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Which Antibiotic Is Best to Prevent
Sudden Acute Pneumonia

By Dr. Peter W. Kujtan, B.Sc., M.D., Ph.D.

This article originally appeared on page 22 in the April 5-6, 2003 issue of
The Mississauga News under the feature: Health & Wellness, Doctor's Corner.

The yet unproven but chief suspect in the outbreak is a virus. The possibilities under investigation include coronaviruses, paramyxovirus and influenza viruses. A mutated coronavirus originating in China is first on the list. This family of viruses is one of the less and usually mild common cold viruses. o appreciate the difficulties, consider the differences between bacteria and viruses. Size is the major one. Viruses contain only a protein coat and a small core of DNA or RNA. Some also have a spiky envelope. Viruses cannot reproduce themselves, since they do not carry the machinery required. Instead, they invade cells by attaching to their membranes and injecting their DNA, which then takes over the reproductive machinery. The cell is directed to produce millions of copies of the virus until it swells and bursts releasing the virus to start the cycle again. If we take an average human cell and enlarge it to the size of a football field, bacteria would be about the size of a car parked in the middle of it. A virus would be about the size of one hubcap.

Viruses can easily penetrate most porous surfaces. Bacteria being larger share many features with human cells, with one main difference. They have a rigid cell wall surrounding the cell membrane. Antibiotics exploit this feature and interfere with cell wall synthesis in bacteria to stop growth. Human cells do not have cell walls, so antibiotics do not affect them. Bacteria tend to exist in body fluid and between cells. Viruses, on the other hand are so small and simple, that in essence they can hide in the cell. Viruses are difficult to detect and antibiotics have no action. The few antiviral drugs that do exist simply try to slow down the reproduction process enough to allow the body's immune system to clean up the rest. The soup does thicken at times. Sometimes, even though a person has a primary illness caused by a virus, the body's defenses do weaken and allow a secondary bacteria to invade. In these cases, patients are treated with antiobiotics.

SARS (Severe Acute Respiratory Syndrome) is only a syndrome at this point. It has shown up at the end of our cold and flu season and unfortunately cannot be distinguished from influenza in the early phases. The diagnosis of a syndrome is difficult. It relies on proving what something is not, rather that what it is. For this reason, several blood tests are required to exclude known and treatable causes. Evidence of a new coronavirus has been found in only two cases, and at this point in time routine testing is not available. Chances are good that most adults have encountered a few members of the coronavirus family in our life times in the form of a cold and fought them off successfully. It is thought that the virus spreads in the small droplets of saliva that we expel when we cough.

Human hands function primarily as a tool to bring things to our mouths. Keeping them clean by repeated washing is a good idea. Quarantine is the best way to stop spread. We all know what happens when one family member gets a cold. Only some people who get infected will go on to develop the pneumonia though. The data is just not available to attach percentages to these numbers.

One thing is for sure, taking an antibiotic in the hopes of preventing this health hazard is a false assumption and is not recommended. Much more information will become available about the cause in the very near future. Exercising good and sensible judgment in the meantime is your best defense. Let's not panic.

Related resources:

Severe Acute Respiratory Syndrome (SARS) - What Everyone Should Know - Basic information, frequently asked questions, etc. from CDC.
Severe Acute Respiratory Syndrome (SARS) - Guidelines, recommendations, descriptions, travel advice, etc. from World Health Organization (WHO).
SARS Reference: Severe Acute Respiratory Syndrome (SARS) edited by Bernd Sebastian Kamps and Christian Hoffmann. SARS Reference is a medical textbook that provides a comprehensive overview of severe acute respiratory syndrome (SARS). Access to the online version is free.

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