Saving Patients With Infectious Diseases

Today's health care providers frequently encounter patients who say they are not helped by certain antibiotics. “I can't take that amoxicillin, doc, I'm immune to it.” Or we encounter patients who are fearful of vaccines. “I don't want any immunizations. They're like poison and we don't know what might happen years from now because of that shot.” Of course, some of us know that, aside from immunizations being extremely safe, there are a few things that might happen even as soon as this year if patients are not vaccinated. Yet that very same patient who says he does not want any immunizations may say later in the course of his visit (likely just as he is walking out the door), “I'd like that shot for the Zika virus” (or Ebola, or anthrax, or the disease most recently in the news). “Do you have that one?”

The diagnosis, treatment, and prevention of infectious diseases are the bread and butter of many physician practices. In the hospital, the proper diagnosis and treatment of infection is often the difference between life and death. In both settings, though, we are coming to a point where the harm we do by prescribing antibiotics can—or maybe already does—outweigh the benefits. This is certainly true when antibiotics are prescribed for viral illness in the office or emergency department. It is just as true when a broad-spectrum antibiotic is started in the hospital while we wait for a culture result but then we fail to stop the antibiotic when the culture is negative.

This issue of the NCMJ is not just about our patterns of use of antibiotics, although almost every article argues that a diagnosis ought to guide treatment so that we can reduce the number of patients who become “immune to amoxicillin” — or more accurately, to reduce the likelihood that Streptococcus pneumoniae or Clostridium difficile will become resistant to that antibiotic. Taking a broad look at infectious diseases, this issue of the journal reintroduces us to some familiar and unfamiliar microbial “friends” and tells us how they have been doing since our residencies, fellowships, and continuing education classes. We should be on the lookout for diseases that were previously considered uncommon. We should be alert to diseases that may come our way via foreign travel. We should also be aware that some diseases that previously could not be treated can now be treated well.

We are not just treating infections. We are saving lives and even preventing cancer. We are also stewards of remarkable drugs that will become unremarkable if our stewardship lapses. Of course, we do miss some diagnoses. We do not recognize those diseases we never thought to see in our lifetimes.

Let's diagnose and treat better than we ever have. Lives depend on us.

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