When You Need Antibiotics and When You Do Not

Public Domain. | Tuberculosis treatment before the age of antibiotics.

Half of antibiotics prescribed by primary-care doctors are done so inappropriately and are fueling the emergence of antibiotic-resistant superbugs.

So it went something like this. A lot of people got simple infections and often died from them. Then we invented the medical miracle of antibiotics and a lot of people no longer got simple infections and no longer often died from them. And then we started using antibiotics all the time and the bacteria they were meant to fight started fighting back. The bacteria started getting stronger and stronger, and now many of these so-called superbug bacteria laugh in the face of our once-miraculous antibiotics. And voila, welcome to the scary world of antibiotic resistance – which the CDC calls one of the most serious public health problems in the United States and which "threatens to return us to the time when simple infections were often fatal."

How bad is antibiotic resistance?

According to a new report from the Organisation for Economic Co-operation and Development (OECD), superbug infections could cost the lives of some 2.4 million people in Europe, North America and Australia over the next three decades unless more is done to fight antibiotic resistance. As of now, in the United States alone, at least 2 million people each year get infected with antibiotic-resistant bacteria, and at least 23,000 people die from those infections. The antibiotics are useless in the face of these resistant microbes.

In the countries covered in the OECD report, half of antibiotics prescribed by primary-care doctors are done so inappropriately. In the U.S., according to the CDC, about 30 percent of antibiotics – equivalent to 47 million prescriptions – are prescribed unnecessarily in doctors’ offices and emergency rooms.

The importance of using antibiotics correctly

The authors of the OECD report suggest five strategies for tackling this potentially catastrophic healthcare issue, from improving hygiene in hospitals to better diagnostic tools (read more about these strategies starting on page 19 of the report). But the one that caught my eye, and the one that we can begin to address as patients, is to promote a more prudent use of antibiotics. For while the report lists numerous reasons why a doctor may prescribe antibiotics when not necessary, it is often to satisfy the patient's request for them. (The reasons doctors frequently inappropriately dole out antibiotics is fascinating, you can read more about it on page 28, of the report.)

So, antibiotics are often essential and life-saving for fighting infections caused by bacteria. We need antibiotics to tackle serious infections like pneumonia, and life-threatening infections like sepsis. We need antibiotics for people who are at high risk for developing infections, like those undergoing surgery or patients undergoing chemotherapy. Fair enough.

But not all bacteria infections will be helped by antibiotics. The CDC notes, "Antibiotics won’t help for some common bacterial infections including most cases of bronchitis, many sinus infections, and some ear infections."

Here's the key though: Antibiotics will not help you if you have a viral infection. If you are sick from a virus – like a cold, flu, runny nose, or even something like a novel coronavirus (for example, COVID-19) – antibiotics will not tackle the virus. They may be needed to fight secondary infections, but not the virus itself.

Viruses or bacteria: What's got you sick?

when to use antibiotics


The overuse and inappropriate use of antibiotics amongst humans and in agriculture are the driving forces behind antibiotic-resistance, says the OECD report – so it behooves us to only use them when really necessary. Not to mention the side effects, like: rash, dizziness, nausea, diarrhea, yeast infections, and Clostridium difficile infection, which causes diarrhea that can lead to severe colon damage and death. Someone close to me just had both achilles tendons rupture thanks to antibiotics. And of course, people can also have severe and life-threatening allergic reactions.

What to do instead?

The CDC recommends talking with your healthcare provider about the best treatment for your or your loved one’s illness. "If you need antibiotics, take them exactly as prescribed. Talk with your healthcare professional if you have any questions about your antibiotics, or if you develop any side effects especially diarrhea, since that could be a C. difficile infection, which needs to be treated immediately."

The Center explains that simple respiratory viruses usually go away in a week or two without treatment. (If you have more serious symptoms, contact your doctor.) And in the meantime, there are ways to make yourself feel better, which you can ask your doctor about.

And it never hurts to not get sick in the first place. Washing your hands properly is your first defense; get a flu shot. And if you do get sick, spare the others – cover your cough (and careless spitting and sneezing!) and stay home if you can.

TB poster

Wikimedia Commons/Public Domain

This updated story was originally published in 2018. In times of pandemic (hello, 2020), stay up to date with the COVID-19 pages from WHO and the Centers for Disease Control.