Podcast 14 - Antibiotics for Upper Respiratory Tract Infections?

Antibiotic Use for Upper Respiratory Infection


Chad: This is Dr. Chad Edwards and you’re listening to Podcast 14 of Against The Grain Podcast. Are you tired and fatigued? Are you frustrated with doctors because the just don’t listen? Do you want to fix your pain without surgery? If you answered yes to any of these questions then we are the clinic for you. We offer TulsaProlotherapy P.R.P. and Stem cell, I.V. nutritional therapies, bioidentical hormone replacement therapies and functional medicine to get you back on track to more optimal health. Call us 9-1-8-9-3-5-3-6-3-6 or visit our website at www.revolutionhealth.org to schedule your appointment today.


Male: Welcome to Against The Grain podcast with Dr. Chad Edwards, where he challenges the status quo when it comes to medicine. We get into hot topics in the medical field with real stories from real patients to help you on your way to a healthy lifestyle. Get ready because we’re about to go Against The Grain.


Chad: Welcome back, this is Dr. Chad Edward back for another podcast. We are once again without Bryan Wilks but we’re going to be okay, because we’ve got the wonderful, beautiful, talented and amazing Miss Courtney.


Courtney: What’s up?


Chad: Thank you for so much for coming back. It’s always good because one, nobody wants to hear me just ramble on, and two, you bring so much to the table. That’s right, we’re going to have fun. We’re going to talk about a topic that’s near and dear to my heart-


Courtney: Chad, if there if there’s any topic out there that this could be a really long podcast or it’s this one right here. Marshall knows it.


Chad: Exactly it’s one of these things that just gets under my skin, and the reason it gets under my skin is because patients will come in and they’ll think, “I have this problem. I need this solution,” it’s just been perpetuated.


Courtney: They see even the medical school themselves.


Chad: Exactly, and the sad thing is they don’t know better than some of the doctors.


Courtney: They don’t mean anything by it, they just go and buy what they’ve always gotten.


Chad: Exactly, and we just perpetuate this habit based on absolutely no foundation. There’s a story that Zig Ziglar tells and Dave Ramsey tells it in his Financial Peace University. It’s about this guy that brings home he won this ham. This prized ham. He brings it home and he gives it to his wife to cook the ham, and the first thing the wife does is cut the end off the ham. He’s like, “What are you doing? You’re cutting off the end of my priced ham,” and he was like, “Why are you doing that? You’re wasting part of it.” She was like, “Well, that’s what my mom taught me and that’s the way she taught me to do it.” He said, “Why?” and she said, “I don’t know, let’s call mom.”


They get mom on the phone and they’d say, “Well, I’m making this ham and they cut the end off of it and why’d you do that?” and she was like, “I don’t know, my mom taught me and that’s right that’s the way she always did it.”


Courtney: The way it’s always been.


Chad: They get grandma on the phone and they said, “Grandma, we’re making this ham and they cut the end off of it, why do we cut the end of it?” She said, “I don’t know why you’re doing it but my pen was too small.”


These things just get perpetuated over and over and over again because that’s what you do. As physicians, as medical practitioners, we’re supposed to do — it is truly an art based on science. We’re supposed to take the scientific data and apply it to each patient. What we’re talking about today is antibiotics in the setting of an acute upper respiratory tract infection, including sinuses and bronchitis and coughs, and all of these kinds of things. How often do you see patients and they’re like, “I’ve got a sinus infection I need antibiotic?”


Courtney: They’ll tell what antibiotic they want. Sometimes they’re more polite than others and they’ll wait until they see what you say and then they’ll bring it up. A good half the time they’re just like, “Hey, I think I’m pretty sure I got a sinus infection and I need a Z. pack.” It never fails like all the time, so you’re a 100% right about that.


Chad: Obviously, one of the points in this podcast, we’re trying to dispel some of the myths that are out there right. In this case, “I’ve got a sinus infection, an upper respiratory, a cough, bronchitis, fill in the blanks and I need my antibiotic.” I hear it all the time and so here we’re going to talk about some of the scientific evidence about the use of antibiotics. The thing is at revolution with the way we practice medicine, we have to weigh the risks of an intervention versus the benefits. The first dictum of medicine is, “First, do no harm.”


There’s always a chance that we can screw somebody up and we’ll have a hip a compliant story here in just a little bit, about a recent patient that took antibiotics that had a pretty nasty outcome.


Courtney: I think I know exactly what you are talking about.


Dr. Edward: Exactly. We do these things and we think, “What’s the harm?” You work Urgent Care, you see a lot of patients in acute care setting. I’ve done a lot of emergency room work in the past and we get these patients that come in and sometimes they’ll browbeat us, and make it rough on us and say, “I’ve got to have this,” and if we don’t give it to them then they leave dissatisfied.


Courtney: Which in turn comes back because you once said it’s people go tell their friends, “This is where you need to go.”


Chad: Right, exactly. Unfortunately it would be like somebody coming in and saying, “I heard I need my Percocet,” and we’re just like, “Okay, here you go.” There’s harm to this, there’s potential harm to this stuff. Let’s get into —


Courtney: Give us the stats, what’s the stats on upper respiratory infections and antibiotic use?


Chad: First of all, upper respiratory infections represents one of the most if not the most common reasons that an acute illness patient would go into an outpatient setting. Their primary care physician, their urgent care, the ER, those kinds of things. One of the most common reasons that they will be seen. In the Journal of the American Medical Association in 2009, they published a paper that showed that antibiotic prescription rates for acute respiratory tract infections were actually decreasing, but the interesting thing is overall prescriptions were decreasing. It’s important understand exactly what that means.


Old school, we look back over history and one of the first two antibiotics were sulfur based antibiotics and penicillin. Nowadays for strep infection for example, standard plain old pin V.K, plain old penicillin still works for strep pharyngitis.


Courtney: For those of us that are not that smart.


Chad: For strep throat, so that’s a very targeted antibiotic for a specific bacteria. When we intervene with antibiotics, that should be our focus. You have bug A and you want an antibiotic ideally that will target bug A and not affect anything else.


Courtney: You want it to be as specific as possible.


Chad: Exactly, and what we’re seeing, what this article from JAMA 2009 was showing, was that while the number of overall antibiotic infections were declining there was actually an increase in the prescriptions for azithromycin and Quinolone. Azithromycin is that ZPack that you mentioned and so many of our patients were coming, “I need a ZPack. It’s like I sneezed I need a ZPack.”


Courtney: I think is where you’re going, if you look at the ideal antibiotics for an upper respiratory infection it’s not azithromycin unless you got some allergies and then that is one option. Truly for the average population that doesn’t have any allergies to any of the antibiotics. That’s not really the choice. It’s not the best choice.


Chad: Absolutely, we want to be very focused and specific there are actually guidelines for that stuff. Azithromycin is not number one. It’s a great antibiotic. As we’ll get into it there’s risks associated with this stuff. Then the Quinolones is a class of prescription antibiotics, I know you know this I’m looking at you like you don’t know. For our listeners —


Courtney: What’s a Quinolone?


Chad: The Quinolone antibiotics are things like Cipro, and Gardifloxaxin, Moxifloxacin, and these different Quinolones. Levaquin is a very common one and we’ll use that for pneumonia and sinus infections and things like that. Again, all of these antibiotics have potential complications and some of them are profound and severe.


Courtney: We’ve established, number one, if we’re going to use antibiotics we need to target that bacteria specifically. I know you well and you hate antibiotics, so why no antibiotics?


Chad: To be clear, I don’t hate antibiotics —


Courtney: For this, I should clarify that for upper respiratory infections, for simple things that we could probably do without.


Chad: First of all, how many of these things actually require intervention? How many patients are not going to get better unless we intervene? It’s really a very small percentage. I’m not telling every patient that’s listening or every listener that, “Don’t ever get an antibiotic for anything,” for sure and but again we have to weigh the risks and benefits of things. I’ll tell the story. I had a patient that was playing in the ocean and broke her toe. No big deal, but broke her toe. It hurt. She got pain medication for her toe, and she went back to her physician, who’s actually a friend of mine. she went back to her physician a week or 10 days later and she was like, “It’s still hurting. I need more pain meds.”


This very wise physician was not me, but this very wise physician, this was actually one of my residency staff, one of my mentors. He said, “You’ve had enough pain medication. Your toe hurts because you broke it. Maybe you should stop doing all the things that you do and just let it heal. Not stay completely off your feet but don’t get up and do everything like you used to do. It hurts for a reason. Let it heal.” When we’re talking about these acute respiratory infections, maybe we should just let it run its course, unless the risks of not doing anything are so high that we need to intervene.


The reality is that most of the time, we don’t need to do that. Why not treat these things with antibiotics? Well, the first thing is that currently we are prescribing antibiotics, 41% of cases of viral pharyngitis are treated with antibiotics.


Courtney: You’re telling me that if I have any type of pharyngitis, if it’s viral, it’s not bacterial, an antibiotic is not going to take care of that.


Chad: That’s absolutely correct. Not to get too geeked out on this but — don’t you always love that?


Courtney: But here we go.


Chad: It’s important to understand the distinction between a virus and a bacteria. Virus is actually it’s a non-living thing that is DNA or RNA. Like the flu, or HIV or any number of Norwalk viruses, fill in the blanks. They all have different characteristics but basically they are genetic material that gets plugged into the cell, and it alters the function of that cell. Not a living thing, it’s genetic material, plugs into the host cell, and then there’s a different effect. When you’re talking about a bacteria, it is a different living structure. Their cell structure is different than human cell structures, and the antibiotics that we take often when you’re talking about Penicillins and Cephalosporins, they are cell wall inhibitors.


When we talk about Penicillin, Augmentin, things like that, they are cell wall inhibitors. They inhibit the synthesis of your creation of that cell wall. When these dividing cells, they can’t create a new cell wall so they fall apart.


Courtney: The antibiotic, if it’s a bacteria, is stopping the bacteria from reproducing basically in its tracks.


Chad: Yes. They work by different mechanisms but that’s the general concept.


Courtney: General concept.


Chad: Yes. Then when you get something like a macrolide, which is the azithromycin or the ZPack is a macrolide antibiotic, and they work by a different mechanism, and it interferes with protein synthesis in the bacterial cells. There’s different classes of antibiotics, they all work by different mechanisms. Some inhibit 30S ribosomes and some inhibit 50S ribosomes. These Quinolones are DNA gyrase inhibitors, and there’s all these different mechanisms but none of those mechanisms are viral. None of those things target a virus. Now, you have a viral infection, sinus infection, runny nose, pharyngitis, bronchitis, anything like that. They call it the flu, and you come in and say, “I need a ZPack for the flu.”


Well, it doesn’t work that way at all. It’s trying to put a square peg through a round hole, it just doesn’t work that way. When you come in feeling bad and you want an antibiotic, we’re often not treating a bacterial infection. Many, many times these are viral infections.


Courtney: How do you know if it’s a virus or a bacterial infection?


Chad: Well, a lot of the times we don’t but that goes back to, do you need to treat this at all, viral or bacterial? I would argue that many times we don’t. Now, obviously you have to weigh each patient, is this a life-threatening illness, is this a severe infection, is this something that really we need to intervene on? If it’s been going on just a couple of days, short period of time, even if there’s a fever.


Courtney: Most people’s bodies are designed and are capable of really clearing that on their own.


Chad: That’s exactly right. We just don’t need to prescribe antibiotics for this. Then you get the patient that’s like, “Well, I’ve got green phlegm.”


Courtney: Yes, yes.


Chad: Okay, then it’s an infection.


Courtney: Right.


Chad: They actually did a study. They done studies, 60% of the time it works, every time. They’ve done a study and they were evaluating reported sputum color. You got a cough, you hack up a loogie and it’s green. Is that the presence of a bacteria? In this study which was in clinical microbiology infection, something in 2010, they showed that the reported sputum color was not reliable at all for the presence of bacteria. That was actually done in COPD patients but —


Courtney: Geez, even more pronounced in my opinion because if you look at a lot of the algorithms that we’re given in traditional medicine, the person’s got chronic lung problems. They almost give you no choice, just cover them with an antibiotic. You could always do a sputum culture and prove it, and really within a couple of days you can get back at least a preliminary report.


Chad: Many times for many patients, obviously there’s — for the listeners, don’t misconstrue what I’m saying as medical advice as to whether or not you should or should not get an antibiotic for any specific condition. Because I can’t say that unless you’re an established patient, and we’ve done a physical exam and all of those kind of things.


Courtney: Sure.


Chad: I just want to be careful about how I’m saying that. There’s risks to this stuff, to antibiotics and we’ll get a little bit more into that. The question is, are you going to get better if we don’t do anything? The reality is, and this was reported in the American Academy of Allergy Asthma and Immunology, so dealing with a lot of these upper respiratory things. They stated that 60% to 70% of patients with sinus infections recover without antibiotics. The vast majority, up to 70% of the time, you don’t need antibiotics.


Courtney: That’s probably even a little bit skewed. I’m not sure how they did that study, but standard of practice unfortunately is almost always sinus infection, especially if it’s been longer than four, five days, throw an antibiotic on board. I’m not sure, I haven’t read that specific article, but I wouldn’t doubt one bit that even that is a little bit skewed for what we can really do if you really took 100 people with sinus infections, and managed them with over-the-counter therapy and avoid the antibiotic, what could happen?


Chad: Sure. A lot of times, I view the sinuses, because the sinuses are these air-filled cavities in our facial bones. Basically, you’ve got this little itty bitty hole called an ostia, that’s lined with a mucus membrane. Part of the nose and the airway and all that stuff, that gets plugged off because of congestion and swelling and edema and those kinds of things. Then you have this basically this walled off dark moist warm area, it’s prime for some kind of bacterial or fungal growth in those settings. I view that like an abscess.


An abscess is this collection of bacteria and inflammatory things and dead debris in the skin or down deep that just gets walled off. The treatment especially like a cutaneous or an abscess on the skin, the ideal treatment for that is you open it. You cut that bad boy open, let it drain, pack it, those kinds of things. Many of those patients don’t necessarily need an antibiotic.


Courtney: Are you telling us that we should cut our sinuses open?


Chad: No.


Courtney: [laughs]


Chad: No, I’m not.


Courtney: How do we clean out our sinuses?


Chad: That’s a great question. You definitely want to open those things up so that they’re not walled off and they get air exchange and all that stuff., There are things that you can do like Afrin or Oxymetazoline. You got to be careful with that one because you can only use it for three days


Courtney: Three days.


Chad: It’s my standard. It helps decongest, it helps open things up. Then things like sinus rinse or saline irrigation.


Courtney: Tons of good products out there for that.


Chad: There are several things that you can do, and then lots of immune support that you can do just to support the innate immune system. Open up those sinuses where you can breathe, number one, symptom control makes you feel better.


Courtney: Absolutely.


Chad: Number two, it can help prevent some of the secondary infections and some of — If you have a viral infection and it causes all these symptoms and congestions, things like that then it can lead to a secondary infection. Which again is further reiterating, sometimes you do need it but we just don’t need to reflexively give antibiotics to everything that has —


Courtney: I totally agree. Whenever I was in grad school I did a rotation with ENT, and one of the most common problems especially in Oklahoma with our weather and the humidity in such a high mold that we have here, is that actually finding that in chronic sinus infections we’ve got in Oklahoma most patients have some sort of mold or fungal infection growing in their sinuses which most antibiotics aren’t going to really target or take care of it anyways.


Chad: That’s right, that’s exactly right. Not to interrupt the party but let’s go ahead and pay a bill real quick, and then we’ll come back and we will talk about why you shouldn’t take antibiotics in some cases and the harm that they can cause.


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Chad: Courtney we’re back and we’re going to talk about why antibiotic could be harmful.


Courtney: Yes, you tell us why should we not be using them?


Chad: Well, there’s a lot of potential harms that can come with antibiotics, and number one is, bacteria or what I heard in my microbiology courses is that the bugs have the numbers on us. What that means is there are mutations — like bacterial resistance is where I’m getting into. It’s almost a natural selection process where we give an antibiotic for say a sinus infection. You take a bunch of bacteria. put them in a petri dish and there are some that are going to be very resistant or very susceptible to in antibiotic. Then you’ll get some that are only susceptible, and there’s whole range.


If we give the antibiotic and it kills all the ones that are really susceptible but we leave the ones that are the only kind of susceptible and we don’t completely kill all of them, which I would argue is most of the time. Your immune system will generally clean up the rest. It leaves these guys that were able to survive behind and then they’re the ones that are going to grow. Next time we get that same antibiotic and they’re a little bit stronger against that antibiotic. There are these capsids and they’re these different resistance genes that certain bacteria will adopt. We’ve seen over time with some of these resistance markers that have just been absolutely phenomenal in how they will adapt and develop resistance.


When Vancomycin first came out, it’s one of the heavy hitter antibiotics against gram-positive right, it’s given IV unless you have C. Diff or Clostridium difficile and you can give it orally for that. It’s one of these big guns that when this antibiotic first came out they said that the mechanism in order to develop resistance for Vancomycin is so lengthy that it will most certainly never occur. Well, now we have Vancomycin resistant enterococcus. We have other super bacteria that have resistance against all kinds of antibiotics, and we hear about Mercer and MRSA Methicillin-Resistant Staph Aureus, which is a problem and it can be a severe problem.


One of my fears and the CDC says this and it’s a big potential problem that we are in a position where we are developing the superbugs for which we have no treatment. There are patients that get these and about these are bacteria that because of repeated use of antibiotics, one in an individual when they’re treated with antibiotic’s multiple, multiple, multiple times, plus consider the antibiotics that we get in our food sources and what they feed our animals and all of these kinds of things, that just lead to the resistance of all of these bacteria. It’s a real and profound problem. I’ll just read this, “Effective antibiotic prescribing and primary care on antimicrobial resistance in individual patients systematic review and meta-analysis.” Their statement in this study, this was systematic review and meta-analysis, kind of a looking at all of the literature.


What they said was, “Individuals prescribed in antibiotics and primary care for a respiratory or urinary tract infection develop bacterial resistance to that antibiotic.” It says that they do this. This effect not only increases the population, the carriage of organisms resistant to first-line antibiotics but it also creates the conditions for increased use of second-line antibiotics in the community. We’re giving, one, the first line antibiotics and they develop resistance to it. Then we have to give the second line of antibiotics. Well, it would make sense that if were giving the second line of antibiotics in the develop resistance the first line, what’s going to can happen? We’re going to breed resistance the second line.


Courtney: Especially with all this repetitive use of EC all the time.


Chad: Absolutely, and we reflexively give these bigger and bigger guns. If you go back up you know earlier when we talked about that, we’ve been decreasing our use of antibiotics in general but were increasing the use of these broad-spectrum antibiotics. These second and third hitters for these bacteria and those are almost becoming our first line, well now where is our second line, where is our third line, where is the big guns now? Because we’re developing resistance to all these things.


Courtney: Right, and the medical community, in pharmaceuticals were not ready for that.


Chad: That’s right.


Courtney: We don’t know, we don’t know what’s going to be needed to fight some of those superbugs that are coming up. I think I read it somewhere in the CDC and they were talking about I think just exactly what you’re saying. Just that if we don’t stop this pattern of repetitive use, in five years we’re going to be in big trouble five,10, 20, we’re going to be in big trouble. I almost equated just like 30, 40 years ago we all needed to get vaccinated for certain big bugs, right? Now, it’s almost the same thing but we need to do the opposite, we need to stop taking antibiotics unless we absolutely have to take them or it’s life-threatening kind of situation.


Chad: That’s right. Talking about this resistance thing, we have to look at you know the greater good, and almost I hate to say that because it sounds like some communist thing or something.


Courtney: It’s true, if you recycle you shouldn’t be using in antibiotic all the time.


Chad: [laughs] That’s a great point. Keep planting trees going to the doctor and getting antibiotics. That’s what you’re saying, right?




Courtney: It’s okay, I’m not telling you that you shouldn’t go the doctor. We’re in business for this.




Get evaluated but don’t always go to the doctor and jump the gun to say, “I’ve got a sinus infection, I need an antibiotic.”


Chad: I would say that the average person, I don’t know, I don’t want to speak for them. I think there’s a lot of people out there that I’m not going to say that I’m not guilty of this. That I’m like, “That’s the greater good, I care about me.” I feel bad, I need treatment now. I understandably everybody else needs to quit using ZPacks, but by golly sick I’ll get it.


Courtney: This is intense; I bet you if we didn’t say men would be worse.


Chad: Yes, probably.


Courtney: Men will tough it out. They’re taking care of everybody else that’s sick in their house, they’re the last ones to go.


Chad: There’s a reason God didn’t men carry babies and deliver them.


Courtney: This is so true.


Chad: A lot of people may be kind of thinking about, “Okay, that’s the greater good thing but what about when I get really sick I need something.” But the reality is that antibiotics can be very harmful, can be very harmful.


Courtney: What are the big side effects or adverse effects I should say?


Chad: We’re talking about antibiotics in general, now we can have another podcast really for each category available of antibiotics. Because some of this especially Azithromycin, there are some serious potential heart issues associated with that. This is mainstream medical stuff, it’s just it doesn’t that happen in every patient, so we tend to dismiss that and ignore that. Antibiotics account for 20% of all drug-related emergency room visits in the United States.


Courtney: That’s a lot.


Chad: How many ER visits are there in the United States? I was in a relatively small ER in Tennessee and we had 45,000 visits a year and that one ER 45,000. 20% of that —


Courtney: Well, 20% of the drug-related.


Chad: Yes, that’s a good point.


Courtney: It’s a small number but still if you consider you’ve got people coming in for overdose of drugs, trying to commit suicide, adverse effects from all kinds of things. Coumadin or blood thinner, all kind of things you see people coming in for. 20% of those are because of an adverse effect from an antibiotic.


Chad: It’s just amazing that it’s that high. The second thing is antibiotics are the second most common cause of an adverse drug effect in the elderly. Second most common cause, think about how many patients do we see especially elderly patients that are on multiple medications? The fact that antibiotics are the second most common cause.


Courtney: It’s big.


Chad: It’s amazing, we like to think that these antibiotics, “It’s no big deal, just take a ZPack for a few days or take a Quinolone, take Cipro, take Levaquin and that’ll fix what ails you.” We could go on and on and on about this but my last point —


Courtney: Especially you.


Chad: Thanks Courtney, I’m feeling some love here. That’s awesome.


Courtney: I’ve worked with Chad for a long time and he mentored me whenever I was in grad school. I’ve always heard your spill about this and I respect you. There’s no one more suiting to do this podcast than you. Devout the myth.


Chad: The thing is these rules apply to me. I carry this home. I say the same thing about my kids. I think my son’s been on one round of antibiotics and I don’t think my daughter ever has, but they haven’t been perpetually sick and maybe they haven’t been perpetually sick because they’re not on antibiotics but they’ll always argue it.


Courtney: In all reality I joke with you about it, but you’re honestly one of the most respected providers especially in this area. You’re obviously known for Tulsa Prolotherapy and lot of other things, great things, maximum medicine and Tulsa. I think that it’s pretty well known that you’re going to do everything that you can to do the right thing for the patient, get them feeling better but avoid antibiotic use unless obviously legitimately necessary. I know a lot of people in the community and they all know Chad is outside of the box on antibiotic therapy, and rightfully so, so much respect for honestly for you. Just not going really with the grain and just doing what everybody else does, throwing in their antibiotic board and moving on for the patient but really going Against the Grain fighting for a just cause.


Chad: Again, you look at the literature and it’s there.


Courtney: You’re right.


Chad: I’m not making this stuff up and we get patients that will call and say, “I think of a sinus infection I need an antibiotic,” and I’m like, “But you don’t know what you’re asking for.” It’s not that I don’t care in fact if I didn’t care I would just say, “Well, here you go.” That’s the truth. Because it’s easier to not fight that battle.


Courtney: It is we’re in the industry of customer service. You want to get the patient what they want but in all reality there’s other ways to get patient feeling better. There’s a lot that we can do and avoid the harmful possibilities of antibiotics use. Four Quinolones in particular, let’s just touch on the side effects or the adverse effects from four Quinolones.


Chad: Four Quinolones, that includes Cipro and Levaquin, would probably be two of the more common ones. The issue with these and these are real, and of course we do Tulsa Prolotherapy so we see a lot of tendon and ligament issues. There’s actually a black box warning on Quinolones for tendon rupture and I’ve seen it. It’s like you taking that —


Courtney: They’re doing box jumps and they had been on a recent use of this and they totally ruptured their Killie’s.


Chad: It is it blows my mind and the mechanism behind. It fascinates me that you can take one prescription, it’s not like these people were on it for six months. We’re talking about —


Courtney: Five to ten days.


Chad: Exactly, a short course of traditional antibiotic that resulted in something that was severe. A relatively severe injury, not life threatening but this is a big deal. Those Quinolones can also have central nervous system adverse effects. You can get neuropathy from those, potentially fatal problem with Q.T prolongation and that’s when you look at the heart waves and the deep polarization repolarization of the heart. When you get a prolongation of that it could result in a potentially fatal situation. You can photo toxicity, and certainly as within antibiotic you could have Tulsa Prolotherapy.


Courtney: Which is?


Chad: I’m sorry, thank you.


Courtney: Not everybody is.


Chad: Phototoxicity is when you take an antibiotic, you go out in the sun and that can have a negative effect, you get sunburns easier and stuff like that. One of the one of the bigger issues with really any antibiotic is hypersensitivity. You can develop anaphylaxis and have drug rashes and those kinds of things, and you can develop that at any time. You can be on an antibiotic multiple times through your life and then one day you just get a reaction from it. Tulsa Prolotherapy


Courtney: Across the board, we talk about this all the time, how important gut health is. What if antibiotics do briefly just shortly here to get health, what’s the problem?


Chad: I’m glad you said that because this is our HIPAA compliant story.


Male: HIPAA, Health Insurance Portability and Accountability.


Courtney: We got it ready.


Chad: We had a patient recently that had some upper respiratory something and it was the same thing and exactly what we’re talking about here. I don’t remember which antibiotic, do you remember which antibiotic it was?


Courtney: I could guess, but I’m not going to guess.


Chad: Maybe I’ll give an update on the next podcast. It’s a common in antibiotic for this upper respiratory issue. This patient was like, “I just got to do something,” and they know how I feel about antibiotics but they are like, “I just got to do something.” Took the antibiotics and -Tulsa Prolotherapy


Courtney: That they got from another provider?


Chad: That’s correct, and actually within a couple a few days they started having some bowel and gut problems. Started having some cramping. Now this is an early to mid-40’s male that’s in great shape, fit, all this kind of good stuff that was —


Courtney: Relatively healthy person.


Chad: Exactly. That was bent over in the fetal position crying like a schoolgirl because his belly hurts so bad, couldn’t stand up. This was a severe problem and had to do something. Of course, I recommended gut testing but this got progressively worse over the weekend. We had to prescribe medications because the concern was C. Diff or clostridium difficile, which is an overgrowth of what we call an opportunistic infection bacteria. It’s a normal bacteria, but when you kill off the healthy bacteria there’s nothing to keep it in check. This bacteria then over grows and was causing severe diarrhea, severe belly cramps, all kinds of things. C. Diff is it’s a known side effect of certain antibiotics and that can get you in the hospital.


Courtney: A barely common thing and it happens all the time in hospitals.


Chad: It does, so you really have to guard against that and it can be difficult to treat. In fact, one therapy that we talk about for C. Diff is what we call fecal transfer.


Courtney: I was going to say that but I didn’t want to totally gross everybody out. I’m glad you totally went in. C. Diff is nasty too, horrific smell. It’s crazy even more common in C. Diff is just these mild gas symptoms and long term they develop more and more bad bloating, intermittent between constipation diarrhea, you see all kinds of things. We’ve done stool testing, we see these crazy parasites and different things, but from a foundational standpoint their good bacteria has been disrupted. That’s exactly what antibiotics do, they’re killing all the good and all the bad, they’re not targeting just the bad bacteria, they’re killing everything. It’s becoming more common knowledge, but most people do not use probiotics which is good bacteria.


Chad: Right, that’s right. This is going be a little bit of a teaser on I don’t have a specific plan for this specific topic, but we’re going to do it. Because I think it’s a good topic, yes, I said that has to happen. For those of you that are listening and you doubt the ability of disruption of the bacteria to cause problems. What clued me in on this, and I’m talking specifically about the microbiota or the bacteria in the gut and association with yeast infections. With women, one of the things that we in functional medicine will recommend is probiotics as first line for a yeast infection, and for those of you that doubt that — we’ll do that probably as an entire podcast some time.


If you doubt the ability of antibiotics to disrupt the gut microbiota, if you doubt the ability of probiotics to help with yeast infections, then why is it that many, many women when they get an antibiotic they’ll — I’ve got patients if they’re getting an antibiotic, they’re like, “Well, you might as well go and give me that if you can too.” It’s so blatantly obvious yet many of our colleagues will disregard and say probiotics in their studies validating their benefit. Then why do so many women need a yeast medicine if the gut bacteria isn’t really important and prevents the overgrowth of some of the normal things? I just think it’s a huge topic that’s a great example of how this can really mess things up.


Courtney: I’m a patient hypothetically and I’m seeing Dr. Edwards and I’ve got a sinus infection or something going on. Should I even come in? Because you already telling me you’re not going to give me an antibiotic. Do you have anything for me that you can offer to take care of this?”


Chad: There’s actually a lot of things that we can do. I won’t say that antibiotics aren’t like absolutely not. You have to evaluate risks and benefits, when you consider that antibiotics have real risks, then where are the benefits? It’s got to outweigh it. You’ve got to take it has a case by case bases. The first we want to do is treat the symptoms, get them feeling better, get their nasal cavities, get their sinuses, get all those things opened up. If you got a cough, we’re going to symptomatically treat the cough. We can use medication, we can use supplements.


There are things that we can do from breathing treatments and things like that, to get the lungs working a little bit better; if it’s a lung related condition. Then we want to look at immune support. There’s lots of things that we can do that, we’ve got IV nutritional therapies, we’ve got all kinds of different things that we can use, that are shown to enhance immune support. We’ve got some studies validating a lot of these things. We’re going to do everything we can to get you feeling better, we got nasal medications that help open the sinuses.


Courtney: You’ve done a lot of treatment with chronic sinusitis using the nasal nerve.


Chad: Absolutely. In fact, I saw one today, again [Laughs]. I saw a sundry of patients. One of them specifically came in for a chronic sinus infections; which needs to be treated, from a functional medicine perspective, why is that the case? You got to look at nutrition, gut function, auto-immunity, allergens, contact irritancy, all these different things. You’ve got to work through all of those. There’s so many things that we can do. Yes, it’s absolutely worth coming in, and then, do you really need an antibiotic? My guess is probably not, but you never know.


Courtney:  Good, I like it.


Chad: That’s my thought on that upper respiratory thing.


Courtney: I think that’s great. Great information and we’re giving people an alternative to standard medicine. It’s need it, especially in Oklahoma. All that sinus stuff, all that upper respiratory stuff going on, especially this time of the year.


Chad: That’s right, there’s a lot of it. Unless there’s a real and profound reason, I generally discourage the use, and I would say arm yourself with information, find someone that’s going to help you optimize your health. Understand that if you feel bad, antibiotics may not be the answer for that.


Courtney: Do it for mankind.


Chad: That’s right. Go hug a tree. Well guys, thanks for listening to our show this week with Dr. Chad Edwards and with the wonderful Courtney.


Courtney: Thank you guys.


Chad: Tune in next week, where we’re going to continue to go against the grain.


Male: Thanks for listening to this week’s podcast with Dr. Chad Edwards. Tune in next week we’re will be going Against The Grain.