodes, please log into your account and send us your question. We are here to help.

Getting a Good Night's Sleep

We spend approximately one-third of our lives asleep, but sometimes sleep can be elusive.
Almost everyone has experienced transient insomnia--the occasional inability to fall asleep, or waking up feeling unrefreshed. Thankfully, it's usually short-lived, lasting only a few days.
Chronic insomnia, however, lasts much longer. A common condition, it may be brought on by medical or psychiatric causes, such as colds, pain, or depression. But 10 percent of all insomnia occurs in the absence of any medical or psychiatric disorder and is called primary insomnia.

Primary insomnia seems to have a life of its own and often begins after someone has experienced a significant stressful event that may disrupt his or her sleeping pattern. To make up for lost sleep during this stressful period, the individual may develop poor sleep habits that perpetuate the insomnia long after the problem has passed.

Sticking to the following good sleep habits help most
people sleep well:

• Keep a regular schedule. Regular times for getting up, eating meals, taking medicines, doing chores, or other activities help to keep your inner clock running smoothly.
• Establish a relaxing pre-sleep ritual. Activities such as taking a warm bath, reading for ten minutes, or having a light snack let your body know that bedtime is near.
• Go to bed only when sleepy and get out of bed if you're not sleeping. By spending long periods awake in bed, your body learns that it's OK to be awake in bed.
• Exercise regularly. It's best to exercise in the late afternoon about six hours before bedtime.
• Avoid caffeine, alcohol, and smoking around bedtime. In fact, don't drink caffeinated beverages within six hours of bedtime.
• In general, don't nap. If you must, it's best to take naps during the mid-afternoon.

If establishing these habits is either difficult for you or doesn't seem to be working, let your doctor know. Further assessment and treatment may be required.

If you have any questions about sleep issues, please log into your account and send us your question. We are here to help.

Is it a Cold or the Flu?

During this time of the year, many eDoc clients write in to ask if their symptoms are more suggestive of a cold or with the flu.  While both are caused by viruses, influenza or "flu" generally causes more severe manifestations than the common cold.  Flu is characterized by the sudden onset of body aches, fever and respiratory symptoms.  Colds on the other hand are more likely to cause upper respiratory tract symptoms such as runny nose and sore throat.  The following chart should help to clarify the differences between these two illnesses: 

Symptom	Cold	Flu
Fever	Uncommon	Common, may be as high as 102-104 degrees
Headache	Uncommon	Common
Muscle aches	Uncommon	Common, often severe
Fatigue, weakness	Sometimes	Common, may last up to 2 weeks
Cough	Mild to moderate	Moderate to severe
Stuffy nose	Common	Occasionally
Sneezing	Common	Occasionally
Sore Throat	Common	Occasionally

  In most cases, people with either a cold or the flu improve on their own without specific treatment.  Influenza, however, can be a life-threatening illness, particularly in those with chronic illnesses or in the very young or elderly. These individuals should consult their health-care provider should they develop flu-like symptoms. There are three FDA-approved influenza antiviral drugs recommended by Centers for Disease Control (CDC) for use in acute influenza cases:  Relenza (zanamivir), Tamiflu (oseltamivir) and Rapivab (peramivir). These are prescription medications, and a doctor should be consulted before the drugs are used. The method of delivery, dosages, and duration of treatment are different for each of these. As of yet, there are no antiviral medications available for treating the common cold. Treatment is primarily symptomatic with antihistamine/decongestants for the runny nose, analgesic lozenges for sore throat and acetaminophen or ibuprofen for body aches.
 
The single best way to prevent seasonal flu is to receive the influenza vaccine ("flu shot") each year.  No such vaccine against the common cold currently exists.  This is because over 200 different
viruses can be responsible for causing cold symptoms and scientists have yet to develop a vaccine that will protect people against all of them.  The CDC offers the following suggestions to help prevent the spread of respiratory illnesses from either colds or the flu:

1. Avoid close contact with people who are sick. When you are sick, keep your distance from others to protect them from getting sick too.
2. Stay home when you are sick.  This will help prevent spreading your illness to others.
3. Cover your mouth and nose with a tissue when coughing or sneezing. It may prevent those around you from getting sick.
4. Clean your hands. Washing your hands often will help protect you from germs. If soap and water are not available, use an alcohol-based hand rub.
5. Avoid touching your eyes, nose or mouth. Germs are often spread when a person touches something that is contaminated with germs and then touches his or her eyes, nose, or mouth.
6. Practice other good health habits.  Clean and disinfect frequently touched surfaces at home, work or school, especially when someone is ill. Get plenty of sleep, be physically active, manage your stress, drink plenty of fluids, and eat nutritious food.

Sources for article:
Flu Symptoms & Complications from the Centers for Disease Control and Prevention
Common Colds: Protect Yourself and Others from the Centers for Disease Control and Prevention
Preventing the Flu: Good Health Habits Can Help Stop Germs from the Centers for Disease Control and Prevention

If you have any questions about colds or flu, please log into your account and send us your question. We are here to help.