Antibiotics aren't always the answer

You're coughing, achy and weary. You call your doctor, and he prescribes bed rest and plenty of fluids. But wait, isn't there a pill for that? Sometimes, yes. Sometimes, no. Things were simpler a few decades ago when it seemed every ailment could be cured by a bottle of penicillin. To find out what happened, let's take a quick history lesson.

In the 1940s and 50s, the development of antibiotics transformed the way doctors fought diseases by protecting patients against life-threatening illnesses like pneumonia, diarrhea and skin infections.

In the last two decades, fueled by antibiotic overuse, the rise of superbugs accelerated, making a growing number of infections harder to treat.

Today, antibiotics are still a critical tool in fighting bacterial infections. But doctors are a lot more measured about when they prescribe them.

Antibiotic dangers

According to the Centers for Disease Control and Prevention (CDC), at least 30% of the antibiotics used in outpatient settings in the U.S. are prescribed unnecessarily.

Shiva Mahinrad, MD, a family doctor with Baptist Primary Care in Green Cove Springs, said any time antibiotics are used, they can cause antibiotic resistance. This happens when bacteria develop the ability to defeat the drugs designed to kill them.

She acknowledged that it can be hard to tell a patient who is feeling sick to wait for a few days to start feeling better, but sometimes patients don't need antibiotics.

And, though many people think antibiotics are always good, the medications can cause harm too.

“Reactions from antibiotics cause one out of five medication-related ER visits. In children, it's the most common cause of medication-related ER visits,” she said. “Antibiotics can lead to C. difficille infection, which causes potentially deadly diarrhea.”

Antibiotic use and overuse

Antibiotics fight bacteria, not viruses. They can treat illnesses like strep throat, bacterial pneumonia and urinary tract infections. They don't treat common colds, the flu, or most sore throats and sinus infections.

Dr. Mahinrad said upper respiratory tract infections are a big culprit when it comes to antibiotic overuse. Eight times out of 10, these infections are viral, not bacterial.

Typically, patients come in a few days after they've had symptoms, which is usually how long it takes the illness to peak. Then, they start taking antibiotics and think they got better because of it, but the virus actually just cleared on its own, she said.

Doctors stick to clinical guidelines in deciding when to prescribe antibiotics. Many of these haven't changed over the years, but some have. For example, the American Academy of Pediatricians today recommends that when a child has an earache, to watch and wait for three to five days.

Dr. Mahinrad said that wasn't always the case; if a child had an ear infection in the past, they would have been prescribed amoxicillin immediately.

When antibiotics are the right medicine

When doctors do use antibiotics, they screen patients in several ways. Dr. Mahinrad said it’s important to identify the source of the infection, such as the urinary tract, skin or lungs.

A urinary tract infection can be diagnosed by testing the urine. Pneumonia can be identified with a chest x-ray. Strep throat can be found by taking a throat culture.

Fever beyond two to three days is one red flag that a bacterial infection is present. So is an illness that lingers for more than a week, especially if symptoms ease off, and then get worse again.

One thing doctors don't do anymore is prescribe antibiotics over the phone.

"A physical exam is important," said Dr. Mahinrad. "If your lungs sound wet, you’re coughing up colored phlegm, or I see white patches on tonsils, that would trigger me to prescribe antibiotics."