Antibiotics: To Prescribe or Not Prescribe?
You are sick and feel miserable. So you go to your doctor for antibiotics to kill what ails you. But instead, your doctor takes a different treatment route that does not include prescribing antibiotics. So why won’t your doctor give you antibiotics? Sometimes drugs can be more harmful than helpful.
When Medicine Meets Resistance
Many things can make you sick; such as bacteria, viruses, fungi, and other microorganisms. The most commonly prescribed antibiotics only work against bacteria. Therefore, they may not be helpful if a virus or other microorganism causes your condition. But when prescribed and taken correctly, antibiotics can be very effective. They can shorten the time you are sick and keep the disease from spreading to others.
However, perhaps because they are so effective, doctors may have a tendency to prescribe them too often. Because of this overuse, over time some bacteria adapt ways to resist antibiotics, making these medicines less effective or unable to work at all.
Antibiotic resistance is harmful because as more antibiotics are introduced into our environment, by either over-prescribing or entering our food chain through their use in the dairy, poultry, and livestock industries, more strains of bacteria have the potential to become resistant. Some that are already resistant to antibiotics are
- Methicillin-resistant Staphylococcus aureus (MRSA)—These dangerous bacteria can cause infections in areas such as the lungs, skin, blood, and bones.
- Multi-drug resistant Klebsiella—These bacteria can cause pneumonia, bloodstream infections, and urinary tract infections (UTIs).
- Multi-drug resistant Escherichia coli— These bacteria can cause digestive system infections, bloodstream infections, and UTIs.
Some bacteria may be resistant to only one antibiotic, while others are resistant to a range of antibiotics. These multidrug-resistant bacteria create a challenge for doctors. Patients with conditions caused by these types of bacteria not only endure longer hospital stays, but they may have to be put on many drugs in hopes that one of the medicines or the combination of medicines will work. Often these drugs can be toxic and ineffective. Patients infected with antibiotic-resistant bacteria are more likely to die from their illnesses.
To Prescribe or to Not Prescribe?
So when is an antibiotic right for you? That is for your doctor to decide. In cases when your doctor decides against antibiotics, it is most likely because a virus causes your condition or it will go away without medicine.
A cold and the flu are caused by viruses. Antibiotics are not useful in treating these conditions or their symptoms. In certain circumstances, a bacterial infection can occur along with a cold and flu. In these situations, antibiotics may be prescribed.
Viruses also cause many runny noses, congested sinuses, coughs, and sore throats. However, these can also be caused by bacterial infections. For example, if your sore throat is caused by bacteria (strep throat), your doctor will prescribe antibiotics.
Viruses or bacteria can cause middle ear infections. Your doctor will determine if antibiotic treatment is needed.
UTIs are often caused by bacteria and are usually treated with antibiotics.
You may also be prescribed antibiotics if bacteria are known to cause your illness or the cause is unknown and the doctor determines it is better to treat with antibiotics than not.
If Given Antibiotics…
If your doctor does decide to prescribe antibiotics, it is important that you follow all dosing instructions carefully and completely. This goes for any medicines your doctor may prescribe.
- Read the label on the medicine bottle, along with any handouts your doctor gave you about your medicine. Follow all instructions.
- Do not share your medicine.
- Do not save your medicine for when you get sick again. It is important to take all of your antibiotics, even if you start to feel better. Not finishing them may allow some of the bacteria to remain alive in your body, which can cause another infection.
Although generally safe, if you are taking antibiotics there are some things you should know:
- Antibiotics might cause side effects or allergic reactions.
- Antibiotics may change the effectiveness of other medicines you are taking. This includes birth control pills.
- There are bad bacteria (the ones antibiotics are designed to fight), and there are good bacteria, like the ones that live in our digestive system to help us break down food. Some antibiotics do not discriminate and kill good bacteria in the process. This can cause upset stomach, diarrhea, vaginal infections (women only), and other unpleasant symptoms.
- Tell your doctor if you are pregnant, think you may be pregnant, or are nursing. Antibiotics may be harmful to your baby.
Now that you are aware of why your doctor may or may not give you antibiotics, it is important that you continue to have open discussions with her about your treatment options. Ask questions. Share any information regarding your medical history. Discuss side effects that concern you. And if you do not understand something, speak up. Having a two-way discussion will help your doctor plan the best treatment approach for you.
Alliance for the Prudent Use of Antibiotics
Centers for Disease Control and Prevention
Pharmacy and You
American Pharmacists Association
Canadian Medical Association
About antimicrobial resistance: a brief overview. Centers for Disease Control and Prevention website. Available at: http://www.cdc.gov/drugresistance/about.html. Updated July 22, 2010. Accessed March 15, 2011.
Antimicrobial (drug) resistance: prevention. National Institute of Allergy and Infectious Diseases website. Available at: http://www.niaid.nih.gov/topics/antimicrobialResistance/Understanding/Pages/prevention.aspx. Updated February 18, 2009. Accessed March 15, 2011.
Consumer & practitioner education. Alliance for the Prudent Use of Antibiotics website. Available at: http://www.tufts.edu/med/apua/consumers/education.shtml. Accessed March 15, 2011.
Last reviewed Updated: 3/28/2011 by David L. Horn, MD, FACP
Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.
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