When to take antibiotics... and when you should just stay home

When you’re sick – or when your kid is sick – you want relief immediately. For many people, that means going to the doctor to get a prescription for antibiotics.

It may surprise you to find out that doing so is often the wrong move. In the U.S., a recent study by the Centers for Disease Control and Prevention (CDC) found that 25 per cent of the general population is under the mistaken belief that antibiotics can treat a cold.

What are antibiotics used for?

Antibiotics kill bacteria and stop bacterial infections. They will help if you have strep throat, bladder and skin infections, and some ear infections, which are all caused by bacteria. Antibiotics will not cure viral infections such as the common cold or flu.

Sometimes a lab test is needed to identify whether you have a bacterial or viral infection, says Maryse Durette of Health Canada.

“We try to avoid antibiotics when we can,” says Hoda Mankal, a nurse practitioner at the Carlington Community Health Center in Ottawa and the Director of Communications of the Nurse Practitioners’ Association of Ontario. “If you take the time and try to educate the patient, and reassure them, let them know when to come back and when to follow up, it eliminates unnecessary second opinions.”

When should I go to the doctor?

“If you have a child less than three months of age, you want to get them assessed sooner rather than later because their immune system is not quite established, and also with the geriatric population,” says Mankal. “If you have a fever or worsening symptoms or any concerns, it’s always good to check in.”

How can I use antibiotics safely and effectively?

“Take antibiotics exactly as directed by your healthcare professional,” says Durette. Make sure you know the correct dosage, when to take them and the duration of the treatment. Do not share the treatment with others.

Only stop taking antibiotics if directed to by a health professional, and to return the extra medication to a pharmacy for safe disposal. Always inform the doctor if you have a bad reaction or side effect.

Antibiotics will never hurt me, right?

Wrong. Taking antibiotics incorrectly can do plenty of harm. Misuse can lead to adverse drug events and antibiotic resistance, says the CDC. They found that 54 per cent of healthcare providers said patients expect a prescription for a viral illness, and even though most (94 per cent) of medical professionals are aware of the risks associated with over-prescribing, “perception of patient expectations for an antibiotic is important, because it has been shown to be a reliable predictor of overprescribing.”

What is antibiotic resistance?

Antibiotic resistance occurs when bacteria that cause illness survive and spread, becoming resistant to the drugs that treat them. It is often caused by the inappropriate use of antibiotics.

A public health concern around the world, antibiotic resistance can make easily treatable illnesses such as pneumonia, tuberculosis and minor illnesses difficult or impossible to treat. Few new antibiotics are being developed, and infections caused by resistant bacteria may be resistant to more than one antibiotic.

Can’t they just create new antibiotics?

“The time course of the antibiotics is usually measured in weeks, and so the amount of antibiotic you can sell is relatively limited,” says Dr. Gary Garber, Chief of Infection Prevention and Control of Public Health Ontario and infectious diseases physician at The Ottawa Hospital.

“The pharmaceutical industry can develop a Viagra pill for women and the market would be larger and the profits would be 100- or 1000-fold,” Garber said. “They focus on Alzheimer’s medications, cholesterol agents, cardiac medications, because when you get a person on that medication they’re on it for years or their lifetime. The development costs of new drugs are so high vis-à-vis the return that many of these companies have not felt it’s worth the investment.”

How can I catch an antibiotic-resistant infection?

“If you are sick, stay at home until you are feeling better,” says Durette. “This helps stop the spread of bacteria and other germs.”

Further good advice is offered on the Health Canada website: “Drug-resistant bacteria spread in the same ways as non-resistant bacteria. They spread from touching, coughing and being exposed to bodily fluids. Surfaces such as doorknobs, keyboard and utensils can also be contaminated, as well as foods such as meat, dairy and fresh produce.”

Who faces the greatest risk?

People with weak immune systems: infants (especially premature babies), seniors, the homeless and others with compromised immune systems due to illness. Anyone who is in close contact with others and who doesn’t practice good hygiene can be at risk, as well as medical personnel.

What is Antimicrobial resistance?

In layman’s terms, there is no effective difference between antibiotic resistance and antimicrobial resistance, explains Garber.

Antimicrobial resistance (AMR) is “now a major threat to public health,” said the WHO in a 2014 report. Common infections and minor injuries, which have been treatable for decades, could once again be deadly.

In some countries, treatment for hospital-acquired infections such as pneumonia, bloodstream infections, and infections in newborns and intensive-care unit patients no longer works for more than half the people treated for these K. pneumoniae infections, said the WHO.

“We have major initiatives in Canada related to antimicrobial stewardship,” says Garber. “Hospital-based programs to try and improve the utilization of anti-microbials to maximize the benefit and minimize the potential toxicities.”

How do you treat patients with AMR infections?

Sometimes we’re limited to the antimicrobials that will work and often those microbials are causing a lot of toxicity, explains Garber. And in some cases if an individual has a serious infection with one of these resistant organisms, there is no effective treatment available. “Sometimes people use combinations, sometimes people die.”

How do medical professionals determine who should get drugs?

“We take into consideration a few fundamental things before we prescribe antibiotics: allergic history, whether they’ve been on antibiotics within the past three months, (because you’d want to choose a different class of antibiotics), and also we use the anti-infective guidelines a lot, and use them as an education piece for patients,” says Mankal.

These guidelines help nurse practitioners educate patients about when to come back for follow-up and how to evaluate if symptoms get worse. “So someone with sinusitis for example, I often say it’s going to last 10 days, you’re going to feel exhausted, but come back to me if you’re spiking fevers, you’re making more and more sputum, and if you start to develop jaw pain, sinus pain, so the anti-infective are really clear,” she says.

Are anti-vaccination advocates using more antibiotics?

Potentially yes. Dr. Garber explains that 20 per cent of common infections such as pneumococcus are resistant to penicillin. Doctors will prescribe a penicillin derivative, but you won’t know for several days if the treatment will work on your illness. “Wouldn’t it be smarter to prevent the infection in the first place by using vaccinations against pneumococcus?” Garber asked.

“If you’re not vaccinated and you get the infection, you may need antibiotics. And if you were vaccinated maybe you wouldn’t have had the infection - so therefore not being vaccinated puts you at greater risk for the need of antibiotics,” he said.

The bottom line: What do I need to know?  

Prevent illness by washing your hands, says Mankal.

Know your body and “recognize that every fall most of us will get a cold and most of us will get better and almost all of us don’t need antibiotics,” says Garber.