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No Z-pack for this cold!

March 25, 2013 / Jeff Tobler / Randy's Blog
0

kleenex

I’m sitting here on the 3rd day of a wicked late winter cold.  Heliene has it too.  I’m hacking, keeping Kleenex stockholders happy, irrigating my aching sinuses regularly, and sipping tea and honey to soothe the scratchy throat the virus brings.  But it’s that cough, mostly dry, sometimes not, but reliably incessant, that leads me to question my better sense and think about antibiotics.  How about a Z-pack?  Couldn’t hurt, right?  If you think so, think again.  The medical news stream just gave us all pause for thought.  More on that later.

After all, I say to myself, the community buzz is that there’s a lot of “walking” pneumonia going around, and while there’s no universal agreement on exactly what that means, one usage applies to a mild form that resembles a bad chest cold, and it’s caused by an antibiotic sensitive germ-Mycoplasma pneumoniae.  Typically this isn’t the curl-up-in-a-ball, dead in bed and short of breath type lung infection that also means shaking chills, tapioca-producing cough and often, hospitalization.  No, it’s just like a chest cold that’s like the recession…it just won’t recover normally!

When contemplating whether to call my buddy and ask for some antibiotics, I ask 5 questions, and recommend you do too:

  1. How really sick am I?  Cold viruses can make you feel lousy, but usually it’s mild achiness, creepy feeling skin, and an absent or low-grade fever.  You have a runny nose and some congestion, along with a scratchy throat.  BUT, you can make it through a day at work, or complete life’s daily chores.
  2. How long have I been sick?  Colds can last a week or more, easily.  Usually they plateau at certain level and just hang out, giving hope the next day will bring improvement.  Most bacterial pneumonias, on the other hand, are progressively downhill.
  3. Is there something else in my current health picture that complicates the picture?  I have hypertension…a holdover from a battle with Cushing’s disease earlier on…. so I take couple of meds.  Some who have known heart or lung disease or diabetes, for example, don’t have as much reserve to cope with viral or bacterial infections, so the calculus is a bit different
  4. Are the day- and night-time cold relievers helping?  Generally I’m pretty confident that if the orange or blue-green “crutches” are helping me get by, I’m more willing to stick it out.
  5. What does a course of antibiotics do to my future chances with an infection?

That last one is increasingly the one we should all ask first.  There are real, and in some cases shockingly important effects antibiotics have on our personal and public health.  One that applies to the cold vs. pneumonia dilemma was widely reported just the other day when the FDA mandated a warning on the label of Azithromycin , the antibiotic in a “Z-Pack”.   Based on a finding of increased risk of sudden cardiac deaths among several hundred thousand courses of a 5 day Z-pack in Tennesseans reported the New England Journal of Medicine last year, they cautioned its use without thinking things through, especially in certain groups of patients.

The problem lies in this drug’s propensity, like many others, including erythromycin, some other antibiotics, several anti-arrhythmics and more, to slow certain electrical impulses within the heart, leading in some cases to heart rhythms that are often fatal.  One in particular, torsade de pointes, is the focus of much angst.
Before you swear off ever taking another Z-pack, let’s put it in perspective.

zith_pkg

The absolute risk of cardiac sudden death attributed to azithromycin in the study was still very, very low.  Across all types of patients, it was about 1 in 12,000, compared to 1 in 30,000 for otherwise matched patients taking amoxicillin (which doesn’t cause arrhythmias), or no antibiotics at all for a similar 5 day window.  But it gets better, and more reassuring for the vast majority of us.  The majority of excess deaths occurred among patients with the highest cardiovascular risk, as defined by already having had an arrhythmia or being treated with rhythm stabilizers, being on other medications that predispose to the same EKG changes as azithromycin, and those with low potassium, magnesium or out of control heart failure.  For low risk patients, like most reading this, the risk plummets to an exceedingly rare 1/111,000.

So while the absolute numbers of catastrophic consequences of everyone’s friend, the Z-pack, are low, why would you take it if you don’t need it?  Add to this the alarming rise in antibiotic-resistant bugs; we should all take pause before calling your doctor’s nurse and asking for the casual call-in.  I do, and am, with this cold.

If it continues beyond a week, or turns for the worse, I’ll go see my doc and let him decide.  If it’s that pesky Mycoplasma, there’s actually a better alternative, and I’ll probably get that one instead.  Remember, there’s a complex matrix of decision-making that should go into every prescription.  If your doctor asks you to wait, but wants to know that you’re getting better, she has done you a favor, not blown you off.  That’s it for now…. back to the tea and honey, a little extra Vitamin C and zinc, and a good night’s sleep so my immune system can win the day!

Photo Credit: vanherdehaage via photopin cc
cold, flu, health, immune

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