Antibiotics and When to Use Them

30 07 2012

Summer has its share of illnesses, but for most physicians, the “illness season” begins to ramp up in the fall. Colds, sore throats and ear infections, among other illnesses, are much more common.

Patients come to the doctor’s to get better, and for many years that has meant leaving the office with a prescription for antibiotics. Many illnesses were treated unnecessarily, and as a result, antibiotic resistance has increased.

Antibiotics first came into widespread use in the 1940s and revolutionized medical care. Bacterial illnesses, such as pneumonia, strep throat, bladder infections, etc. could now be treated. Within a few years, however, bacteria resistant to penicillin were already present.

Antibiotics kill sensitive bacteria, but resistant ones can survive and multiply. Through the years, antibiotics that used to work for infections become less effective.

While antibiotics work against bacteria, they do not treat viruses. Viruses cause the majority of infections (colds, many sore throats, influenza, most coughs). In many cases, however, antibiotics are prescribed for viruses. This leads to increasing bacterial resistance.

Why are antibiotics overused? The answer is multi-fold. Parents often come to the office with an expectation that they will be given something to make their child better. Doctors want to help people.

In the early years of my practice, it was common to treat for an “early” ear infection, or sometimes, “to head off the illness.” Our knowledge of the natural history of illnesses has advanced. We used to think that if a cold produced yellow or green drainage, this was an indicator of sinus/bacterial infection. Now we know that discolored drainage is a normal part of an illness that may last 10-14 days. Some ear infections will clear up on their own. Sore throats that are not caused by strep do not need an antibiotic.

When antibiotics are needed, the most specific antibiotic is best. Some antibiotics are “broad spectrum.” They kill many bacteria, not just the ones causing the infection. Many of these are newer antibiotics, and while they might be more convenient, taste better, etc, they may be more than is needed, hastening antibiotic resistance.

The advantages of using antibiotics wisely are many. Short term, there will be fewer side effects (diarrhea, rashes, stomach ache), and long term, hopefully, when antibiotics are needed for a serious bacterial infection, they will be more effective.

So, when your doctor says, “Good news, they don’t need an antibiotic,” it really is good news.

By Dr. Katherine Vaughn

Image courtesy of AJC1


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