Prevention

Antibiotics: When you need them and when you don’t

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One-third of antibiotics are prescribed unnecessarily, according to a recent study, leading to a surge in antibiotic-resistant bacteria that are becoming increasingly difficult to treat.
Antibiotics often are seen as wonder drugs. And in many ways they are. Antibiotics revolutionized medicine and have saved countless lives over the past century. Unfortunately, many health care providers now rely too heavily on antibiotics and prescribe them when they aren’t necessary. Patients also have come to expect – and even demand – antibiotics every time they get sick.

Nearly one-third of the antibiotics prescribed in the United States aren’t appropriate for the conditions being treated, according to a May 2016 study published in the Journal of the American Medical Association (JAMA).

Why is this a problem? Because it’s led to a surge in antibiotic-resistant bacteria that are becoming increasingly difficult to treat. In fact, the first bacteria resistant to last-resort antibiotic treatment was identified in the United States in May 2016.

If your doctor prescribes an antibiotic (or before you ask for one), learn which conditions they can treat, why antibiotic resistant infections are so scary, and how doctors and patients can be smarter about antibiotic use.

What do antibiotics do?

I often see patients who come in complaining about a cough, sinus pressure, or earache and leave disappointed because I didn’t prescribe an antibiotic. But antibiotics can’t cure everything.

Antibiotics treat bacterial infections. They do not work against infections caused by viruses (viral infections). So which illnesses are bacterial and which are viral?

Examples of bacterial infections:
  • Strep throat
  • Pneumonia
  • Urinary tract infections (UTIs)
  • Skin infections

Examples of viral infections:

  • Cold
  • Flu
  • Bronchitis
  • Most coughs
  • Most sore throats
There are instances in which an illness could be bacterial or viral, such as an ear or sinus infection. The JAMA study found that of the 17 million prescriptions written for sinus infections – the most common reason to prescribe antibiotics – 6 million were unnecessary. For antibiotics prescribed for acute respiratory conditions (like coughs or congestion), only half were deemed appropriate. This is because the vast majority of upper respiratory infections are viral, not bacterial.

Viral infections, for the most part, just have to run their course. Symptoms can last two to four weeks. I know you want them to clear up in a few days, but we never want to give you a medication that you don’t need – especially one that won’t help you get better. While antibiotics are prescribed often, they are not without risks. In fact, one out of five visits to the emergency room for an adverse drug event is due to an antibiotic. One common antibiotic, Azithromycin (more commonly known as a Z-Pak), can cause a potentially fatal arrhythmia in people with pre-existing heart conditions. Even amoxicillin carries a risk of serious side effects.

Besides the risk of side effects, there is another reason to avoid prescribing antibiotics when they are not needed: antibiotic-resistant infections.

The rise of antibiotic-resistant infections

When antibiotics were first discovered, there was a boom in developing new ones. However, that has slowed dramatically since the 1950s. In fact, a new class of antibiotics hasn’t been discovered in the past 30 years. We’ve been prescribing the same drugs for years because they’ve worked – until now.

Bacteria are smart. They evolve in order to survive future antibiotic attacks. The more often an antibiotic is used, the more bacteria develop antibiotic resistance, rendering the drug less effective. This is true even when an antibiotic is used to treat a viral infection. The antibiotic won’t cure the viral infection, but it will attack bacteria that weren’t causing you harm – and the bacteria will adapt to avoid being targeted next time.

As bacteria become resistant to antibiotics, patients may need stronger antibiotics or may need to take them longer. Oral antibiotics may even stop working, and patients will need to switch to IV medications. Or, there may come a point where no antibiotic will work on a particular strain of bacteria.

The Centers for Disease Control and Prevention said 2 million people were infected by and 23,000 died from antibiotic-resistant infections in 2013. One report predicts that by 2050, antibiotic-resistant infections will kill more people than cancer. By working together, we can help ward off this public health threat.

How doctors are curbing antibiotic overuse

As the people prescribing antibiotics, providers need to be at the center of this effort. Every time we go to write a prescription for an antibiotic, we should ask ourselves if it’s truly needed. We also can’t give in to pressure from patients who demand an antibiotic when we know it won’t help them.

Antibiotic stewardship programs have proven to be extremely useful to help us target a particular bacteria with the right antibiotic based on our population. Our infectious disease specialists monitor bacteria and antibiotic resistance patterns in the Dallas-Fort Worth area. Every community uses antibiotics differently. Because of this, bacteria and antibiotic resistant infections here may differ from those in Los Angeles.

For example, if I treat a patient with a UTI that I know was caused by an E. coli bacteria, I can look up the specific bacteria and see what’s called an antibiogram. This tells me which antibiotics are used to treat the bacteria and what percent chance they have of working in the Dallas-Fort Worth population. So if a large number of residents here are resistant to ciprofloxacin, I will choose something else.

Another simple solution doctors can employ to promote responsible antibiotic use is to hang educational posters in examination rooms. A 2014 study found that clinics with signs explaining the risks and benefits of antibiotics and providers’ commitment to responsible prescribing saw 20 percent fewer inappropriate antibiotic prescriptions for acute respiratory infections.

This works on two levels: It creates buy-in from the physician and educates the patient even before the doctor enters the room. This study was new to me, but I think this technique is brilliant and plan to use it in our Richardson/Plano clinic!

Tips for patients to use antibiotics responsibly

We need your help as well. There are three ways you can help fight antibiotic resistance:

  • Do not pressure a doctor to prescribe an antibiotic: You want to feel better fast. We want that, too. However, antibiotics won’t help in every case. Sometimes all we can do is give the illness time to pass. We often get calls from patients a day or two after visiting use who say they still don’t feel better and want an antibiotic. That just isn’t enough time for most viral infections to clear up. You still need a few more days – try to be patient.
We also often field calls from patients who want an antibiotic prescription but don’t want to come in for an exam. It’s important we evaluate you in person because so often these illnesses are viral, not bacterial. We may not be able to tell the difference on the phone.

It’s not unusual for patients to tell me, “Well, last time I had this, antibiotics cleared it right up.” I explain to them that every infection is different. They may have had a bacterial infection last time, in which case the antibiotics would have been effective. It’s also possible that it was a viral infection and their symptoms disappeared after a couple days not because of the antibiotic, but because that’s how viral infections work. The symptoms subside on their own.

  • When prescribed an antibiotic, ask, “Do I really need this?”: Asking forces the doctor to stop and think, “Am I prescribing this properly?” Most doctors will be happy to explain why an antibiotic is necessary for your illness. I often get this question from patients who don’t like medications in general, in which case I explain why an antibiotic is the most effective way to treat their bacterial infection.
If you are prescribed an antibiotic, follow these guidelines:
  • Take them exactly as prescribed.
  • Take all of the medication as prescribed, even if you feel better.
  • Don’t use old antibiotics for a new infection.
  • Don’t share antibiotics with family or friends.

How to help relieve cold and upper respiratory symptoms

As I said earlier, viral infections can linger for two weeks or more. You may feel terrible for three or four days, but then the symptoms tend to fade away. During this time, you can try over-the-counter medications and home remedies to help relieve your symptoms:

  • Cough: Expectorant or cough suppressant, steroid nasal spray, humidifier
  • Nasal congestion and sinus pressure: Nasal or oral decongestant, steroid nasal spray, humidifier
  • Sore throat: Lozenges, humidifier, warm teas with honey and lemon, warm water with salt gargles
  • Fever: Acetaminophen,ibuprofen, or aspirin
If you experience more than one of these symptoms, there are many medications that offer multi-symptom relief. Along with taking medication, stay hydrated and get rest. I know you want to get back to work and your daily life, but your body needs time to heal – plus you want to avoid giving the virus to someone else.

If you have a fever that lasts more than two or three days, go to the doctor. If your symptoms last more than 10 days, or if you start to get better and then get sick again, see your doctor.

Antibiotics are not evil, and we shouldn’t fear them. But we do need to use them responsibly to ensure they continue working when we need them for years to come.


Our doctors can assess whether an antibiotic would work for you. Schedule an appointment online or call 214-645-8300.

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