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Student Health explains distribution of antibiotics

For sophomore Alicia Zelek, Sudafed from Duke's Student Health Center just didn't cut it.

"They kept saying it was just a cold, but I wasn't getting any better," Zelek said, who was sick for three weeks. "Finally my mom had to send me antibiotics from home."

Zelek said she has a similar experience she was sick last year and went to see a doctor in Durham. The doctor prescribed her antibiotics and asked her why Student Health had not given them to her earlier.

Many students like Zelek have complained about antibiotics distribution at Student Health, saying it withholds the medication when it is often needed.

Jean Hanson, administrative director of Student Health, said the widespread belief that the clinic has a strict antibiotics policy has been at the root of many conflicts among students, care providers and at times, concerned or angry parents calling from home.

Hanson explained that Student Health has no policy against giving students antibiotics.

"Each student is evaluated, and they are given or not given antibiotics based on the symptoms they have, the history they give, the examination and any lab testing that may have been done," Hanson said.

Another reason for student-doctor conflicts is a misunderstanding among students about the function of antibiotics, Hanson said.

"I think there is a general perception in the population, not limited to students, that there is a pill to fix everything," Hanson said.

The best way to prevent these conflicts is to fully explain to students why they have been given or denied antibiotics, she said.

"We do have a lot of students coming in and saying, 'I get this illness every year, and I get antibiotics for it [back home],' and they get really angry sometimes," Hanson said.

The reasoning behind such careful evaluations, Hanson explained, is the tendency of bacteria to mutate and become immune to medication.

Dr. Keith Kaye, associate professor of medicine and infectious diseases, said there are three ways bacteria acquire resistance.

Some have preexisting genes that make them resistant, some develop resistance through chromosomal mutations and others acquire resistance genes from other bacteria that already have them.

In addition to becoming useless against certain bacterial infections, antibiotics also have other shortcomings, Kaye explained.

"Generally, antibiotics have a very difficult time distinguishing between 'good' bacteria and 'bad' bacteria," he said.

The "good" bacteria line areas of the body like the mouth and colon-serving a protective function-whereas the "bad" bacteria cause infections, Kaye explained.

"You may get diarrhea or a yeast infection because the antibiotics are eliminating the "good" bacteria [in your body]," he said.

Researchers are addressing the failings of oral antibiotics by creating new ways to fight bacterial infections.

Dr. Kim Lewis, professor of biology at Northeastern University, has been working on two innovative techniques.

The first is altering cells so that antibiotics will stay in them better. Lewis' second technique-the creation of sterile surface materials-was featured in the November 2005 issue of Popular Science.

"The idea is to take an antibiotic and tie it covalently by one end to a polymer and attach the end of this polymer to a surface," Lewis said. "Basically, it's like having antibiotics on a leash. On the one end, the antibiotic is immobilized. On the other end, it is still able to get in microbes and kill them."

The antibiotics could be affixed to everything from towels to keyboards, working to keep surfaces clean and preventing the spread of bacteria as a result. Lewis hopes the sterile surfaces will be available within two to three years.

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