Interview with Kevin Kavanagh M.D., Otolaryngologist
TOPIC: Antibiotics
AO/Beck: Hi Dr. Kavanagh. Thanks again for spending a little time with me today.
Kavanagh: Hi. Dr. Beck, thanks for the invitation.
AO/Beck: Today's topic is antibiotics. However, as always, it is important to remind the reader that antibiotics, just like all other prescription medicines, can be very dangerous and should never be taken or dispensed without a prescription from a licensed physician.
Kavanagh: You're entirely correct. Very often people tend to think of antibiotics like aspirin, and that can be a very big mistake. Antibiotics come in all sorts of brand names, chemical names, strengths and doses. It is easy to make a mistake, and as you pointed out, never take an antibiotic or any prescription medicine without first checking with your doctor.
AO/Beck: Can you please discuss the three common categories of germs? By that I mean can you differentiate the three categories (viruses, bacteria and funguses) and please discuss their impact on human health.
Kavanagh: All three categories are unique. Bacterial and viral infections can often mimick one another and they can be difficult for patients and health care providers to differentiate. However, when someone has an ear infection of the middle ear, such as otitis media, most of them are going to be bacterial infections. Viral and fungal infections certainly occur, but they are less common. In the outer ear and the ear canal, all three types of infections occur, and they are all common in that location. A bacterial infection of the outer ear or the ear canal is often called swimmer's ear or acute otitits externa. This is a very painful condition and it usually occurs rapidly, the ear canal swells shut. Treatment consists of having the doctor open the canal and clean it, and then place a wick in the canal with special antibiotic drops to treat the bacterial infection. The bacteria that causes otitis externa is almost always pseudomonas. Unfortunately, pseudomonas is not readily treatable with oral antibiotics in children. Cipro is about the only oral antibiotic that might be effective for this, but then again, Cipro is not recommended for children as it may interfere with processes related to growth.
Viral infections of the outer ear are less common, but you might see these as shingles, and these too, are very painful. They can also be described as hemorrhagic blebs or blisters and they are treated with anti-viral agents. If they're not treated, they can start to involve other nerves, such as the facial nerve, and that would be referred to as Ramsey-Hunt Syndrome.
Regarding fungal infections of the outer ear and the ear canal, these are actually common. By the way, infection means invasion and I'm not sure if that applies to fungal situations, but certainly a reaction or an irritation due to a fungus does indeed occur. The ear canal is a wet, dark, damp place and it harbors fungal growths very well.
Sometimes you'll be able to see the fungus growing, and sometimes it's just a dry, scaling itching, scaly irritation of the ear canal as a chronic itching. Fortunately, these are easily treated locally with lotions and creams most of the time, but there are oral antifungal agents too, if needed.
AO/Beck: So basically, bacterial and viral infections can look and behave similarly?
Kavanagh: Yes, those two can look identical in some respects, but again, most external and middle ear infections are going to be bacterial. A reaction to a fungus is usually more chronic, and a reaction to a fungus itches more, as opposed to causing acute pain associated with bacterial and viral infection.
AO/Beck: I hate to ask this, but I will.... Do fungal infections (or fungal irritations) have a more odiferous quality to them?
Kavanagh: No they don't.
AO/Beck: What about the appearance of spores? Seems to me I have occasionally seen them in ear canals under otoscopic magnification. They look like little white fuzzy or powdery growths?
Kavanagh: Yes, sometimes you might see spores with certain fungal growths growing on the surface of the skin. They really are just on the surface, and they don't burrow into the skin.
AO/Beck: Dr. Kavanagh, you mentioned Cipro, and of course many people will recognize that as the antibiotic being used to combat anthrax. Can you tell us a little about that drug please?
Kavanagh: Cipro is a very strong antibiotic. However, as we mentioned at the beginning, you wouldn't want to take it for a long period of time without a good reason as it can damage the liver and cause other problems too - particularly in children.
AO/Beck: What about folks who are stocking up on these drugs at home as they are scared about an anthrax invasion?
Kavanagh: Basically that's a bad idea. Cipro and all other prescription drugs are available as needed through the regular pharmaceutical dispensing chains. If they're needed, they're available. Besides, antibiotics can be dangerous if used improperly, if they're out of date, if they're used too long etcetera and antibiotics used inappropriately can do more harm than good. Additionally, if you use a drug like Cipro when you really don't need it, it may not be effective when you do need it, as bacteria tend to build up resistance to drugs that they are exposed to. For example, we know that even common ear infections originating from diplococcus pneumonia, which used to be virtually 100 percent controlled by low level antibiotics, are now reaching 50 percent resistance rate to antibiotics and this is primarily due to the overuse of antibiotics. So again, we don't want to use antibiotics unless we really need them. Luckily, if you back off on the use of antibiotics, sometimes the germs become less resistant to antibiotics.
Another issue is there are many other drugs that are effective against anthrax. The problem with anthrax is not primarily an issue of treatment, we know how to treat it with safe and effective drugs. The primary problem is timely identification of anthrax exposure.
AO/Beck: What about issues related to the half-life of the antibiotic in your system?
Kavanagh: Some of the powerful antibiotics like Zithromyin have a very long half life and again, with inappropriate use, this becomes a real problem if the drug is around for weeks at a sub-therapeutic level, which again encourages bacterial resistance, and more and more problems. When the bugs develop resistance, it's usually not just to the one antibiotic involved, but may involve whole and even different classes of antibiotics.
AO/Beck: Thank you so much for the explanations and your time today. Dr. Kavanagh, if the readers want to correspond with you, what is the best way for them to contact you?
Kavanagh: On most of these issues, the best person for the reader to contact is their personal doctor. Again, I want to caution everyone that antibiotics are drugs. They are potent and can be dangerous if not used inappropriately. Nonetheless, they can email me at kavanagh@entusa.com. I can't promise I'll be able to answer all of them, but I'll do the best that I can.
AO/Beck: Thanks Dr. Kavanagh.
