When Antibiotics Won't Help

When shouldn't you take antibiotics?

When you don't need them.

Well, that's a bit obvious, but what's less obvious is when is it that you don't need them.

Antibiotics treat infections caused by bacteria. Specific antibiotics only work on specific bacteria. An antibiotic that works on infections X and Y won't work on infections A and B. It's just how it is. Different bacteria are very different; different antibiotics are very different.

Many infections are not caused by bacteria - and cannot be treated by antibiotics. Viruses cause many of the illnesses that make us sick. Antibiotics don't treat viruses. Likewise, antibiotics don't usually treat fungi or parasites that can cause infections.

What's the harm?

Antibiotics used incorrectly can lead to a lot of problems.

  1. Antibiotic Resistance. Increasingly the antibiotics that used to work for common infections aren't working. Antibiotics that used to work may not work anymore against simple bacterial infections like a urinary tract infection or an infected cut.
  2. Microbiome and overgrowth. We are full of bacteria. There are probably as many bacterial cells as human cells in our body. Using antibiotics can flush out whole systems of bacteria in our bodies. This can lead then to some bacteria that we don't like overgrowing. Our intestines, full of bacteria, can then have one type of bacteria overgrow and cause diarrhea - when antibiotics kill off the other bacteria that had kept this bacteria in check. This can lead to infections like CDiff.
  1. The infection won't be treated. Taking antibiotics can give a false sense of security. Sometimes another treatment might have been effective.
  2. Side effects. Antibiotics can always have side effects. It's not a good idea to take a drug when you're sick that won't help you, but might just make you sicker.
  1. Mistaken Allergies. Sometimes the infection is caused by a virus that causes a rash, but if you're already taking an antibiotic, you and your doctor might think that the rash was an allergic reaction to the antibiotic. As a result, many people who take antibiotics for viral infections mistakenly think they have allergies to important antibiotics. This means they don't use these antibiotics in the future when they might have helped - and may use antibiotics with more side effects or that are less effective in the future.

What sort of infections are antibiotics used for when they shouldn't be?

1. A cold

What we call a cold is generally caused by viruses, not bacteria. The flu is also a virus. A standard cold (or flu) does not need antibiotics. In fact, they would do little good.

Respiratory infections that are more serious, like pneumonia, can be caused by bacteria (or viruses). A virus, like one that causes a cold, can also make someone vulnerable to catching a more serious, and possibly bacterial, infection, like pneumonia. It's important if a cold gets a lot worse, especially with a deep cough, problems breathing, or fast breathing that someone does see a health professional; antibiotics may be needed then.

2. An ear infection

Some ear infections need antibiotics; some do not. Those that need antibiotics are only those caused by bacteria; viruses are a common culprit.

The problem is knowing when an infection is caused by a virus and when by bacteria. For ear infections, it's harder to test. We can't just swab deep inside your ear. if a kid is very sick with an ear infection, antibiotics will be used. However, doctors may wait if symptoms are mild (no high fevers, one sided infection, pain mild) to see if the infection resolves in 2-3 days.

3. A sinus infection

Sinusitis often does not need antibiotics.

Sinusitis is often caused by allergies or viruses - which aren't treated by antibiotics. Even when sinus problems are due to bacteria, these infections may pass quickly without antibiotics.

4. A case of diarrhea

It's important to talk to your doctor or nurse before taking antibiotics for diarrhea or picking up a prescription for diarrhea before you travel. Diarrhea, even when caused by bacteria, does not always need antibiotics. Early rehydration is often the most important step. Antibiotics and other drugs may not help. There are, however, cases where antibiotics do help - especially with specific bugs; it's important to discuss this with a medical professional.

Many cases of diarrhea are caused by viruses, like norovirus. Moreover, many cases of diarrhea are associated with antibiotic use; antibiotics may have caused the infection in the first place. In addition, using antibiotics for diarrhea can select out resistant strains of bacteria, causing problems in the future.

5. An infection resistant to or not treated by the antibiotic

Sometimes people will look through a medicine cabinet, knowing they're sick, and take a leftover antibiotic. This antibiotic may do no good. Infections need specific antibiotics. The infection may be resistant to this antibiotic, even if the antibiotic used to work. It may also be that it's an antibiotic that never treated the particular bug causing the infection.

It's important to discuss with a doctor which antibiotic to take.

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