antibiotic use

Let’s get this out: we doctors prescribe antibiotics far too much and far too often.  The development of antibiotics to treat bacterial infections is another major triumph of 20th century medical science that has saved millions of lives.  But like any good tool, it must be utilized in the proper situation to be helpful.  90-98% of upper respiratory infections are caused by viruses.  Now, viruses are very different critters than bacteria.  Some microbiologists question whether its appropriate to even classify them as “living.”  You can dissolve viruses in solution, crystalize them, and in 100 years they can be dissolved and be just as active.  Try that with a bacteria, let alone a human.  Now, penicillin kills bacteria by weakening their cell walls causing them to overswell and burst.  Erythromycin destroys ribosomes, the structures within bacteria that they use to make protein to run their life cycles.  But viruses don’t have cell walls or ribosomes.  These chemicals therefore have no effect on viruses in the same way that you cannot be the vicitm of car theft if you do not own a car.

Most antibiotics are pretty mild and well tolerated but they are far from free of adverse effects:

  • abdominal pain and diarrhea; infrequently this can be severe
  • allergic reactions.  Note that taking an antibiotic does not prove that you will not have a reaction the next time, or the next.  In fact, the more you take, the greater the risk
  • resistance.  This is a danger to each individual as well as a major public health challenge.  

Keep in mind that above is only a partial list.  I will note that >80% of antibiotics manufactured in the US are used in animal feed as a growth agent: yes, antibiotics make livestock grow bigger and fatter faster.  I keep that fact in mind with each presecriptioin I write.

Professional medical societies, with the above in mind, work diligently to develop specific and stringent categories for proper antibiotic use in an effort to avoid overuse.  Here are summaries for sinusitis, strep throat, and otitis media.

I try very hard to follow the above guidelines when prescribing antibiotics. Once, a patient commented to me that she knew I was cautious about antibiotics “because you think they should fight off the infection themselves.”  That is not the reason.  I am not tryinig to be the medical equivalent of the harsh coach making the athlete “tough it out.”  If I can give my patient something that is reasonably safe and will help, of course i will.  But if the illness does not fit into the above, using the antibiotics will be of no benefit, and could likely cause harm: in those situations, using the antibiotics will result in the condition dissipating in 3-5 days and NOT using the antibiotics will result in the condition improving in…3-5 days.  So there is no “up side”–only risk, and that’s the bottom line.

Please contact me with questions, and thanks for following.


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