Antibiotic: When Do You Really Need to Take One? – 01/07/2024 – Balance

Warding off an infection with the right antibiotic can seem like magic. Acute sore throat improves, coughs subside, earaches disappear. A treatment can save us from pneumonia and protect us during surgery. The discovery of penicillin was hailed as one of the greatest discoveries in medicine.

But antibiotics can also be dangerously seductive. Although medications work by killing or inhibiting the growth of bacteria, we often turn to them for runny noses and colds that can be caused by viruses. It is estimated that 28% of antibiotics prescribed to children and adults are unnecessary. When a virus like those that cause the flu or Covid is causing your symptoms, antibiotics not only don’t help, they can also harm.

Taking an antibiotic is like bombarding the trillions of microorganisms that live in the gut, killing not just the bad ones but the good ones as well, says Martin Blaser, author of the book “Missing Microbes” and director of the Center for Advanced Biotechnology and Medicine at Rutgers University. Drug-resistant bacteria are already present in all of us, and beneficial bacteria help keep them in check.

When an antibiotic eliminates beneficial bacteria, resistant germs can thrive, making present and future infections more difficult to treat. With the overuse of antibiotics, our microbes are disappearing, a crisis with far-reaching consequences that scientists still don’t fully understand.

“I believe the medical profession in general has systematically overestimated the value of antibiotics and underestimated the cost,” says Blaser.

Antimicrobial resistance is one of the main global threats to public health, according to the WHO (World Health Organization). If you take too many antibiotics, you have a higher risk of developing an antibiotic-resistant infection and passing it on to others. This can contribute to the emergence of antibiotic-resistant bacteria, known as superbugs. Additionally, taking antibiotics regularly can also make you more susceptible to other illnesses.

In recent years, experts have been advocating an overhaul of the way we use these medications. “That’s a mindset,” says Sara Cosgrove, professor of medicine in the division of infectious diseases at the Johns Hopkins University School of Medicine. “You need to get rid of the traditional — to some extent American — mentality that antibiotics are always good and do no harm.”

Here are some tips on how to have an open conversation with your doctor about antibiotics.

FIND OUT IF YOU REALLY NEED AN ANTIBIOTIC

So your doctor suggests an antibiotic. “Say, ‘Okay, doctor, what are we talking about here?'” recommends Jeffrey Gerber, associate professor of pediatrics and epidemiology at the University of Pennsylvania’s Perelman School of Medicine. He clearly understands which bacterial infection the antibiotic is fighting. Ask if there is a test to make sure the medicine is indicated and if you can wait a few days to fill the prescription if you are not improving.

“A little skepticism is in order,” says Emily Spivak, an infectious disease physician at University of Utah Health.

Also ask which medicine has the fewest side effects. Adults and children frequently go to the emergency room for problems resulting from antibiotic use. A broad spectrum, capable of fighting many different types of bacteria, can kill the most beneficial ones and generally has more side effects, such as diarrhea. This type of medicine can also lead to greater antibiotic resistance, although there are times when it may be the correct treatment. Your doctor or pharmacist can explain which type of antibiotic is being prescribed and also tell you whether a narrow-spectrum option might work.

Either way, don’t ask for an antibiotic: Research suggests that doctors are more likely to prescribe the medication when they see patients expecting it.

ASK FOR THE SHORTEST TREATMENT

For a long time, it was believed that if you didn’t finish the entire course of antibiotics, bacteria could become resistant. But evidence has emerged that the longer you take antibiotics, the more susceptible you are to another bacterial infection.

“After minimizing the biological costs of antibiotics for decades, medical scientists are finding evidence that longer courses are more harmful than shorter ones,” says Blaser, who was not involved in the new research. “This will change how we approach treatment duration in the future.”

Research has also begun to show that shorter courses of antibiotics for some conditions can be as effective as longer ones. When Blaser started in medicine, he said doctors would often treat a simple urinary tract infection with two to three weeks of antibiotics. Now it could be three days or less.

The American College of Physicians recommends shorter courses of antibiotics to treat common bacterial infections, such as community-acquired pneumonia. Most cases do not require antibiotics for more than five days.

For most children, the recommended course of antibiotics for a sinus infection has been cut in half and is now 5 to 7 days; It’s the same with community-acquired pneumonia, according to the American Academy of Pediatrics.

However, some doctors still prescribe longer treatments. If this happens, Hicks recommends respectfully asking if you need to do the entire cycle.

Prolonged treatment may be necessary for chronic or recurrent infections. An expert can help make that decision, says Blaser.

Some doctors suggest asking if you can stop antibiotics if you’re feeling better.

“Some patients will have strong immune systems and will be young and healthy, and may improve after just a few days,” says Erin McCreary, pharmacist and director of infectious disease improvement and clinical research innovation at UPMC.