Monday, November 28, 2005

Antibiotics: When They Can and Can't Help

What are antibiotics?

Antibiotics are strong medicines that can stop some infections and save lives. But antibiotics can cause more harm than good if they are not used the right way. You can protect yourself and your family by knowing when you should use antibiotics and when you shouldn't.

Do antibiotics work against all infections?

No. Antibiotics only work against infections caused by bacteria. They don't work against any infections caused by viruses. Viruses cause colds, the flu, and most coughs and sore throats.

What is "antibiotic resistance"?

When bacteria are repeatedly exposed to the same antibiotics, the antibiotic can't fight the germs anymore. Being exposed to the same antibiotic for a long time can make some germs change. And sometimes germs just change by themselves. Some of the changes make the germs so strong they can fight back against antibiotics and win the fight. Then these germs are said to be "resistant" to this antibiotic.

Antibiotic resistance is becoming a common problem in many parts of the United States. Resistant bacteria develop faster when antibiotics are used too often or are not used correctly.
Resistant bacteria sometimes can be treated with antibiotics to which the bacteria have not yet become resistant. These medicines may have to be given intravenously (through a vein) in a hospital. A few kinds of resistant bacteria are untreatable.

Why should I worry about antibiotic resistance?

If you take antibiotics that can't fight the germs they are supposed to kill, your infection can last longer. Instead of getting better, your infection might get worse. You might have to make several visits to your doctor's office. You might have to take different medicines or go to a hospital for antibiotics given in your veins.

At the same time, your family members or other people you come in contact with may catch the resistant germs that you have. Then they might also get infections that are hard to cure.

Every time you take antibiotics when you don't really need them, you increase the chance that you will get an illness someday that is caused by germs that are resistant to antibiotics.

How do I know when I need antibiotics?

The answer depends on what is causing your infection.

The following are some basic guidelines:

Colds and flu. Viruses cause these illnesses. They can't be cured with antibiotics.
Cough or bronchitis. Viruses almost always cause these. However, if you havea problem with your lungs or an illness that lasts a long time, bacteria may be the cause. Your doctor may decide to try using an antibiotic.

Sore throat. Most sore throats are caused by viruses and don't need antibiotics. However, strep throat is caused by bacteria. A throat swab and a lab test are usually needed before your doctor will prescribe an antibiotic for strep throat.
Ear infections. There are several types of ear infections. Antibiotics are used for some, but not all of them.

Sinus infections. Antibiotics are often used to treat sinus infections. A runny nose and yellow or green mucus do not necessarily mean you need an antibiotic.

How should I take the antibiotics that my doctor prescribes?

Follow your doctor's directions carefully. Your doctor will tell you to take all of the antibiotic. Don't save some of the medicine for the next time you are sick.

What else can I do to reduce the risk of antibiotic resistance?

Wash your hands with soap and water before you eat and after you use the bathroom. Regular handwashing during the daytime will help keep you healthy and prevent the spread of germs.
Ask your doctor if you have all the vaccinations (shots) you need to protect yourself from illness.

Where can I get more information about antibiotic resistance?

Your doctor.

Centers for Disease Control and Prevention


Alliance for the Prudent Use of Antibiotics

APUA Homepage


Using antibiotics sensibly

Antibiotics are often seen as the first line of defense against many infections. But the overuse and misuse of antibiotics can cause more harm than good. Learn more about how to use antibiotics correctly.

You know the feeling — your head throbs, your nose is stuffy and you're too tired to do anything except flop into bed at the end of the day. You're coming down with a bug — maybe a cold or the flu. A visit to your doctor for some antibiotics should help cure your illness, you think.

But think again. If your illness results from a virus — as a cold, the flu and most sore throats do — antibiotics won't do any good. In fact, taking antibiotics when you don't need them can be harmful.

Frequent and inappropriate antibiotic use leads to the development of antibiotic-resistant bacteria. When bacteria outsmart standard antibiotics, you need stronger and more costly medications to treat infections. Because bacteria mutate much more quickly than researchers can develop new antibiotics, the possibility exists that one day soon highly lethal strains of resistant bacteria will evolve — and there won't be effective drugs to kill them.

Improper antibiotic use isn't just a doctor's fault — you share responsibility with your doctor in using antibiotics carefully and correctly. Start by understanding what antibiotics are, when they should and shouldn't be used, and what you can do to combat antibiotic resistance.

What are antibiotics?

Antibiotics are powerful drugs used for treating many serious and life-threatening infectious diseases. Most infections result from either bacteria or viruses.

Bacteria are responsible for:

Most ear infections
Some sinus infections
Strep throat
Urinary tract infections
Viruses are responsible for:
Most sore throats
Most coughs

Antibiotics can help you get better if a bacterial infection causes your illness, but they'll have no effect at all if you have a virus. What's more, taking antibiotics when you don't need them can lead to germs that are antibiotic-resistant.

Superbugs: How antibiotic resistance develops

After the introduction of the first antibiotic (penicillan) in the 1940's, scientists created hundreds of other antibiotics to combat bacterial infections. It took only a few years of using antibiotics before a troubling pattern emerged. Bacteria frequently treated with the same antibiotic would eventually develop resistance to the drug, and a stronger medication would have to be used. The bugs soon learned to resist the stronger drug too. Thus began a cycle of needing increasingly powerful drugs to treat infections.

When you take penicillin or another antibiotic for an infection, the drug usually kills most of the bacteria. But, sometimes a few persistant germs survive. These surviving bacteria can multiply quickly and thrive despite the presence of an antibiotic.

Since bacteria can adapt their cellular structure, they become resistant to future treatment by the same drug. As a result, the antibiotic-resistance bacteria - also known as superbugs - no longer respond to first or even second choice antibiotic therapy. This leaves fewer effective drugs available to treat common but potentially life-threatening illnesses. Unfortunately, superbugs can also exchange survival secrets with other bacteria, even differet species, allowing additional resistance organisms to grow.

For years, the potent intravenous antibiotic vancomycin (Vancocin) provided a reliable last defense against some infections, notably those caused by staphlococcus and enterococcus bacteria. But in recent years, some superbugs have even figured out how to resist vancomycin. A strain of cancomycin-resistant enterococci (VRE) first appeared in the late 1980's and has thrived eve since. Scientists worry that VRE not only will continue to multiply but will share its genetic secrets for survival with other bacteria.

Consequences of antibiotic resistance

As antibiotics continue to be overused and misused, more and more resistant strains develop. As a result, most infections caused by these bacteria don’t respond to typical treatments. Illnesses can last longer, and the risk of complications and even death can go up. Also, failure to treat a particular infection leads to longer periods in which a person is contagious and able to spread the resistant strains to others.

Another consequence is the increased costs associated with prolonged illnesses. According to the World Health Organization, these include the direct costs for additional laboratory tests, treatments and hospitalization along with the indirect costs from loss of income or time away from family. When infections become resistant to typical treatments, unconventional agents come into play. These are usually more costly, and they may have to be given by injection rather than by mouth.

Safeguard effective antibiotics: What you can do

Repeated use and improper use of antibiotics are two of the main causes of the increase in resistant bacteria. Here are some things you can do to promote proper use of antibiotics, which in turn ensures that the drugs will be effective when you need them.

Understand when antibiotics will work and when they won't work to treat an illness. Don't expect to take antibiotics every time you're sick. Antibiotics are effective in treating most bacterial infections, but they're not useful in the fight against viral infections, such as colds or the flu. Each year in the United States, doctors write an estimated 50 million antibiotic prescriptions for viral illnesses — for which antibiotics offer no benefit. Sometimes it's hard to tell whether illnesses result from bacteria or viruses — talk with your doctor if you aren't sure.

Take antibiotics exactly as prescribed. Follow your doctor's instructions in taking prescribed medication, including how many times a day and for how long. Don't stop taking the pills a few days early if you start feeling better. Not completing your full course of antibiotics adds to the antibiotic-resistance problem. A complete course of antibiotics is needed to kill all of the harmful bacteria. A shortened course of antibiotics often wipes out only the most vulnerable bacteria, which allows relatively resistant bacteria to survive and thrive.

Never take antibiotics without a prescription. Antibiotics are drugs only available through prescription. However, if you didn't take the full course of antibiotics that were previously prescribed, you might be tempted to take some of that medication the next time you get sick. Or you might give them to a friend or family member who isn't feeling well. The problem with this practice is that the antibiotic might not be necessary in treating the illness, it might not be the right dose or it might not contain the proper active ingredient to fight the bacteria in your system. All of these can contribute to stronger strains of resistant germs.

Don't pressure your doctor for antibiotics if you have a virus. A prescription for antibiotics won't do you any good if you have a cold or the flu. Instead, talk with your doctor about ways to ease the symptoms of your viral illness. For example, taking a decongestant can help clear a stuffy nose. Or taking medicine such as acetaminophen (Tylenol, others) may reduce fever or muscle aches often associated with influenza.

Protect yourself from infection in the first place. You can keep many germs at bay — and avoid infection — by adopting preventive habits, such as cleaning your hands often, handling and preparing food in a safe manner, and keeping up-to-date on immunizations.

These rules apply to everyone in your family, from your children to an aging parent.


Clean your hands: A simple way to prevent infection
Immunization: Why vaccines are so important to safeguarding health
Runny nose and stuffy nose: Self-care

The scope of your responsibility

If you take antibiotics inappropriately, the resistant microorganisms that you create are a threat not only to you, but also to your family and community. With frequent antibiotic use, resistant organisms persist and become widely established over time. These resistant organisms can cause new and hard-to-treat infections — even in people who haven't abused antibiotics.
Your responsibility in using antibiotics — unlike almost any other medicine you might take — extends far beyond your reach. Responsible antibiotic use protects the health of your family, neighbors and community — and ultimately the global community, too.


Antibiotic-associated diarrhea Bookstore
'Mayo Clinic on Digestive Health' (Softcover)

Web Resources
Centers for Disease Control and Prevention: General information about antibiotic resistance

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