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Olympics Offer Model for Cutting Antibiotic Use: Presented at ACP

By Jane Salodof MacNeil

SAN DIEGO, CA -- April 8, 2003 -- The 2002 Winter Olympics in Salt Lake City are an example of how antibiotic use can be minimized with a strategy of surveillance and antiviral therapy, according to Merle Sande, MD, Program Director, Department of Internal Medicine, University of Utah Health Sciences Center, in Salt Lake City.

Only 10% of patients with respiratory symptoms received antibiotics, according to Dr. Sande, who was in charge of the Olympic Village Polyclinic set up for athletes and their entourages. Those who required treatment for viral infections received targeted antiviral medications.

"The important thing here is the mindset," Dr. Sande said, describing the strategy in response to a question during the infectious disease update at the 2003 Annual Session of the American College of Physicians, held here April 3-5. "You're thinking virus. You know it's virus. You have a test to prove virus and a therapy to treat virus," he said.

Before the games began, Dr. Sande worried about the potential for an influenza outbreak because of the impact of flu at the previous Winter Olympics, in Nagano, Japan. What alarmed him, he said, was an American coach's request that he have lots of "Z-Packs" -- azithromycin (Zithromax) -- for athletes wanting to treat colds.

Instead, Dr. Sande, in his words, "concocted a scheme." When athletes came in with respiratory tract symptoms, he had them flush their noses with 10 c.c.s of saline solution. "We told them, 'We are going to wash out your sinuses and make you feel better,'" he said. "Some came back for seconds and thirds."

Meanwhile, the medical staff tested the secretions, finding pathogens in 40% of 188 people with flu symptoms. These pathogens included parainfluenza, adenovirus, respiratory syncytial virus (RSV), and, though it caused no alarm at the time, in one patient coronavirus.

Instead of antibiotics, the clinic gave oseltamivir (Tamiflu) to those who had influenza -- and to those people who came into close contact with them. Antibiotics were only prescribed for bacterial infections.

The real test came when four members of one team were found to have flu. Instead of waiting for the other members to come in with symptoms, Dr. Sande anticipated the outbreak would spread and treated the whole team.

Confidentiality prevented his saying which team, but Dr. Sande offered a clue: "We got one gold and two silver [medals]." The team's success resulted in coaches sending more athletes to the clinic for testing.

"It was the first time we tried this in a population with enormous heterogeneity in one location," Dr. Sande said, adding, "This was an operational result, not really a study."

Another lesson from the Olympics was the importance of vaccination. The majority of people with flu had not been vaccinated, according to Dr. Sande.

He said he planned to make a strong case for vaccinating athletes before the next Olympics -- and, in response to the original question, that vaccinating schoolteachers and parents of young children might also be a good idea.

"In the long run it is going to be a lot easier to vaccinate people than to change this incredible behavior of ours of using antibiotics for colds," he said.

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