Antibiotic overuse causes problems
Dear Dr. Roach: I am an 81-year-old male. I have CMML (chronic myelomonocrytic leukemia), but Vidaza has stabilized my condition. I am otherwise in good health.
I recently had diverticulitis and took ciprofloxacin and metronidazole for seven days. The oral antibiotics for the diverticulitis caused me to have stomach cramps, as do all oral antibiotics.
The problem is, I frequently have cuts and abrasions that turn the surrounding area red. I would like to manage infections and inflammations while reducing the need for oral antibiotics.
I also wonder about letting a fever continue to allow natural healing.
When should I take medication to reduce a fever, and how high does a fever need to be before I should go to the emergency room?
R.P.
Answer: Overuse of antibiotics is a serious problem, and I am glad to hear that you want to reduce your use of them. The less we use antibiotics, the less likely their targets will develop into highly resistant organisms.
The decision to use antibiotics is for you and your doctor to make, but if you communicate that you are trying to avoid them, you are less likely to have them prescribed.
There is no precise level of fever that indicates a need for medication or evaluation.
Although some people run too fast to the ER or their doctor demanding antibiotics, that’s not what’s happening with you.
In your case, because you have a disease of the bone marrow (CMML), and are taking the cancer chemotherapy drug azacitidine (Vidaza), you are at higher risk of developing a serious bacterial infection. For that reason, you should be more inclined to get evaluated for a possible infection than a person who does not have these medical conditions.
Further, because of the leukemia and its treatment, you are a little less likely to show signs of infection; a fever means more for you than it would for a 40-yearold with no cancer. In your situation, a temperature of 100.5 F (38 C) should prompt a visit to your doctor for evaluation. Readers may email questions to: ToYourGoodHealth@med .cornell.edu or mail questions to 628 Virginia Dr., Orlando, FL 32803.