What Are Antibiotics and When Should They Be Used?
Antibiotics are medications which work together with our bodies’ immune systems to slow or stop infections caused by bacteria. Because particular antibiotics are geared toward particular infections, they are best used after careful diagnosis and decision-making to confirm a bacterial diagnosis and match that to the proper antibiotic. Because many common infections are caused by viruses, and antibiotics do not work for viruses, antibiotics should not be used then.
Why Are Americans Overusing Antibiotics and Why This Is a Problem?
This is a bad habit that patients and clinicians have gotten used to over time. We all seem to feel more comfortable when “something is being done” for an ill patient, rather than the watchful waiting that is all that’s truly needed for many infections. It’s a problem because overuse leads to potential complications for patients (allergic reactions, diarrhea, etc.) when no benefit is expectable and antibiotic overuse leads to unnecessary antibiotic resistance.Â
What Is Antibiotic Resistance?
Exposure to antibiotics creates a situation of “survival of the fittest” where the bacteria that survive treatment with antibiotics, and some do, are resistant to that antibiotic and make up a larger percentage of circulating bacteria into the future. This makes it harder and harder to treat future infections with the same antibiotics, so stronger antibiotics are needed, and the cycle continues. This “micro-evolutionary” occurs even when appropriate or necessary antibiotics are used. When antibiotics are overused or used when not needed, that resistance occurs for no good reason.
What Questions to Ask Your Doctor When Prescribed Antibiotics?
Patients should ask what the pros and cons are of treatment and nontreatment with antibiotics in their particular case. This varies according to the baseline health of the patient and by the infection. It can be that different patients with the same symptoms or infection have a different risk/benefit equation. Even the same patient with, for example cough, at different times, may have bronchitis, which rarely benefits from antibiotics, or pneumonia, which does. It’s important to understand the particulars each time.Â
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Antibiotics are powerful life-saving medications. In modern history, the commercial development of antibiotics has saved countless lives and have reduced morbidity and mortality from common infectious diseases. More recently, widespread use of antibiotics has resulted in the emergence of multi-drug-resistant pathogens, and this has contributed to increased morbidity and mortality rates. The public often forgets that antibiotics are not benign drugs and patients may experience adverse effects that can be life threatening including significant drug-drug interactions, anaphylaxis or C. difficile colitis.
U.S. Antibiotic Awareness Week serves as a reminder to clinicians and the public on the importance of appropriate antibiotic utilization.  An effective Antibiotic Stewardship program is about educating clinicians and patients on when antibiotics should be prescribed, selecting effective antibiotics and choosing the correct duration of treatment, as well as conditions where antibiotics are more likely to cause more harm the benefit. Clinicians need to stay up to date on guidelines and recommendations to avoid outdated treatment that do not improve outcomes and potentially exposing patients to risk.
In the era of social media, there is tremendous pressure placed by patients on clinicians to prescribe antibiotics through outdated information. Patients may incorrectly believe that antibiotics are beneficial for viral illnesses such as influenza and COVID-19. Patients may incorrectly believe that antibiotics will make a viral infection go away faster or antibiotics are benign medications. Patients are often unaware or underestimate the potential harm of antibiotics.
As clinicians, we are advocates for our patients. We need to evaluate each patient’s situation, assessing the risks and benefits of antibiotics and whether antibiotics will improve patient outcomes. By avoiding unnecessary antibiotic utilization, we will reduce risk for adverse effects, as well as preserve these medications for future generations. Remember, do no harm!
