When should you take antibiotics?
Antibiotic-resistant superbugs are on the rise and we're being urged
to forgo antibiotics wherever possible to limit their spread. But
serious bacterial infections can only be dealt with effectively using
So when should you take antibiotics? The easy answer, of course, is
when your doctor tells you to. But there's more to it.
know that rates of bacterial resistance track antibiotic usage rates.
So, as a community, the more we take these drugs, the more likely we are
to have superbugs down the line.
Antibiotic myths and facts
• a 2014 poll of workers showed 65% believed taking antibiotics would
help them recover faster from a cold or flu
• 20% of people expect antibiotics for viral infections, such as a
cold or the flu
• nearly 60% of GPs surveyed would prescribe antibiotics to meet
patient demands or expectations
• surgical prophylaxis (giving antibiotics before or during surgery
to minimise the risk of infection) is used in 41% of cases, which is
much higher than the recommended best practice of less than 5%.
Clearly, we still don't understand that antibiotics won't kill
viruses responsible for the flu and many common colds. And a majority of
doctors take a seemingly lackadaisical approach to antibiotic
Antibiotics are amazing drugs that can prevent serious harm and stop
infections becoming fatal. They're often used for:
• lung infections, which include bacterial pneumonia and pertussis
• urinary and genital infections, some of which are sexually
• eye infections (conjunctivitis)
• ear, nose and throat infections (otitis, sinusitis and pharyngitis)
• skin infections (from impetigo in schoolchildren through to more
serious diabetic foot ulcers)
• diarrhoea and more serious gut infections, such as those caused by
In general, a patient will be given antibiotics if her symptoms are
severe (a high fever or skin rash, for instance, or inflammation
spreading around an infection site); she has a higher risk of
complications (such as an elderly patient with suspected pneumonia); or
if the infection is persistent.
Getting it right
To prescribe, the doctor makes an educated guess as to what may be
causing the infection. This is based on knowledge of what type of
bacteria are normally found in these cases and, if available, the
patient's history. But she doesn't know exactly what type of bug is
causing the infection. In the absence of an accurate diagnosis, as well
as to minimise potential risk to the patient, a broad-spectrum
antibiotic is used to "cover as many bases" as possible.
Until we can develop point-of-care technology that can identify a bug
on demand, such broad-spectrum drugs (the grenade approach to bacteria)
are a better option for doctors than targeted specific drugs (a sniper
against superbugs). But the latter is the better long-term option for
the patient and the community, although it may not always work.
One key problem with broad-spectrum 'grenade' antibiotics is that
they can cause collateral damage by killing a lot of good bacteria. We
now know that we have about a kilogram and a half of good bacteria in
our guts that help us digest food. They also 'crowd out' potential nasty
infections caused by bad bacteria.
There are cases where patients on antibiotics end up with diarrhoea,
thrush (a vaginal infection caused by Candida that goes wild when
protective bacteria are wiped out), or nasty infections, such as
Clostridium difficile, that can lead to severe colitis.
And it gets worse: a recent Danish study that followed more than a
million patients found an association between frequency of antibiotic
use and Type II diabetes, generating considerable media interest. It
found people who received more than four courses of the drugs over 15
years were 53% more likely to develop diabetes.
Of course, there's the cause-effect corollary. People who were
already heading towards the disease may simply have been less healthy,
more prone to infection, and hence had more visits to the doctor to get
antibiotics. The study showed an association between antibiotics and
diabetes, not causality.
So where do we stand now? Remember bacterial infections can kill, and
antibiotics save lives, so if you're really feeling crook, go to your
doctor and take her advice. But also think twice. If you have a bad cold
or think you have the flu, remember this may be due to a viral
infection. And using antibiotics could do you more harm than good in the
The real game changer in all of this will be a 'tricorder' diagnostic
that can identify a bug on site. With such a technology, a doctor could
prescribe the right drug, the first time, in time. So be sensible about
using antibiotics and let's keep our eyes on this prize.
- The Conversation