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Canwest News Service
Infectious disease experts worry the H1N1 virus will drive a surge in antibiotic prescribing, potentially leading to more drug-resistant organisms.
As Canada enters the normal peak season for flu, doctors are facing a perennial problem: how to distinguish flu from rare and grave bacterial infections such as meningitis and serious Group A streptococcal infections.
Early signs of meningitis include some of the same symptoms recommended in screening questions for H1N1, including fever, sore throat, headache, muscle aches, vomiting and diarrhea, two doctors writing in the British Medical Journal warned recently.
Bacterial infections need to be treated with antibiotics. Should doctors face what they term "diagnostic uncertainty," doctors will prescribe the antibiotics as well as an anti-viral medicine, such as Tamiflu, just in case.
While flu activity is falling, officials warned Tuesday that H1N1 is far from gone, and the number of visits to doctors nationwide for flu-like symptoms have been at levels not seen in 12 years.
"What's going to happen now with H1N1 is physicians are going to see more people whom they can't distinguish," said Dr. Allison McGeer, an infectious disease specialist at Toronto's Mount Sinai Hospital.
"They're therefore going to prescribe antibiotics for them, so they're going to prescribe antibiotics for a lot of people with influenza. What the H1N1 outbreak is going to drive is a substantial surge in antibiotic prescribing, which is then going to result in more antibiotic resistance."
McGeer understands the dilemma. "You see somebody in your office who is on day four [of illness], they've still got a fever, they've got green [secretions from their nose], and you look at them and you think, they might be developing a bacterial infection. And so you treat them with antibiotics for insurance.
"But it's really just influenza, that's what influenza does. The problem is you can't tell that absolutely, and in order to be sure you give them an antibiotic," she said. "A big piece of it is about teaching people about the natural history of influenza, what it's supposed to look like, and understanding when you should, and should not intervene with antibiotics."
But the flip side is the risk of misdiagnosing serious bacterial infections as H1N1.
