Several classes of drugs are commonly abused in the acute care setting. Here are some facts to be aware of.

Antibiotics continue to be grossly overutilized by amny health care professionals. According to recent reserach, bronchitis and sinusitis both respond no better to antibiotics than to placebo.  These infections are mainly caused by viruses.  Antibiotics should be reserved for severe or resistant cases.  The fluoroquinolone drugs, like Cipro, may cause agitation or confusion.  They may also cause damage to connective tissues, especially the Achilles tendon, which may rupture.  Penicillin-related drugs may cause allergic reactions such as skin rash.  All antibiotics cause changes in intestinal flora, with elimination of good bacteria and promotion of antibiotic-associated diarrhea or yeast infection.  Anyone taking antibiotics should also take probiotics (good bacteria) to avoid intestinal complications, particularly children and older people.  Probiotics should be taken during the course of antibiotic therapy and for three weeks after.

Sedatives and pain medications are grossly overprescribed.  Prescription of these drugs for pain sets the stage for addiction.  Non-narcotic drugs should be used preferentially for pain, and sedatives should be offered only rarely in the acute situation, and only in small amounts and in low doses when necessary.  Natural substances are often effective for sedation, such as the amino acids tryptophan and 5HTP, as well as St. John’s wort, L-theanine and GABA.

I often recommend to patients that anti-depressants be avoided in the acute care situation, because of their unpredictable effects.  They may worsen the conditions for which they are prescribed, and in children, teenagers and young adults they are known to increase the risk of suicidal ideation.

Blood pressure lowering drugs are also overused in acute care situations.  Many patients entering emergency rooms or urgent care centers will have high blood pressure brought on by their anxiety or by pain.  They are not truly hypertensive.  Unless blood pressure is dangerously high, they should not be treated with antihypertensive drugs, but should be referred to their primary care physicians for follow-up. There are many effective and avenues to pursue in your quest to lower blood pressure that do not involve the use of drugs.

Allan Sosin, M.D.

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