We will be publishing the Greatest Hits of our three years of “Six Things” postings throughout December, starting with this new one.
The only way your employees can easily access information like this is via Quizzify. If you learn something from these Six Things postings, wouldn’t they? Contact us now.
Antibiotics are America’s most overused prescription non-opioid. Here’s what your employees should know about them. [SPOILER ALERT: They don’t.]
(1) Do not demand an antibiotic if one is not offered
Americans get enough antibiotics without asking for more. Official statistics show that half of all antibiotics are the wrong dose, wrong duration, or wrong drug – including a quarter that should not have been prescribed at all.
My personal tally is probably 75% wrong, in one way or another, as in this harrowing example, one of the highlights of which is a dentist asking me; “So, what’s your favorite antibiotic?”
There is nothing, nothing in Quizzify, that suggests the correct way to prescribe an antibiotic is to ask your patient what their “favorite” is. Quite the opposite, taking the same antibiotic multiple times is a good way to create antibiotic resistance.
Alexander Fleming himself predicted the rise of antibiotic resistance by using the same antibiotic repeatedly.
(2) Some specialties are worse offenders than others
Pediatricians often immediately prescribe these for earaches, when the best evidence clearly says this choice should be far from automatic.
Urgent care is the worst, with almost 50% overuse for respiratory issues. ERs, for all their faults in the billing department, seem to be much more responsible in this respect, with “only” 25% inappropriate.
Dentists, with Exhibit A being my former one as noted above, are major overprescribers. With a few exceptions, of course.
And if a telemedicine doctor prescribes one, consider this: how can they possibly be sure you have a bacterial infection? There’s no in-person exam and no culture. You guessed it – they are also major overprescribers.
(3) If an antibiotic is proposed, ask some questions
“Are you sure this is a bacterial infection?” is the best. If you get an answer like: “This is just to be safe,” or something similar, your best bet may be to get the prescription, but maybe only fill it once the culture is completed and is positive for bacteria. Or maybe whatever you have will go away on its own. Or ask (and call back if needed) what new symptoms might lead the doctor to think this is bacterial, and start taking the antibiotic then.
There is also a decent chance that whatever antibiotic the doctor guesses at before the culture is completed is the wrong one. Or is an overly powerful “broad spectrum” antibiotic when the culture reveals a specific organism that should be targeted.
(4) “Finish your entire course even if you are feeling better” is an urban legend
The one thing drilled into us when we are prescribed an antibiotic is that stopping early gives the hardier bacteria a chance to rebound.
Turns out that is false. (This is new data and we ourselves had to revise our quiz answers recently.)
There is zero evidence – zero – that you should take every single pill. Instead of being based on evidence, prescription durations are usually based on either the number of days in a week or the number of fingers on our hands. Have you ever received an antibiotic prescription for 6,8,9,11,12, or 13 days?
If your infection is perfectly obviously gone in a few days, ask your doctor if you can discontinue early. This is especially the case among the most common things for which antibiotics are prescribed: UTIs, sinusitis, earaches, and bronchitis. (The latter three may not have needed them in the first place.)
And yet you are told to keep taking meds until the bottle is empty, even though…
(5) …Taking more antibiotics than you need can harm you!
It’s not just that those extra days are worthless. They have a specific downside.
The bacteria (and fungi and other microbes) that call your body home number in the tens of trillions. They comprise about four pounds of your body’s weight. Most live in your intestines, helping with fiber digestion and other chores you never think twice about.
If you assault this “gut microbiome” with 4 antibiotics a day longer than necessary, you could kill off the “good” bacteria colonizing your gut, and allow the “bad” bacteria, which are normally kept in check by the good guys, to flourish.
Symptoms might be as obvious and immediate as bloating or diarrhea but could be much worse. As this 2019 study says:
The disruption of gut microbiota in neonates and adults contributes to numerous diseases, including diabetes, obesity, inflammatory bowel disease, asthma, rheumatoid arthritis, depression, autism, and superinfection in critically ill patients.
If you read that study, you’ll never want to take an antibiotic again, though swearing off antibiotics altogether isn’t the right answer either. As I used to say when I taught economics: “In economics as in many other aspects of life, the answer is rarely all or nothing.”
Clearly, though, you should teach employees to be more cautious about their use of antibiotics. And a good first step is #6.
(6) Take probiotics with your antibiotics
Probiotics are the collective name for the microbes, referenced above, that inhabit your gut. You want to replace the ones you kill off by mistake with antibiotics.
That broad-brush advice needs some nuance.
First, you should space out taking your probiotics at opposite intervals from your antibiotics. Like two hours apart. Otherwise, the pro- and the anti- will cancel each other out.
Second, more than 500 identified “good” microbes inhabit your gut. No probiotic supplement is likely to contain all of them. Since probiotic supplements are one of the world’s great bargains – less than a dime a pill – we would recommend buying a few different supplements and alternating them. (There are also no FDA standards for labeling which probiotics they contain, which doesn’t help.)
Keep in mind, we here at Quizzify generally have very little good to say about nutritional supplements. So if we “endorse” a supplement, even for a limited use like this, you know it’s cleared a very high hurdle.
In addition to supplements while taking antibiotics, don’t overlook them in everyday life. Whether or not you are taking antibiotics, yogurt can be a probiotic “superfood.” We say “can be” because these are not the brands you recognize from your childhood (except Dannon, which makes Activia), which are generally not “active culture.” And are also full of sugar, with Yoplait being an extreme example.
Rather, the obscure ones with unpronounceable names, sometimes from countries most people couldn’t find on a map (we could, but that’s because we run a trivia company) labeled as “Active Culture.” Even then, as with supplements, mix ‘em up. Not every culture contains every beneficial microbe, by a longshot.
In addition to replacing your probiotics, you should “feed” them with “prebiotics.” If you guessed that a healthy diet is the best way to do that, you guessed right. Specific sources of prebiotics are onions, garlic, oats, apples and others listed here.
Considering all the effort you undertake to possibly avoid the 1-in-1000 chance of a covered employee or dependent being hospitalized for diabetes, wouldn’t it make sense to also help them avoid a few of the 47-million inappropriately prescribed antibiotics?
If you’re still not quite ready to hit that “Contact Us” button, watch our corporate video. Just to set expectations low enough that we can easily exceed them, this is the second-best employee health vendor video ever produced.