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 infection. But doctors are a lot more measured about when they prescribe them.

Antibiotic dangers

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

One reason antibiotics may be overused is because patients insist their doctors order them, said Jonathan Gonzalez, MD, a family doctor with Baptist Primary Care on Beach Blvd.

"It's hard to tell people who really feel sick to watch and wait for a few days," he said. "But sometimes patients don't need antibiotics. When we treat stuff that can't really be cured by antibiotics, we end up creating resistance."

Antibiotic overuse is no joke. Dr. Gonzalez once treated a patient who was hospitalized for two weeks with a bad skin infection on his leg. He had taken antibiotics for ear and sinus infections many times over the years.

"It took much longer to fight the skin infection. Because of resistance, they had to keep switching between antibiotics to treat him," Dr. Gonzalez said. "People think antibiotics are always good. But they can cause harm too."

Antibiotic use and overuse

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

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

"The problem is patients come in a few days after they've had symptoms, and that's how long it usually takes to peak," he said. "They start taking antibiotics and they think they got better because of the antibiotic, when really, the virus just cleared on its own."

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 Academy of Pediatricians today recommends that when a child has an earache, to watch and wait for three to five days.

"That's one of the big ones," Dr. Gonzalez said. "It used to be, if a child had an ear infection, you would just treat it with amoxicillin immediately."

When antibiotics are the right medicine

When doctors do use antibiotics, they screen patients several ways in making their decision.

The first step is to identify a source for the infection, such as the urinary tract, skin, or lungs, Dr. Gonazalez said. Then, they look for signs that symptoms are being caused by an infection. 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 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.

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

"A physical exam is huge," Dr. Gonzalez said. "If I hear your lungs and they don't sound appropriate, if they have lots of congestion, or you have a really wet throat, that would trigger me to prescribe antibiotics."

For more answers about the proper use of antibiotics, contact your Baptist Health primary care physician. If you don't have a primary care provider, visit baptistjax.com/bpc-appt to find a doctor near you.