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Monday, May 20, 2019

This article discusses infectious diseases, shedding light in particular on antibiotics, vaccinations and the role of the infectious disease physician in safeguarding the health of the individual patient, as well as the community at large.

What is the infectious disease specialty and its role in medicine?

The field of infectious disease interacts with the whole spectrum of medicine. Infectious disease specialists care for patients with multiple issues that are often complicated by an infection. An infectious disease can be bacterial, viral, fungal or parasitic. We diagnose and treat the more unusual infections, which the general internist or surgeon doesn’t typically encounter. Frequently, we consult on the more complex cases for these and other specialists. Our goal is to get people well without causing complications from the treatment.

What is the role of the infectious disease specialist in curbing the overuse of antibiotics?

As infectious disease specialists, we advise other specialists on the appropriate use of antibiotics, both in the hospital and in the community. We have two main goals: optimal treatment of the individual patient and responsible use of antibiotics in the wider community. The improper use of antibiotics can cause resistance and other complications. When the use of antibiotics is appropriate, our aim is to use the most specific antibiotic, for the shortest course of treatment, to avoid complications.

At Englewood Health, our antibiotic stewardship committee is focused on improving the use of antibiotics throughout our health system. We educate physicians on best practices in antibiotic treatment and maintain a formulary in our pharmacy, which helps to ensure that physicians prescribe medications that are specific to the type of bacteria causing the infection and appropriate for the individual patient. We reserve the use of more broad-spectrum antibiotics for when they are most needed.

Over time, community education has been effective at reducing the misuse of antibiotics. Antibiotics should be used only to treat bacterial infections; they do not affect viruses, such as those that cause colds. In the past, patients might go to their doctor and demand an antibiotic for a cold. We see that much less now. Today, patients often say, “Thank you. I’m glad I don’t need an antibiotic.”

Please discuss vaccinations and disease prevention.

Vaccination against disease is effective for both individuals and the community. In the past, in the United States, when infectious diseases such as polio caused high rates of death and disability, people welcomed vaccines. Now that many of these diseases have been eradicated in this country, some people mistakenly believe they have the luxury of not getting vaccinated. Families that do not get vaccinated put not only their own family members, but their communities, at risk. The recent measles outbreak in New Jersey and New York highlights this problem. In other parts of the world, there are still thousands of cases and significant morbidity and mortality from measles.

People who can’t take vaccines—for example, the immunocompromised such as cancer patients—are very susceptible to infectious diseases. When the majority of those in a community are vaccinated, they also protect the unvaccinated, because the disease cannot spread from person to person. This concept is called “herd immunity” or “community immunity.”

The measles vaccine (either MMR for measles, mumps and rubella, or MMRV, which also includes chicken pox) is one of the most effective vaccines we have, and it is a vaccine with minimal risk, based on multiple studies. When it comes to vaccinations, patients should listen to their healthcare provider—not rely on what they read on the internet, which may or may not be accurate.

The Centers for Disease Control publishes guidelines for vaccination by age on its website. This is a helpful resource for those seeking more information.

Where has the field of infectious disease been especially successful?

Over the past decades, we have seen great advances in treating infectious diseases. We have become much more adept at identifying and treating new infectious agents. We have new molecular genetic tools that can identify new strains of disease, ultimately increasing our understanding of these diseases and allowing treatments to become more individualized.

HIV is an example of an infectious disease where medical science has made significant advances in improving outcomes. In the beginning, almost everyone with HIV eventually died from the disease. Now, virtually no one who is treated appropriately should die from HIV. Unfortunately, many patients may not seek or follow appropriate treatment, or they do not know they have the virus.

What are the most important tips to remember?

Get a flu vaccine every year.

Keep children up to date on all vaccines.

Follow your provider’s recommendation regarding antibiotics.

After 35 years specializing in infectious diseases, what continues to excite you about the field?

It is a very intellectually challenging specialty, which frequently deals with diagnostic dilemmas. We are focused on getting at the root of complex conditions. In infectious disease, you can treat patients and cure them—I have always liked that about the specialty.

By Steven J. Weisholtz, MD


Steven J. Weisholtz, MD, is an infectious disease specialist at Englewood Hospital and a member of the Englewood Health Physician Network. He practices at Leonia Medical Associates, in Englewood.