Do you really need that antibiotic?

Fighting an infection with the right antibiotic can feel magical.

Stinging sore throat improves, cough decreases, earache fades. A course can save us from pneumonia and protect us during surgery. The advent of penicillin is hailed as one of the greatest discoveries in medicine.

But an antibiotic can also be tempting. While the medications work by killing or inhibiting the growth of bacteria, we often seek them out for runny noses and chest colds, most of which are caused by viruses. An estimated 28 percent of antibiotics prescribed to children and adults are redundant. When a virus like the flu or Covid causes your symptoms, antibiotics not only don’t help, but they can hurt.

Swallowing an antibiotic is like bombarding the trillions of microorganisms living in the gut, killing not just the bad ones but the good ones too, said Dr. Martin Blaser, author of the book “Missing Microbes” and director of the Center for Advanced Biotechnology. and Medicine from Rutgers University. Drug-resistant bacteria are already present in all of us; beneficial bacteria help keep them in check. When an antibiotic wipes out beneficial bacteria, the resistant bugs can flourish, making current and future infections more difficult to treat. The overuse of antibiotics is destroying our microbes, a crisis with far-reaching consequences that scientists do not yet fully understand. “I think the health care system in general has systematically overestimated the value of antibiotics and underestimated the costs,” said Dr. Blaser.

Antimicrobial resistance is one of the biggest global threats to public health, the US research agency said World Health Organisation. Every year in the United States, it is estimated 2.8 million antimicrobial resistant infections occur, leading to more than 35,000 deaths. If you take a lot of antibiotics, you are at greater risk of developing an antibiotic-resistant infection and spreading it to others. This can contribute to the rise of antibiotic-resistant bacteria, also known as superbugs. To top it all off, taking antibiotics regularly can also make you more susceptible to other diseases.

Antibiotics also disrupt the good gut bacteria responsible for helping with metabolism, digesting food and training the immune system. Researchers are currently investigating whether this can lead to metabolic disorders, such as type 2 diabetes, and autoimmune diseases. Research in animals shows that it leads to chronic diseases. The data suggests this applies to humans too, said Dr. Lauri Hicks, director of the CDC’s Office of Antibiotic Stewardship, but the link between antibiotic use and several chronic diseases requires further research.

In recent years, experts have been calling for an overhaul of the way we use these drugs. “This is a mindset,” said Dr. Sara Cosgrove, professor of infectious disease medicine at Johns Hopkins University School of Medicine. “You have to break away from the traditional – to some extent American – mentality that antibiotics are always good and do no harm.”

Here are some tips for having an open conversation with your doctor about antibiotics.

Find out if you really need an antibiotic.

That is why your doctor suggests an antibiotic. “Say, ‘Okay, doctor, what are we treating here?’” recommends Dr. Jeffrey Gerber, associate professor of pediatrics and epidemiology at the University of Pennsylvania’s Perelman School of Medicine. Gain a clear understanding of the bacterial infection targeted by the antibiotic. Ask if there is a test to make sure the medication is indicated and if you can wait a few days to fill the prescription if you don’t improve.

“A little skepticism is necessary,” said Dr. Emily Spivak, an infectious disease physician at University of Utah Health.

Also ask which medicine has the fewest side effects. Adults and children routinely go to the emergency room because of problems arising from the use of antibiotics. A broad-spectrum antibiotic, which can fight many different types of bacteria, may kill more good bacteria and generally has more side effects, such as diarrhea. These types of medications can also lead to increased resistance to antibiotics, although there are times when this may be the right treatment. Your doctor or pharmacist can explain which type of antibiotic you are being prescribed and also tell you whether a narrow-spectrum option might work.

Whatever you do, don’t ask for an antibiotic: Research suggests that doctors are more likely to prescribe the medication if they think patients expect it.

Ask for the shortest course.

For a long time it was thought that if you did not complete the course of antibiotics, the bacteria could become resistant. But evidence has emerged that the longer you take antibiotics, the more likely you are to be susceptible to them another bacterial infection. “After decades of minimizing the biological costs of antibiotics, medical scientists are finding evidence that longer courses are more harmful than shorter ones,” says Dr. Blaser, who was not involved in the new investigation. “This will change the way we approach treatment duration in the future.”

Research has also shown that shorter courses of antibiotics can be as effective as longer courses of antibiotics for some conditions. When Dr. Starting in medicine, Blaser said, doctors usually treated a simple urinary tract infection with a two- to three-week course of antibiotics. Now it could be three days or less.

The American College of Physicians recommends this shorter courses of antibiotics to treat common bacterial infections, such as community-acquired pneumonia. In most cases, antibiotics are not needed for more than five days.

For most children, the recommended course of antibiotics for a sinus infection has been halved and is now 5 to 7 days; According to the American Academy of Pediatrics, it is similar to community-acquired pneumonia.

However, some doctors still prescribe the longer courses. If that happens, Dr. Hicks to respectfully ask if you need to take the full course.

Chronic or recurring infections may require long-term treatment; a specialist can help make the decision, said Dr. Blaser.

Some experts suggest asking if you can stop your antibiotics when you feel better. “Some patients will have a rocket immune system, be young and healthy, and may be better after just a few days,” said Erin McCreary, a pharmacist and director of infectious disease improvement and clinical research innovation at UPMC.

Reconsider probiotics.

Often, doctors recommend taking a probiotic in combination with an antibiotic, to relieve some of the associated diarrhea and with the idea that it can help restore the range of good bacteria in the microbiome. But Dr. Blaser said the jury is still out: Some findings suggest probiotics may be possible extend the time it takes for the microbiome to return to its pre-treatment state. There’s something proof that probiotics may help prevent antibiotic-associated diarrhea, although this is inconclusive, says Hye-Sook Kim, a program director who oversees microbiome and probiotics research at the National Center for Complementary and Integrative Health.

Probiotics can Reduce the risk of developing the life-threatening infection Clostridioides difficile, which can cause severe diarrhea and inflammation of the colon called colitis. It is usually caused by exposure to antibiotics; those who use them more often are at greater risk.

For the majority of people, Dr. Spivak says that probiotics are “fine to take, I just can’t guarantee that they will make any difference.”

If you are going to take them, you can do so after you have finished your medication. “Practically speaking, it doesn’t make sense to take them at the same time,” since an antibiotic can kill the good bacteria in a probiotic, said Dr. Neil Stollman, a gastroenterologist at Alta Bates Summit Medical Center. in Oakland, California, and a guy from the American College of Gastroenterology.

Of course, even the experts who are critical of antibiotic overuse sometimes take the drug, when it is really necessary. Dr. Blaser himself took a full course after noticing a huge bull’s-eye on his torso, the telltale sign of Lyme disease. And dr. Cosgrove did, too, after her black cat, Angus, scratched her. “The redness was creeping up my arm,” she said. “Antibiotics were certainly indicated.” A short course quickly made it clear. Several years later, neither doctor has used antibiotics since.