December 7, 2025 • 28 mins
12/07/25
The Healthy Matters Podcast
S05_E05 - Antibiotics - When They're Strong vs. When They're Wrong
With Special Guest: Dr. Caitlin Eccles-Radtke
Antibiotics have been around for almost a century, in that time they've been responsible for saving countless lives - in both humans and in livestock. But these meds have gone from medical marvels to "use with caution" in recent times. But what's driving this change? When are antibiotics actually called for and when are they ineffective? And what's the latest on these antibiotic resistant superbugs?
Antibiotics have stirred up some big conversations recently, and on Episode 5 of our show, we'll be joined by infectious disease expert Dr. Caitlin Eccles-Radtke to explore the myths, mishaps, and mind-blowing discoveries shaping antibiotic use today. Wanna know why your doctor side-eyes unnecessary Z-packs? This episode breaks it all down. Join us!
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Transcript
Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
SPEAKER_00 (00:01):
Welcome to the Healthy Matters Podcast with Dr.
David Hilden, primary carephysician and acute care
hospitalist at HennepinHealthcare in downtown
Minneapolis, where we cover thelatest in health, health care,
and what matters to you.
And now here's our host, Dr.
David Hilden.
SPEAKER_01 (00:19):
Hey everyone, and welcome to episode 5 of season 5
of the Healthy Matters Podcast.
We've all been there (00:24):
sniffles, sore throat, and the hope that
antibiotics will fix it.
But do they really?
Today, we're talking about thatgame changer of modern medicine.
These tiny pills have savedmillions of lives, but they've
also caused some pretty bigproblems when used the wrong
way.
So, how do antibiotics actuallywork?
(00:46):
Why don't they help with thecold or the flu?
And what's really behind all thetalk about antibiotic
resistance?
To help us sort it all out, I'mjoined by Dr.
Caitlin Eccles Radge.
She is an infectious diseasephysician and one of the
smartest people I know when itcomes to germs, bugs, and the
medicines we use to fight them.
Caitlin, thanks for being here.
Welcome to the podcast.
SPEAKER_03 (01:05):
Thanks for having me.
I appreciate the uh intro.
Thank you.
SPEAKER_01 (01:08):
So I've worked with Dr.
Eccles Radke for many years, andthrough the COVID pandemic, she
was our hospital's point personon infection control during a
pandemic that nobody knewanything about infection
control.
So you're the perfect person totalk us through this stuff,
Caitlin.
Um, start us out.
What are antibiotics?
How do they actually work in thebody?
SPEAKER_03 (01:29):
So antibiotics on the simplest level, they treat
bacteria.
And so as an infectious diseasespecialist, we think about
different kinds of infections.
One are bacteria, we think aboutviruses, parasites, fungal
infections.
But here, as we're talking aboutantibiotics, those only treat
bacterial infections.
So it's important to note that.
SPEAKER_01 (01:50):
So penicillin, the first one, at least the first
one that most people know about.
Is it actually true that thatthing was invented kind of by
accident?
And a long time ago.
SPEAKER_03 (01:59):
Yeah, I can't remember the exact timeline,
forgive me, but I do know it wasdeveloped by a Scottish
physician named AlexanderFleming, who had known or found
out that for many years,actually, they were using molds
and in sort of theseenvironmental things that could
kill certain types ofinfections.
And so out of that, out of amold called penicillium, which
(02:22):
That's the mold.
Convenient, correct?
Yeah, they developed and foundout that they could make
antibiotics or a specific onecalled penicillin.
And that's sort of where theadvent of antibiotics came from.
SPEAKER_01 (02:33):
That was a game changer.
Prior to that, you got aninfection, you didn't you didn't
do so hot.
So it is a true statement thatthey have been a game changer.
They have changed the course ofhuman health around the whole
world.
But we're gonna get into some ofthe modern uses of them in this
episode.
Briefly, if you could, Caitlin,explain what the difference is
then between a bacteria treatedby antibiotics and a virus,
(02:55):
which is not.
SPEAKER_03 (02:56):
Yeah, as I mentioned, there's various types
of microorganisms, two of whichare bacteria and viruses.
They work differently indifferent parts of the body.
There's many different bacteria,there are many different
viruses, and how they reproduceand grow and change help
distinguish them from eachother.
And then as you noted, there'sthere's going to be different
treatment recommendationsdepending on what you have.
SPEAKER_01 (03:18):
You guys in infectious diseases geek out
about germs and bugs andorganisms and pus and all that
stuff.
Could you tell us what some ofthe common bacterial infections
that people see in their life?
SPEAKER_03 (03:30):
Yeah, yeah.
A lot of them, um, you may thinkof urinary tract infection or
UTIs, as people call them forshort.
Certain types of pneumonia canbe bacterial.
SPEAKER_01 (03:39):
But not all.
SPEAKER_03 (03:40):
Not all.
Uh, you can have fungal, viral,you know, other types of
pneumonia as well.
Yep, which is a virus, exactly.
And so those are kind of thecommon things you may think of,
like a boil on the skin.
Basically, think of any part ofyour body you could
theoretically get a bacterialinfection.
But the most common ones thatpeople may think about are a
sinus infection, which can beviral or bacterial, certain
(04:02):
types of pneumonias, urinarytract infections, skin
infections are probably whatyou'd think of.
SPEAKER_01 (04:07):
Stuff that people get all the time.
How about some of the stuff thatpeople get all the time that
aren't caused by bacteria?
SPEAKER_03 (04:13):
Yeah, good question.
So there are a lot of thingsthat we actually think we need
antibiotics for, we don't,because they're viruses.
So the common cold, which isusually different types of
rhinovirus, enterovirus,coronavirus, to name a few, the
flu.
Everyone calls it the flu,right?
But really that's short forinfluenza virus.
And so that also does notrequire antibiotics.
SPEAKER_01 (04:36):
Which is different from the stomach flu, which
isn't flu at all, right?
SPEAKER_03 (04:40):
Correct.
Yeah.
I don't know how the stomach flugot named as it was.
It's not flu at all.
No, it it that's usually couldbe viral or bacterial uh stomach
infection or GI infection aswell.
But to your point, I think it'simportant to note that a lot of
things that people think theyneed antibiotics for that are
pretty common actually areviruses and we don't.
SPEAKER_01 (04:59):
Is one more serious than the other?
And it's kind of a funnyquestion, but you know, are
viruses more serious thanbacteria or the other way
around, or is it somethingdifferent?
SPEAKER_03 (05:10):
I think they're just two totally different things.
I mean, certain viruses can bevery deadly, as you remember in
the beginning of the COVIDpandemic when we had this new
novel virus and people weredying from it.
Whereas, say maybe a small skininfection, which could be
bacterial, might not be as bigof a deal.
So I don't know that you cancompare them.
I think there's a lot of thingsthat go into severity, right?
(05:32):
The type of infection, thelocation of infection, the host,
right?
Us.
Um, do we have good workingimmune systems?
Are we immune compromised?
And so there's a lot ofdifferent things that play a
role in terms of, you know, howsevere is this infection?
SPEAKER_01 (05:50):
I want to, I wanna go back just for a second to
2020.
And I know this is aboutantibiotics.
We didn't have an antibiotic forCOVID.
It was a virus.
That's what it stands for.
It stands for coronavirus.
And that's what the V is.
And we didn't have an antibioticfor it.
So that deadly thing then, if weonly had an antibiotic for that
(06:11):
thing at that time, it maybewouldn't have been so deadly.
But it was a virus that wasdeadly.
You remember those years andwhat how we were just we didn't
know what to do about them.
SPEAKER_03 (06:19):
I do remember them.
I try and black them out alittle bit.
SPEAKER_01 (06:22):
I think you were working about 120 hours a week.
And that was a that was a it wasprobably what they were dealing
with a hundred years ago whenepidemics broke out and doctors
stood around kind of wringingtheir hands, not knowing what to
do because the anime, there wasno nothing to treat it with.
SPEAKER_03 (06:37):
Yeah.
I think the difference betweenthen and now is the information
age, right?
And so we had a lot easier, moreavailable ways to transfer
information, research, who'sdoing what, where, across the
country, across the state, youknow, telephones, communication,
et cetera, that allowed us to beable to share and learn how to
(06:58):
deal with this quickly.
But you're right, it was reallyhard at the time.
We didn't have any treatmentoptions before some of the
antivirals and monoclonalantibodies were developed.
And so we we'll talk more aboutthis later, I think.
But just thinking about sort oflike the pre-antibiotic era, if
we get back to antibiotics andbacteria, like what did that
look like?
It was scary and you couldn't doanything about it.
SPEAKER_01 (07:20):
Couldn't do anything about it.
We were kind of building theplane as we flew it just in
2020.
And that's what they were doing100 years ago.
So I'm a patient, I come intoyour office.
How do you decide or how dodoctors decide when an
antibiotic is needed?
SPEAKER_03 (07:33):
That's a great question.
So I think the first steps areto go back to the basics, right?
We wanted to patient.
So, how long did you have thesesymptoms?
What symptoms are you having?
Did you have any exposures toanyone else who was sick?
Uh, are some of the big thingsthat we ask.
And and then depending on sortof what type of infection they
(07:55):
have, whether it's a sinus sortof infection or an upper
respiratory infection, a urinarytract infection, then we'll
decide if any additional testingis needed.
And based on that, then we'llsometimes prescribe antibiotics
or antivirals, but a lot oftimes we don't even need
testing, right?
If you came into my office andsaid, I've had cold symptoms for
(08:17):
two days, a little runny nose, acough, you know, everyone in my
family is sick.
My assumption is that that'sgonna be a virus.
You know, most symptomaticillnesses that sound like that,
right?
That have that sort of syndromeare going to be viral
infections.
SPEAKER_01 (08:33):
But doctor, mine's different.
I know my drainage is green whenit for me, it's always a
bacterial infection.
I know everybody else is sicktoo.
I need an antibiotic, doctor.
So how do you answer that?
I'm being a little facetioushere, but that's a kind of the
message doctors get asked allthe time.
(08:55):
But for me, couldn't you justgive me an antibiotic for this?
SPEAKER_03 (08:58):
Yeah, you're not you're not wrong.
That does happen.
And usually how I counsel peopleis that if this were to be a
bacterial infection, you'reright, antibiotics are
warranted, but it's a little toosoon to tell, right?
And the majority of these areviruses.
And so I would highly recommendgoing home with supportive
cares, rest, symptom management,you know, chicken soup.
(09:19):
Chicken soup, some fluids, allthat.
And if you're not getting betterwithin a week, or at least on
the mend, you don't have to beperfectly better, but at least
sort of moving in the rightdirection.
Let's talk again, right?
Because I want to know what'sgoing on and treat you if
there's a bacterial cause.
SPEAKER_01 (09:35):
Right.
So your bronchitis, your cold,your upper respiratory
infection, most sinusinfections, you just don't need
one, especially in that firstweek or so.
SPEAKER_03 (09:45):
Correct.
SPEAKER_01 (09:45):
So what does a self-limiting infection mean?
SPEAKER_03 (09:48):
Well, it's exactly what you're saying, right?
It's it's limited in itstimeline and that it goes away
on its own.
It doesn't, you don't needadditional things to stop the
infection, right?
So most viral infections likecommon colds, the flu, even
quote, uh other stomachillnesses, stomach viruses, and
things like that, those will goaway on their own over time.
(10:10):
You don't need antibiotics, youdon't need other treatments
other than things that mightmake you just feel better
throughout it, right?
Rest, a decongestant, uh,something for your runny nose,
et cetera.
SPEAKER_01 (10:21):
So let's assume now that I do have an infection that
requires an antibiotic or thatyou're prescribing to somebody.
They have community acquiredpneumonia, they have bacterial
pneumonia, for instance, and yougive them an antibiotic.
Why is it important or why do wetell patients, take them all and
take them till they're gone, doit for this many days.
Don't just take, you know, wesay, here's how long you're
(10:42):
gonna take them, do it for thatwhole time, don't stop.
Why do we do that?
SPEAKER_03 (10:45):
I have two answers to that.
So, one, we do it because wewant to make sure the infection
is fully cleared.
And when we prescribeantibiotics for a set period of
time, you know, the hope is thatwe give you the exact right
amount to clear the infection,hopefully not more than you
need.
And we don't want you to stopearly if you're feeling better
because we don't want you topartially treat that infection
(11:07):
and then have it either comeback or develop resistance to
the antibiotics.
Now that said, there's a littlebit of a that statement I would
say is also a little bitoutdated because I think the
message that it gives when wesay like take all your
antibiotics and don't stop earlysometimes kind of makes people
think like more antibiotics arebetter than less, right?
(11:28):
And the thing that's reallyimportant to note is that every
type of infection is a littlebit different, right?
So seven days for one or fivedays for another or 14 days for
another, like aren't reallycomparable from one type of
infection to another.
And so I think it's important tonote that one, you should take
the prescription as your doctorprescribes it, because that's
quite important.
But also know that differenttypes of infections have
(11:50):
different durations oftreatment.
SPEAKER_01 (11:52):
Are they safe?
That is a broad question.
But in other words, are therebig problems with taking
antibiotics for adverse effects?
And and and this the follow-upthen is what are some of the
common side effects people mightget when you take an antibiotic?
SPEAKER_03 (12:06):
So in general, yes, they are safe.
Like anything we do orprescribe, nothing is a hundred
percent without risk, right?
Everything we do in our life,even out outside of the
infection world, like you drivein a car, we think in general
that's safe, right?
We wear a seatbelt, we followthe traffic stops, et cetera.
But you know, it's not withoutrisk.
And and the same goes for anymedication, not just
(12:28):
antibiotics.
You know, there's always somerisk for side effects, and
certain people respond a littledifferently to medicines, but in
general, they are safe.
And what I would say is rightnow we have a number of
different antibiotics andantibiotic classes that we can
choose from for different typesof infections.
And so the nice thing is weoften will try and choose one
(12:49):
for your skin infection, urinarytract infection, pneumonia that
will be safest for you, right?
So let's say there's threedifferent ones and you have
kidney disease, threeantibiotics that work, and you
have kidney disease, and one ofthe antibiotics has a side
effect of kidney problems.
You know, we're gonna stay awayfrom that one and use one of the
other ones.
So there is a lot of thinkingthat actually goes into making
(13:12):
decisions about what the bestantibiotic is for you when
you're being seen by yourhealthcare provider.
And then you also asked aboutsort of common side effects.
So I tell every patient anyantibiotic can give you a rash,
any antibiotic can give youdiarrhea.
SPEAKER_01 (13:26):
That's common, isn't it?
SPEAKER_03 (13:28):
Whether it's just an upset stomach or something more
serious called Clostrodiumdifficile or C.
diff.
You know, that can happen withany antibiotic.
And so I tell that to everybody.
And then depending on thespecific antibiotic, I usually
go through the risks or adverseside effects that people can
have with that specific one.
SPEAKER_01 (13:45):
Yeah, that queasy tummy intestinal issue seems to
be so common.
We're not gonna get intoclostridium today, but I just
tell folks that you don't wantto get that either.
That's a diarrheal illness thatcomes, it's a different
organism, but it comes after youtook antibiotics.
So it's something that you kindof want to avoid if you can.
We have been talking aboutantibiotics with infectious
disease physician Dr.
(14:06):
Caitlin Eccles Radki.
We're gonna take a short break,but when we come back, we're
gonna discuss the growingproblem of antibiotic
resistance, what's being doneabout it, and maybe even what
you can do to help curbresistance.
So stick around, we'll be rightback.
SPEAKER_02 (14:22):
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life, they mean here for you,your life, and all that it
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They provide all of the primaryand specialty care you'd expect
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(14:44):
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Learn more atHennepinhealthcare.org.
Hennepin Healthcare is here foryou and here for life.
SPEAKER_01 (14:59):
And we're back.
So Caitlin, let's talk aboutantibiotic resistance and why
like your average listenershould even care about
antibiotic resistance.
So to start us off, can youexplain to us what that means?
SPEAKER_03 (15:12):
Yeah, so antibiotic resistance uh really is the
phenomenon where bacteriadevelop resistance to certain
antibiotics.
So that means that while anantibiotic may have worked in
the past for a certain type ofbacteria, now it doesn't work.
That bacteria has grown,changed, mutated to function in
(15:33):
a way that doesn't allow theantibiotic to work anymore.
SPEAKER_01 (15:36):
So what you're talking about is that the
bacteria, the universe of thebacteria, grow resistance to our
weapons, if you will.
Yeah.
SPEAKER_03 (15:43):
Yeah.
If you think about it, I mean,we can think about it on an
individual level or a big scale,but in general, what leads to
antibiotic resistance is whenwe're using more antibiotics
than we need, like as apopulation and as individuals, I
would say.
And so really the goal ofpreventing antibiotic resistance
(16:04):
is to not use as manyantibiotics unless you really
need them.
SPEAKER_01 (16:08):
So that that is true for humans, you know, where
doctors don't prescribe youantibiotics partially to avoid
this phenomenon.
But what about sort of in thefood supply in agriculture and
the global use of antibiotics?
Does that contribute?
SPEAKER_03 (16:22):
Yeah, it's a huge deal, actually.
And it's not something I thinkwe, the general public, we think
about on a regular basis, butthere are antibiotics used in
livestock, poultry, pick youranimal food source of choice in
an attempt to keep those flockshealthy and produce more.
And that actually can lead toantibiotic resistance as well.
(16:44):
And so there are a number ofinitiatives globally, you know,
in Minnesota, in the US, acrossthe world, that are looking to
curb antibiotic resistance andreally looking at sort of how
humans and animals and theenvironment all interface in an
attempt to decrease resistance.
SPEAKER_01 (17:03):
I even heard the World Health Organization has
talked about it as antibioticresistance as one of the top
public health threats globally.
SPEAKER_03 (17:11):
It is.
Yeah.
So so the fear is apre-antibiotic world, right?
And unfortunately, the wayresistance is arising, or at the
(17:34):
pace at which resistance isarising, is moving faster than
our ability to create newantibiotics.
And so while there are newantibiotics and research and
development currently, the drugcompanies sometimes, and I don't
want to speak for them because Idon't know all the nuances of
how they decide who does what,but you know, it's quite
(17:55):
expensive to make new drugs.
And so they have to decide whereto put that money in those
priorities.
And sometimes antibiotics aren'tthe priority, right?
And so it's hard to keep up withmaking new antibiotics when
we're running out of old ones.
SPEAKER_01 (18:08):
Yeah, yep.
That that makes sense.
So can you provide us with somereal-world examples of where
resistance has occurred?
SPEAKER_03 (18:15):
So many years ago, if you heard the term MERSA,
which stands for methicillinresistant staphylococcus aureus
or staph aureus, everyonethought, oh my gosh, super bug,
so scary, don't ever want to getit.
Well, all of that is true.
You don't ever want to get it,but it's actually quite common
right now and it has become sortof mainstream.
(18:35):
I mean, we see patients withMERSA all the time in the
hospital, and it's you know, youdon't really blink an eye.
SPEAKER_01 (18:42):
I did when I was training.
Yeah.
I um to see an MRSA, a MERSAcase was a big deal.
Just 25 years ago.
And now it we never saw it inpeople who weren't in the
hospital.
But even in the hospital, it'skind of a big deal.
Now there's people walkingaround with it.
SPEAKER_03 (18:59):
Yeah.
A number of us are actuallyprobably colonized in our nails
and our noses with it.
And it's much more prevalenteven in the community.
And so that kind of seems likenot as big of a deal now.
And I don't want to downplay itbecause again, any infection and
resistance is a big deal.
But we have bigger, scarierbugs, if you will, with more
(19:20):
resistance to more drug classesand and that are changing
quickly, uh, that are of biggerconcern.
SPEAKER_01 (19:26):
Yeah, but even MRSA can kill you.
It can you get a bad pneumoniawith MRSA and you have you get
septic and septic shock, gottagive you different antibiotics
now, the not though because it'sresistant to the other ones.
SPEAKER_03 (19:40):
Yeah, exactly.
We do see that sometimes.
And and I think you bring up agood point is that the uh the
World Health Organization, I wasjust looking at some stats
recently, and it looks like ifwe continue uh with the current
trends of development ofresistance, that antimicrobial
resistance could contribute toas many.
39.1 million deaths in the next25 years.
(20:03):
So between now and 2050.
39 million deaths just fromantibiotic resistance.
That's a big number and a bigdeal.
SPEAKER_01 (20:10):
That's a really big deal.
SPEAKER_03 (20:12):
The other thing I think is important is that
because this is, I mean, wethink about it all the time in
the infectious disease world,but because it's sort of like a
slow-moving, in some ways,changing thing, right?
It's not like a big pandemic inyour face that you have to deal
with right away.
People don't think about it asbeing as important or don't even
hear about it sometimes when itactually is a really, really big
(20:35):
deal.
SPEAKER_01 (20:35):
It's yeah, I was gonna ask you about that because
you and I in our daily lives,particularly you, you probably
think about this every day aboutthe appropriate use of
antibiotics and what happens ifyou don't use them
appropriately.
And we do that all the time, butthe average person doesn't.
It's sort of like globalwarming.
It's a crisis for our planet.
This is a crisis for our planetand our ability to care for
(20:58):
humanity that has infections,but it doesn't affect your
day-to-day life so much.
And so I think that's reallyimportant that we're talking
about it today.
And then I'm gonna ask you now,I'm gonna shift about um the
path forward.
How can we act in our own livesto do our part, if you will?
So if you could talk to us aboutwhat does antibiotic stewardship
(21:18):
mean?
SPEAKER_03 (21:19):
We actually have an amazing antibiotic stewardship
team here at the hospital.
So the first thing I'll say isthat hospitals and clinics and
medical groups are thinkingabout this.
And the goal is to reallyevaluate, you know, how many
prescriptions are being given?
Are they appropriate?
You know, are we using too manyantibiotics or not?
And on a day-to-day basis, youas an individual, I think it's
(21:42):
important to learn, as we talkedabout at the beginning of this
podcast, that not everythingneeds antibiotics, right?
So be more aware when you go andtalk to your doctor about your
symptoms and asking forantibiotics that that maybe you
don't need it.
And the hope, too, is of coursethat your doctor is educating
you on when antibiotics areappropriate and when they're
not.
So that's from an individuallevel, I think, is one thing you
(22:04):
can do.
And then just taking yourprescriptions as prescribed,
right?
And not taking themintermittently, missing a bunch
of doses, things like that.
But I think that's on theindividual level.
And then I want to look to sortof bigger levels.
Like we as a human populationneed to be working with our
policymakers, our medicalscientists, our agricultural
(22:25):
scientists and leadership andlooking across the globe, right?
Not just here in Minnesota orthe state, but looking across
the globe because there are noboundaries for resistant
organisms.
And so, you know, we'll seepeople here at our hospital in
Minnesota who had health care ina third world country or a
foreign country, and they comeback with a resistant organism
(22:49):
and a really bad infection.
And we're having to deal withthat, right?
And there's there's no bordersfor these things.
And so we have to work togetheras a world and a human
population and acrossdisciplines to be able to create
policies, put funding towardsresearch and development for new
antibiotics and looking at lookat ways to sort of curb this
(23:10):
really bad situation we're in.
SPEAKER_01 (23:12):
That was well said.
I want to unpack that a littlebit.
So when I was practicing um 20,25 years ago, I wrote a lot of
prescriptions from my clinic forantibiotics.
A lot.
You know, everybody wanted azithromycin, and it was so easy.
It even came in a little blisterpack.
You just came, it was easy.
It was four letters on aprescription pad was so much
(23:35):
easier to do.
Just write zithromycin done thanhaving a 10-minute conversation
with the patient about why theydidn't need that.
So I was guilty and the medicalsystem was guilty.
I think we didn't haveantibiotic stewardship programs
back then.
And now I think I can't recallthe last time I wrote an
antibiotic prescription in myclinic because you just almost
(23:58):
never need them for your sorethroats or your bronchitis or
whatever.
So I like what you said aboutthat, but some of it's
individual and some of it's onthe global scale.
So I'm gonna get into both ofthose a little bit more.
So the individual patient, whatwould how would you sum up your
recommendations about what theyshould be thinking about with
their illness?
SPEAKER_03 (24:18):
I think it's important to really review with
your doctor what symptoms you'rehaving, how long you've had
them, what exposures you mayhave been exposed to, and work
with your doctor to kind ofdecide, you know, what do we
think is causing this?
Right.
And not requesting antibioticsfor every sinus infection, upper
(24:38):
respiratory infection.
SPEAKER_01 (24:40):
Just in case.
I need them just in case.
Maybe that's not what you'd say.
SPEAKER_03 (24:43):
Yeah.
Usually the advice I give topatients is if you're still
feeling sick, you have easyaccess.
You know, we have the my chartsystem here where patients can
message you easily.
And I say, you just give me aheads up.
If you're still feeling sick ina week or whatever the timeline
is based on kind of where I sawthem in their illness, you reach
out to me and we'll touch base.
And if we think you need anantibiotic at that point, that's
(25:05):
fine.
And so, but I think yourinfection will probably go away
or be getting better in thatperiod of time.
SPEAKER_01 (25:11):
Time heals in many cases.
SPEAKER_03 (25:14):
Correct.
And I actually want them to tellme that too.
Like, hey, I'm doing better.
You know, I think that's a goodway to reinforce.
Hey, look, that was probablyviral and you're doing better.
That's great.
SPEAKER_01 (25:24):
Or the the opposite thing has sometimes happened to
be whereas somebody said theywere at an urgent care or
somewhere, they got thisantibiotic for whatever their
upper respiratory illness was.
They had a cold.
They got an antibiotic and thenthey come to see their regular
doctor and say, I need anotherprescription because I'm still
sick.
Well, you didn't need it thefirst time.
You simply don't need it asecond time.
So it's some of that awareness,I think, that is helpful.
(25:46):
I don't want to put it onpatients that this is up to you,
but it's just to be aware thatwhen your doctor is not giving
you antibiotics, it's notbecause they're withholding
something that you need.
You just never needed them inthe first place.
SPEAKER_03 (25:58):
Yeah.
And I think the other pointthat's important is with these
self-limiting viral infections,they can last.
Some of the after effects, Ishould say, can last more than a
week, right?
There's some people, myselfincluded, who will get a cough
for two weeks that just kind oflingers and the infection itself
is gone.
It's just that residualirritation of your airways that
(26:20):
will go away, but it's justannoying.
It's annoying.
SPEAKER_01 (26:23):
Give it time and some chicken soup.
So before I let you go, let'srecap with a quick game of true
or false, or just about true orfalse.
SPEAKER_03 (26:29):
All right.
SPEAKER_01 (26:30):
First, if you start feeling better, you can stop
taking your antibiotics.
SPEAKER_03 (26:33):
I would continue your course based on whatever
your doctor prescribed.
SPEAKER_01 (26:37):
Okay.
Antibiotics can treat viruses.
SPEAKER_03 (26:40):
That is false.
SPEAKER_01 (26:41):
Broad spectrum antibiotics are stronger, so
they're better.
SPEAKER_03 (26:45):
They are stronger in the sense that maybe stronger is
not the right word, in the sensethat they cover more types of
bacteria, so they're broader,but they're not always better.
If you know what you'retreating, you want to actually
go with the most narrowantibiotic you can find to
decrease risk for resistance.
SPEAKER_01 (27:01):
How about this one?
Taking antibiotics just in casecan't hurt.
SPEAKER_03 (27:05):
It can hurt, right?
As we said, there's risk forside effects, there's risk for
resistance.
And if they're not doinganything, why?
Why take him?
SPEAKER_01 (27:14):
Last one antibiotic resistance only happens in
hospitals.
SPEAKER_03 (27:17):
Not true.
As we talked about earlier, itcan occur in the community.
And so it's just important to begood stewards of our
antibiotics.
SPEAKER_01 (27:25):
We have been talking with Dr.
Caitlin Ecklesracky.
She is an infectious diseasespecialist and a physician at
Hennepin Healthcare here indowntown Minneapolis, a
colleague of mine for some yearsnow.
It is so good to have had you onthe podcast.
Thanks a ton, Caitlin.
SPEAKER_03 (27:39):
Thanks for having me.
SPEAKER_01 (27:40):
Listeners, thanks for listening.
I hope you learned something,and I hope you'll join us in two
weeks' time for our nextepisode.
And in the meantime, be healthyand be well.
SPEAKER_00 (27:50):
Thanks for listening to the Healthy Matters Podcast
with Dr.
David Hilden.
To find out more about theHealthy Matters Podcast or
browse the archive, visithealthymatters.org.
Got a question or a comment forthe show?
Email us at healthymatters athcmed.org.
Or call 612-873-TALK.
There's also a link in the shownotes.
(28:11):
The Healthy Matters Podcast ismade possible by Hennepin
Healthcare in Minneapolis,Minnesota, and engineered and
produced by John Lucas atHighball.
Executive producers are JonathanComito and Christine Hill.
Please remember we can only givegeneral medical advice during
this program.
And every case is unique.
We urge you to consult with yourphysician if you have a more
serious or pressing healthconcern.
(28:33):
Until next time, be healthy andbe well.
Welcome to the Healthy Matters Podcast with Dr.
David Hilden, primary carephysician and acute care
hospitalist at HennepinHealthcare in downtown
Minneapolis, where we cover thelatest in health, health care,
and what matters to you.
And now here's our host, Dr.
David Hilden.
SPEAKER_01 (00:19):
Hey everyone, and welcome to episode 5 of season 5
of the Healthy Matters Podcast.
We've all been there (00:24):
sniffles, sore throat, and the hope that
antibiotics will fix it.
But do they really?
Today, we're talking about thatgame changer of modern medicine.
These tiny pills have savedmillions of lives, but they've
also caused some pretty bigproblems when used the wrong
way.
So, how do antibiotics actuallywork?
(00:46):
Why don't they help with thecold or the flu?
And what's really behind all thetalk about antibiotic
resistance?
To help us sort it all out, I'mjoined by Dr.
Caitlin Eccles Radge.
She is an infectious diseasephysician and one of the
smartest people I know when itcomes to germs, bugs, and the
medicines we use to fight them.
Caitlin, thanks for being here.
Welcome to the podcast.
SPEAKER_03 (01:05):
Thanks for having me.
I appreciate the uh intro.
Thank you.
SPEAKER_01 (01:08):
So I've worked with Dr.
Eccles Radke for many years, andthrough the COVID pandemic, she
was our hospital's point personon infection control during a
pandemic that nobody knewanything about infection
control.
So you're the perfect person totalk us through this stuff,
Caitlin.
Um, start us out.
What are antibiotics?
How do they actually work in thebody?
SPEAKER_03 (01:29):
So antibiotics on the simplest level, they treat
bacteria.
And so as an infectious diseasespecialist, we think about
different kinds of infections.
One are bacteria, we think aboutviruses, parasites, fungal
infections.
But here, as we're talking aboutantibiotics, those only treat
bacterial infections.
So it's important to note that.
SPEAKER_01 (01:50):
So penicillin, the first one, at least the first
one that most people know about.
Is it actually true that thatthing was invented kind of by
accident?
And a long time ago.
SPEAKER_03 (01:59):
Yeah, I can't remember the exact timeline,
forgive me, but I do know it wasdeveloped by a Scottish
physician named AlexanderFleming, who had known or found
out that for many years,actually, they were using molds
and in sort of theseenvironmental things that could
kill certain types ofinfections.
And so out of that, out of amold called penicillium, which
(02:22):
That's the mold.
Convenient, correct?
Yeah, they developed and foundout that they could make
antibiotics or a specific onecalled penicillin.
And that's sort of where theadvent of antibiotics came from.
SPEAKER_01 (02:33):
That was a game changer.
Prior to that, you got aninfection, you didn't you didn't
do so hot.
So it is a true statement thatthey have been a game changer.
They have changed the course ofhuman health around the whole
world.
But we're gonna get into some ofthe modern uses of them in this
episode.
Briefly, if you could, Caitlin,explain what the difference is
then between a bacteria treatedby antibiotics and a virus,
(02:55):
which is not.
SPEAKER_03 (02:56):
Yeah, as I mentioned, there's various types
of microorganisms, two of whichare bacteria and viruses.
They work differently indifferent parts of the body.
There's many different bacteria,there are many different
viruses, and how they reproduceand grow and change help
distinguish them from eachother.
And then as you noted, there'sthere's going to be different
treatment recommendationsdepending on what you have.
SPEAKER_01 (03:18):
You guys in infectious diseases geek out
about germs and bugs andorganisms and pus and all that
stuff.
Could you tell us what some ofthe common bacterial infections
that people see in their life?
SPEAKER_03 (03:30):
Yeah, yeah.
A lot of them, um, you may thinkof urinary tract infection or
UTIs, as people call them forshort.
Certain types of pneumonia canbe bacterial.
SPEAKER_01 (03:39):
But not all.
SPEAKER_03 (03:40):
Not all.
Uh, you can have fungal, viral,you know, other types of
pneumonia as well.
Yep, which is a virus, exactly.
And so those are kind of thecommon things you may think of,
like a boil on the skin.
Basically, think of any part ofyour body you could
theoretically get a bacterialinfection.
But the most common ones thatpeople may think about are a
sinus infection, which can beviral or bacterial, certain
(04:02):
types of pneumonias, urinarytract infections, skin
infections are probably whatyou'd think of.
SPEAKER_01 (04:07):
Stuff that people get all the time.
How about some of the stuff thatpeople get all the time that
aren't caused by bacteria?
SPEAKER_03 (04:13):
Yeah, good question.
So there are a lot of thingsthat we actually think we need
antibiotics for, we don't,because they're viruses.
So the common cold, which isusually different types of
rhinovirus, enterovirus,coronavirus, to name a few, the
flu.
Everyone calls it the flu,right?
But really that's short forinfluenza virus.
And so that also does notrequire antibiotics.
SPEAKER_01 (04:36):
Which is different from the stomach flu, which
isn't flu at all, right?
SPEAKER_03 (04:40):
Correct.
Yeah.
I don't know how the stomach flugot named as it was.
It's not flu at all.
No, it it that's usually couldbe viral or bacterial uh stomach
infection or GI infection aswell.
But to your point, I think it'simportant to note that a lot of
things that people think theyneed antibiotics for that are
pretty common actually areviruses and we don't.
SPEAKER_01 (04:59):
Is one more serious than the other?
And it's kind of a funnyquestion, but you know, are
viruses more serious thanbacteria or the other way
around, or is it somethingdifferent?
SPEAKER_03 (05:10):
I think they're just two totally different things.
I mean, certain viruses can bevery deadly, as you remember in
the beginning of the COVIDpandemic when we had this new
novel virus and people weredying from it.
Whereas, say maybe a small skininfection, which could be
bacterial, might not be as bigof a deal.
So I don't know that you cancompare them.
I think there's a lot of thingsthat go into severity, right?
(05:32):
The type of infection, thelocation of infection, the host,
right?
Us.
Um, do we have good workingimmune systems?
Are we immune compromised?
And so there's a lot ofdifferent things that play a
role in terms of, you know, howsevere is this infection?
SPEAKER_01 (05:50):
I want to, I wanna go back just for a second to
2020.
And I know this is aboutantibiotics.
We didn't have an antibiotic forCOVID.
It was a virus.
That's what it stands for.
It stands for coronavirus.
And that's what the V is.
And we didn't have an antibioticfor it.
So that deadly thing then, if weonly had an antibiotic for that
(06:11):
thing at that time, it maybewouldn't have been so deadly.
But it was a virus that wasdeadly.
You remember those years andwhat how we were just we didn't
know what to do about them.
SPEAKER_03 (06:19):
I do remember them.
I try and black them out alittle bit.
SPEAKER_01 (06:22):
I think you were working about 120 hours a week.
And that was a that was a it wasprobably what they were dealing
with a hundred years ago whenepidemics broke out and doctors
stood around kind of wringingtheir hands, not knowing what to
do because the anime, there wasno nothing to treat it with.
SPEAKER_03 (06:37):
Yeah.
I think the difference betweenthen and now is the information
age, right?
And so we had a lot easier, moreavailable ways to transfer
information, research, who'sdoing what, where, across the
country, across the state, youknow, telephones, communication,
et cetera, that allowed us to beable to share and learn how to
(06:58):
deal with this quickly.
But you're right, it was reallyhard at the time.
We didn't have any treatmentoptions before some of the
antivirals and monoclonalantibodies were developed.
And so we we'll talk more aboutthis later, I think.
But just thinking about sort oflike the pre-antibiotic era, if
we get back to antibiotics andbacteria, like what did that
look like?
It was scary and you couldn't doanything about it.
SPEAKER_01 (07:20):
Couldn't do anything about it.
We were kind of building theplane as we flew it just in
2020.
And that's what they were doing100 years ago.
So I'm a patient, I come intoyour office.
How do you decide or how dodoctors decide when an
antibiotic is needed?
SPEAKER_03 (07:33):
That's a great question.
So I think the first steps areto go back to the basics, right?
We wanted to patient.
So, how long did you have thesesymptoms?
What symptoms are you having?
Did you have any exposures toanyone else who was sick?
Uh, are some of the big thingsthat we ask.
And and then depending on sortof what type of infection they
(07:55):
have, whether it's a sinus sortof infection or an upper
respiratory infection, a urinarytract infection, then we'll
decide if any additional testingis needed.
And based on that, then we'llsometimes prescribe antibiotics
or antivirals, but a lot oftimes we don't even need
testing, right?
If you came into my office andsaid, I've had cold symptoms for
(08:17):
two days, a little runny nose, acough, you know, everyone in my
family is sick.
My assumption is that that'sgonna be a virus.
You know, most symptomaticillnesses that sound like that,
right?
That have that sort of syndromeare going to be viral
infections.
SPEAKER_01 (08:33):
But doctor, mine's different.
I know my drainage is green whenit for me, it's always a
bacterial infection.
I know everybody else is sicktoo.
I need an antibiotic, doctor.
So how do you answer that?
I'm being a little facetioushere, but that's a kind of the
message doctors get asked allthe time.
(08:55):
But for me, couldn't you justgive me an antibiotic for this?
SPEAKER_03 (08:58):
Yeah, you're not you're not wrong.
That does happen.
And usually how I counsel peopleis that if this were to be a
bacterial infection, you'reright, antibiotics are
warranted, but it's a little toosoon to tell, right?
And the majority of these areviruses.
And so I would highly recommendgoing home with supportive
cares, rest, symptom management,you know, chicken soup.
(09:19):
Chicken soup, some fluids, allthat.
And if you're not getting betterwithin a week, or at least on
the mend, you don't have to beperfectly better, but at least
sort of moving in the rightdirection.
Let's talk again, right?
Because I want to know what'sgoing on and treat you if
there's a bacterial cause.
SPEAKER_01 (09:35):
Right.
So your bronchitis, your cold,your upper respiratory
infection, most sinusinfections, you just don't need
one, especially in that firstweek or so.
SPEAKER_03 (09:45):
Correct.
SPEAKER_01 (09:45):
So what does a self-limiting infection mean?
SPEAKER_03 (09:48):
Well, it's exactly what you're saying, right?
It's it's limited in itstimeline and that it goes away
on its own.
It doesn't, you don't needadditional things to stop the
infection, right?
So most viral infections likecommon colds, the flu, even
quote, uh other stomachillnesses, stomach viruses, and
things like that, those will goaway on their own over time.
(10:10):
You don't need antibiotics, youdon't need other treatments
other than things that mightmake you just feel better
throughout it, right?
Rest, a decongestant, uh,something for your runny nose,
et cetera.
SPEAKER_01 (10:21):
So let's assume now that I do have an infection that
requires an antibiotic or thatyou're prescribing to somebody.
They have community acquiredpneumonia, they have bacterial
pneumonia, for instance, and yougive them an antibiotic.
Why is it important or why do wetell patients, take them all and
take them till they're gone, doit for this many days.
Don't just take, you know, wesay, here's how long you're
(10:42):
gonna take them, do it for thatwhole time, don't stop.
Why do we do that?
SPEAKER_03 (10:45):
I have two answers to that.
So, one, we do it because wewant to make sure the infection
is fully cleared.
And when we prescribeantibiotics for a set period of
time, you know, the hope is thatwe give you the exact right
amount to clear the infection,hopefully not more than you
need.
And we don't want you to stopearly if you're feeling better
because we don't want you topartially treat that infection
(11:07):
and then have it either comeback or develop resistance to
the antibiotics.
Now that said, there's a littlebit of a that statement I would
say is also a little bitoutdated because I think the
message that it gives when wesay like take all your
antibiotics and don't stop earlysometimes kind of makes people
think like more antibiotics arebetter than less, right?
(11:28):
And the thing that's reallyimportant to note is that every
type of infection is a littlebit different, right?
So seven days for one or fivedays for another or 14 days for
another, like aren't reallycomparable from one type of
infection to another.
And so I think it's important tonote that one, you should take
the prescription as your doctorprescribes it, because that's
quite important.
But also know that differenttypes of infections have
(11:50):
different durations oftreatment.
SPEAKER_01 (11:52):
Are they safe?
That is a broad question.
But in other words, are therebig problems with taking
antibiotics for adverse effects?
And and and this the follow-upthen is what are some of the
common side effects people mightget when you take an antibiotic?
SPEAKER_03 (12:06):
So in general, yes, they are safe.
Like anything we do orprescribe, nothing is a hundred
percent without risk, right?
Everything we do in our life,even out outside of the
infection world, like you drivein a car, we think in general
that's safe, right?
We wear a seatbelt, we followthe traffic stops, et cetera.
But you know, it's not withoutrisk.
And and the same goes for anymedication, not just
(12:28):
antibiotics.
You know, there's always somerisk for side effects, and
certain people respond a littledifferently to medicines, but in
general, they are safe.
And what I would say is rightnow we have a number of
different antibiotics andantibiotic classes that we can
choose from for different typesof infections.
And so the nice thing is weoften will try and choose one
(12:49):
for your skin infection, urinarytract infection, pneumonia that
will be safest for you, right?
So let's say there's threedifferent ones and you have
kidney disease, threeantibiotics that work, and you
have kidney disease, and one ofthe antibiotics has a side
effect of kidney problems.
You know, we're gonna stay awayfrom that one and use one of the
other ones.
So there is a lot of thinkingthat actually goes into making
(13:12):
decisions about what the bestantibiotic is for you when
you're being seen by yourhealthcare provider.
And then you also asked aboutsort of common side effects.
So I tell every patient anyantibiotic can give you a rash,
any antibiotic can give youdiarrhea.
SPEAKER_01 (13:26):
That's common, isn't it?
SPEAKER_03 (13:28):
Whether it's just an upset stomach or something more
serious called Clostrodiumdifficile or C.
diff.
You know, that can happen withany antibiotic.
And so I tell that to everybody.
And then depending on thespecific antibiotic, I usually
go through the risks or adverseside effects that people can
have with that specific one.
SPEAKER_01 (13:45):
Yeah, that queasy tummy intestinal issue seems to
be so common.
We're not gonna get intoclostridium today, but I just
tell folks that you don't wantto get that either.
That's a diarrheal illness thatcomes, it's a different
organism, but it comes after youtook antibiotics.
So it's something that you kindof want to avoid if you can.
We have been talking aboutantibiotics with infectious
disease physician Dr.
(14:06):
Caitlin Eccles Radki.
We're gonna take a short break,but when we come back, we're
gonna discuss the growingproblem of antibiotic
resistance, what's being doneabout it, and maybe even what
you can do to help curbresistance.
So stick around, we'll be rightback.
SPEAKER_02 (14:22):
When Hennepin Healthcare says, we're here for
life, they mean here for you,your life, and all that it
brings.
Hennepin Healthcare has ahospital, HCMC, a network of
clinics in the metro area, andan integrative health clinic in
downtown Minneapolis.
They provide all of the primaryand specialty care you'd expect
to find, as well as serviceslike acupuncture and
(14:44):
chiropractic care.
Learn more atHennepinhealthcare.org.
Hennepin Healthcare is here foryou and here for life.
SPEAKER_01 (14:59):
And we're back.
So Caitlin, let's talk aboutantibiotic resistance and why
like your average listenershould even care about
antibiotic resistance.
So to start us off, can youexplain to us what that means?
SPEAKER_03 (15:12):
Yeah, so antibiotic resistance uh really is the
phenomenon where bacteriadevelop resistance to certain
antibiotics.
So that means that while anantibiotic may have worked in
the past for a certain type ofbacteria, now it doesn't work.
That bacteria has grown,changed, mutated to function in
(15:33):
a way that doesn't allow theantibiotic to work anymore.
SPEAKER_01 (15:36):
So what you're talking about is that the
bacteria, the universe of thebacteria, grow resistance to our
weapons, if you will.
Yeah.
SPEAKER_03 (15:43):
Yeah.
If you think about it, I mean,we can think about it on an
individual level or a big scale,but in general, what leads to
antibiotic resistance is whenwe're using more antibiotics
than we need, like as apopulation and as individuals, I
would say.
And so really the goal ofpreventing antibiotic resistance
(16:04):
is to not use as manyantibiotics unless you really
need them.
SPEAKER_01 (16:08):
So that that is true for humans, you know, where
doctors don't prescribe youantibiotics partially to avoid
this phenomenon.
But what about sort of in thefood supply in agriculture and
the global use of antibiotics?
Does that contribute?
SPEAKER_03 (16:22):
Yeah, it's a huge deal, actually.
And it's not something I thinkwe, the general public, we think
about on a regular basis, butthere are antibiotics used in
livestock, poultry, pick youranimal food source of choice in
an attempt to keep those flockshealthy and produce more.
And that actually can lead toantibiotic resistance as well.
(16:44):
And so there are a number ofinitiatives globally, you know,
in Minnesota, in the US, acrossthe world, that are looking to
curb antibiotic resistance andreally looking at sort of how
humans and animals and theenvironment all interface in an
attempt to decrease resistance.
SPEAKER_01 (17:03):
I even heard the World Health Organization has
talked about it as antibioticresistance as one of the top
public health threats globally.
SPEAKER_03 (17:11):
It is.
Yeah.
So so the fear is apre-antibiotic world, right?
And unfortunately, the wayresistance is arising, or at the
(17:34):
pace at which resistance isarising, is moving faster than
our ability to create newantibiotics.
And so while there are newantibiotics and research and
development currently, the drugcompanies sometimes, and I don't
want to speak for them because Idon't know all the nuances of
how they decide who does what,but you know, it's quite
(17:55):
expensive to make new drugs.
And so they have to decide whereto put that money in those
priorities.
And sometimes antibiotics aren'tthe priority, right?
And so it's hard to keep up withmaking new antibiotics when
we're running out of old ones.
SPEAKER_01 (18:08):
Yeah, yep.
That that makes sense.
So can you provide us with somereal-world examples of where
resistance has occurred?
SPEAKER_03 (18:15):
So many years ago, if you heard the term MERSA,
which stands for methicillinresistant staphylococcus aureus
or staph aureus, everyonethought, oh my gosh, super bug,
so scary, don't ever want to getit.
Well, all of that is true.
You don't ever want to get it,but it's actually quite common
right now and it has become sortof mainstream.
(18:35):
I mean, we see patients withMERSA all the time in the
hospital, and it's you know, youdon't really blink an eye.
SPEAKER_01 (18:42):
I did when I was training.
Yeah.
I um to see an MRSA, a MERSAcase was a big deal.
Just 25 years ago.
And now it we never saw it inpeople who weren't in the
hospital.
But even in the hospital, it'skind of a big deal.
Now there's people walkingaround with it.
SPEAKER_03 (18:59):
Yeah.
A number of us are actuallyprobably colonized in our nails
and our noses with it.
And it's much more prevalenteven in the community.
And so that kind of seems likenot as big of a deal now.
And I don't want to downplay itbecause again, any infection and
resistance is a big deal.
But we have bigger, scarierbugs, if you will, with more
(19:20):
resistance to more drug classesand and that are changing
quickly, uh, that are of biggerconcern.
SPEAKER_01 (19:26):
Yeah, but even MRSA can kill you.
It can you get a bad pneumoniawith MRSA and you have you get
septic and septic shock, gottagive you different antibiotics
now, the not though because it'sresistant to the other ones.
SPEAKER_03 (19:40):
Yeah, exactly.
We do see that sometimes.
And and I think you bring up agood point is that the uh the
World Health Organization, I wasjust looking at some stats
recently, and it looks like ifwe continue uh with the current
trends of development ofresistance, that antimicrobial
resistance could contribute toas many.
39.1 million deaths in the next25 years.
(20:03):
So between now and 2050.
39 million deaths just fromantibiotic resistance.
That's a big number and a bigdeal.
SPEAKER_01 (20:10):
That's a really big deal.
SPEAKER_03 (20:12):
The other thing I think is important is that
because this is, I mean, wethink about it all the time in
the infectious disease world,but because it's sort of like a
slow-moving, in some ways,changing thing, right?
It's not like a big pandemic inyour face that you have to deal
with right away.
People don't think about it asbeing as important or don't even
hear about it sometimes when itactually is a really, really big
(20:35):
deal.
SPEAKER_01 (20:35):
It's yeah, I was gonna ask you about that because
you and I in our daily lives,particularly you, you probably
think about this every day aboutthe appropriate use of
antibiotics and what happens ifyou don't use them
appropriately.
And we do that all the time, butthe average person doesn't.
It's sort of like globalwarming.
It's a crisis for our planet.
This is a crisis for our planetand our ability to care for
(20:58):
humanity that has infections,but it doesn't affect your
day-to-day life so much.
And so I think that's reallyimportant that we're talking
about it today.
And then I'm gonna ask you now,I'm gonna shift about um the
path forward.
How can we act in our own livesto do our part, if you will?
So if you could talk to us aboutwhat does antibiotic stewardship
(21:18):
mean?
SPEAKER_03 (21:19):
We actually have an amazing antibiotic stewardship
team here at the hospital.
So the first thing I'll say isthat hospitals and clinics and
medical groups are thinkingabout this.
And the goal is to reallyevaluate, you know, how many
prescriptions are being given?
Are they appropriate?
You know, are we using too manyantibiotics or not?
And on a day-to-day basis, youas an individual, I think it's
(21:42):
important to learn, as we talkedabout at the beginning of this
podcast, that not everythingneeds antibiotics, right?
So be more aware when you go andtalk to your doctor about your
symptoms and asking forantibiotics that that maybe you
don't need it.
And the hope, too, is of coursethat your doctor is educating
you on when antibiotics areappropriate and when they're
not.
So that's from an individuallevel, I think, is one thing you
(22:04):
can do.
And then just taking yourprescriptions as prescribed,
right?
And not taking themintermittently, missing a bunch
of doses, things like that.
But I think that's on theindividual level.
And then I want to look to sortof bigger levels.
Like we as a human populationneed to be working with our
policymakers, our medicalscientists, our agricultural
(22:25):
scientists and leadership andlooking across the globe, right?
Not just here in Minnesota orthe state, but looking across
the globe because there are noboundaries for resistant
organisms.
And so, you know, we'll seepeople here at our hospital in
Minnesota who had health care ina third world country or a
foreign country, and they comeback with a resistant organism
(22:49):
and a really bad infection.
And we're having to deal withthat, right?
And there's there's no bordersfor these things.
And so we have to work togetheras a world and a human
population and acrossdisciplines to be able to create
policies, put funding towardsresearch and development for new
antibiotics and looking at lookat ways to sort of curb this
(23:10):
really bad situation we're in.
SPEAKER_01 (23:12):
That was well said.
I want to unpack that a littlebit.
So when I was practicing um 20,25 years ago, I wrote a lot of
prescriptions from my clinic forantibiotics.
A lot.
You know, everybody wanted azithromycin, and it was so easy.
It even came in a little blisterpack.
You just came, it was easy.
It was four letters on aprescription pad was so much
(23:35):
easier to do.
Just write zithromycin done thanhaving a 10-minute conversation
with the patient about why theydidn't need that.
So I was guilty and the medicalsystem was guilty.
I think we didn't haveantibiotic stewardship programs
back then.
And now I think I can't recallthe last time I wrote an
antibiotic prescription in myclinic because you just almost
(23:58):
never need them for your sorethroats or your bronchitis or
whatever.
So I like what you said aboutthat, but some of it's
individual and some of it's onthe global scale.
So I'm gonna get into both ofthose a little bit more.
So the individual patient, whatwould how would you sum up your
recommendations about what theyshould be thinking about with
their illness?
SPEAKER_03 (24:18):
I think it's important to really review with
your doctor what symptoms you'rehaving, how long you've had
them, what exposures you mayhave been exposed to, and work
with your doctor to kind ofdecide, you know, what do we
think is causing this?
Right.
And not requesting antibioticsfor every sinus infection, upper
(24:38):
respiratory infection.
SPEAKER_01 (24:40):
Just in case.
I need them just in case.
Maybe that's not what you'd say.
SPEAKER_03 (24:43):
Yeah.
Usually the advice I give topatients is if you're still
feeling sick, you have easyaccess.
You know, we have the my chartsystem here where patients can
message you easily.
And I say, you just give me aheads up.
If you're still feeling sick ina week or whatever the timeline
is based on kind of where I sawthem in their illness, you reach
out to me and we'll touch base.
And if we think you need anantibiotic at that point, that's
(25:05):
fine.
And so, but I think yourinfection will probably go away
or be getting better in thatperiod of time.
SPEAKER_01 (25:11):
Time heals in many cases.
SPEAKER_03 (25:14):
Correct.
And I actually want them to tellme that too.
Like, hey, I'm doing better.
You know, I think that's a goodway to reinforce.
Hey, look, that was probablyviral and you're doing better.
That's great.
SPEAKER_01 (25:24):
Or the the opposite thing has sometimes happened to
be whereas somebody said theywere at an urgent care or
somewhere, they got thisantibiotic for whatever their
upper respiratory illness was.
They had a cold.
They got an antibiotic and thenthey come to see their regular
doctor and say, I need anotherprescription because I'm still
sick.
Well, you didn't need it thefirst time.
You simply don't need it asecond time.
So it's some of that awareness,I think, that is helpful.
(25:46):
I don't want to put it onpatients that this is up to you,
but it's just to be aware thatwhen your doctor is not giving
you antibiotics, it's notbecause they're withholding
something that you need.
You just never needed them inthe first place.
SPEAKER_03 (25:58):
Yeah.
And I think the other pointthat's important is with these
self-limiting viral infections,they can last.
Some of the after effects, Ishould say, can last more than a
week, right?
There's some people, myselfincluded, who will get a cough
for two weeks that just kind oflingers and the infection itself
is gone.
It's just that residualirritation of your airways that
(26:20):
will go away, but it's justannoying.
It's annoying.
SPEAKER_01 (26:23):
Give it time and some chicken soup.
So before I let you go, let'srecap with a quick game of true
or false, or just about true orfalse.
SPEAKER_03 (26:29):
All right.
SPEAKER_01 (26:30):
First, if you start feeling better, you can stop
taking your antibiotics.
SPEAKER_03 (26:33):
I would continue your course based on whatever
your doctor prescribed.
SPEAKER_01 (26:37):
Okay.
Antibiotics can treat viruses.
SPEAKER_03 (26:40):
That is false.
SPEAKER_01 (26:41):
Broad spectrum antibiotics are stronger, so
they're better.
SPEAKER_03 (26:45):
They are stronger in the sense that maybe stronger is
not the right word, in the sensethat they cover more types of
bacteria, so they're broader,but they're not always better.
If you know what you'retreating, you want to actually
go with the most narrowantibiotic you can find to
decrease risk for resistance.
SPEAKER_01 (27:01):
How about this one?
Taking antibiotics just in casecan't hurt.
SPEAKER_03 (27:05):
It can hurt, right?
As we said, there's risk forside effects, there's risk for
resistance.
And if they're not doinganything, why?
Why take him?
SPEAKER_01 (27:14):
Last one antibiotic resistance only happens in
hospitals.
SPEAKER_03 (27:17):
Not true.
As we talked about earlier, itcan occur in the community.
And so it's just important to begood stewards of our
antibiotics.
SPEAKER_01 (27:25):
We have been talking with Dr.
Caitlin Ecklesracky.
She is an infectious diseasespecialist and a physician at
Hennepin Healthcare here indowntown Minneapolis, a
colleague of mine for some yearsnow.
It is so good to have had you onthe podcast.
Thanks a ton, Caitlin.
SPEAKER_03 (27:39):
Thanks for having me.
SPEAKER_01 (27:40):
Listeners, thanks for listening.
I hope you learned something,and I hope you'll join us in two
weeks' time for our nextepisode.
And in the meantime, be healthyand be well.
SPEAKER_00 (27:50):
Thanks for listening to the Healthy Matters Podcast
with Dr.
David Hilden.
To find out more about theHealthy Matters Podcast or
browse the archive, visithealthymatters.org.
Got a question or a comment forthe show?
Email us at healthymatters athcmed.org.
Or call 612-873-TALK.
There's also a link in the shownotes.
(28:11):
The Healthy Matters Podcast ismade possible by Hennepin
Healthcare in Minneapolis,Minnesota, and engineered and
produced by John Lucas atHighball.
Executive producers are JonathanComito and Christine Hill.
Please remember we can only givegeneral medical advice during
this program.
And every case is unique.
We urge you to consult with yourphysician if you have a more
serious or pressing healthconcern.
(28:33):
Until next time, be healthy andbe well.
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