Fall is in the air, lots of snow is in the mountains and signs are showing that we are headed for an intense season of respiratory illnesses, making this a good time to share information about when antibiotics are useful and when they only cause harm.
Hospitals have been filled to the brim this fall with children with RSV, a common virus that hits young children and the elderly especially hard. Flu cases have also started climbing, and the rise of these two seasonal viruses seems to be on a collision course with another wave of COVID-19.
When respiratory symptoms become severe, it’s not unusual for people to visit their doctor expecting to get a prescription for an antibiotic, drugs we have come to think of as wonder drugs, for a quick cure. The right antibiotic can be a wonder drug when it quickly resolves a difficult bacterial infection.
But antibiotics do not kill viruses, which are the cause of the common cold, the flu, RSV and COVID. Taking antibiotics when they will not work can harm you without providing any benefits. Common side effects can include rash, dizziness, nausea, diarrhea and yeast infections. More serious side effects can sometimes include a severe life-threatening form of diarrhea. Frequent rounds of unneeded antibiotics have been associated with the development of inflammatory bowel disease.
At University of Utah Health and other health care facilities across Utah, we have teams dedicated to making sure antibiotics are only used when needed and that we choose the right medication at the most effective dose and length of time for the condition. But 80% of antibiotics are used outside of hospitals and up to half are used inappropriately. Primary care providers cite patient pressure for prescribing antibiotics for viral illnesses.
Infections become antibiotic-resistant when the bacteria that cause them adapt and change over time, developing the ability to resist the drugs designed to kill them. The result is that many antibiotics are becoming less effective at treating illnesses. If you take these medicines when they are not helpful, antibiotic-resistant bacteria can grow in your body, and these resistant bacteria can spread to others.
Every patient has a role in protecting themselves from unnecessary side effects and in making sure the drugs we have now continue to work. The first step is to have a basic understanding of how antibiotics work: They kill bacteria that cause infections, but they do nothing to stop viruses.
The next step is to have open conversations with your doctors about whether antibiotics are really needed. Approach your doctor with an open mind about the steps to help you feel better. Sometimes rest and taking time off work when possible is the best approach to healing. Following your doctor’s advice for managing symptoms with things like cough suppressants or ibuprofen is more helpful in many cases than an antibiotic. In other cases, a plan for ongoing monitoring and evaluation, sometimes called “watch and wait,” is better than getting an antibiotic “just in case.”
It is also important to ask your doctor whether you can get better on your own and whether any drugs you are already taking could interact in a bad way with antibiotics.
Avoiding viral infections in the first place is the ideal approach. Get vaccines for flu and COVID right away if you haven’t already. Practice personal infection prevention and protect people around you by staying home when sick, wearing a mask if you or someone at home is sick and must go out in public, and washing your hands frequently.
Antibiotics can be lifesaving when used correctly and should be relied upon when needed to fight off a bacterial infection. But these drugs are a resource we need to use responsibly for our own health and to make sure these life-saving drugs are available for the future.
Emily Spivak, M.D. is an infectious diseases physician and medical director of antimicrobial stewardship at University of Utah Health. The opinions expressed in this piece are those of the author and do not necessarily reflect the views of U of U Health or its leadership.
