Respiratory illness season is in full swing and many states are seeing high levels of influenza, COVID-19, and RSV. The graph below shows the rates of hospitalizations associated with viral respiratory illnesses in the United States.
https://www.cdc.gov/resp-net/dashboard/index.html
While antibiotics are not effective for treating viral illnesses, they are nonetheless still prescribed in many cases. The use of antibiotics and other infection-fighting medications when not indicated have increased the rate of antimicrobial-resistant pathogens. In addition to the threat of antibiotic resistance, the use of antimicrobials increases costs and puts patients at risk of serious side effects.
Antibiotics are used with the intention of killing a particular bacteria. The categories of prescribing include prophylactic, empiric, and therapeutic.
Prophylactic antibiotics are used to prevent an infection. These are commonly used in patients who have a high risk of developing an infection. Examples include patients who are immunocompromised, patients who have been exposed to an illness but haven’t yet developed any symptoms, and patients undergoing a surgical procedure. Prophylactic antibiotics are chosen based upon the bacterial infection the patient is at risk for developing. For example, patients undergoing surgery may receive an antibiotic that targets bacteria present on the skin in an effort to reduce the risk of a surgical site infection.
Empiric antibiotics are used to treat patients who has or is suspected of having a bacterial infection, but the pathogen has not yet been identified. Empiric antibiotics are often started while awaiting results of laboratory testing. Antibiotics are often chosen based upon what type of bacterial infection we believe the patient has.
Therapeutic antibiotics are given when we are treating a specific bacterial illness. In this case, we know what bacteria is causing the symptoms and our antibiotic choice is tailored to that specific bacteria. In some cases, we know quickly, such as when we get results for strep throat or we treat an ear infection with an antibiotic that is effective for the common bacterial causes of ear infections. In other cases, we initially use empiric antibiotics and switch to therapeutic antibiotics once we have test results identifying the organism.
Respiratory illness season often sees unnecessary antibiotic prescriptions. It is important for all members of the healthcare team to keep in mind that using antibiotics for a viral illness will not help our patient improve faster, but will put them at risk for acquiring antibiotic resistant illnesses and serious side effects.