Campus Life

The Medical Minute: Antibiotic resistance a growing problem

The Medical Minute: Antibiotic resistance - The case for careful use of antibiotics
by John Messmer, M.D.,
Penn State Milton S. Hershey Medical Center

You wake up with a scratchy throat. By the end of the day your nose is stuffy, your throat really hurts and you're getting a cough. You are going away in a few days, and you want to feel well so you call the doctor and get an appointment for the next day. By then you have a fever of 101 and pressure in your cheeks and ears. The doctor examines you and recommends rest, lots of fluids and a decongestant. What about an antibiotic? Don't you need an antibiotic to get better by the weekend?

The simple answer is no. Antibiotics are designed to kill bacteria and upper respiratory infections are almost never bacterial at the beginning. Even common ear infections in children start out as viruses. Antibiotics won't be effective because viruses don't have the internal chemistry that antibiotics work against.

So what could it hurt to cover for the possibility of a bacterial infection? Sometimes viral respiratory infections do weaken our defenses against bacteria. However, giving an antibiotic before it's needed can actually make us much worse. Plus, unnecessary use of antibiotics can contribute to the problem of antibiotic resistance—which can lead to the creation of a so-called "super bug" and make some antibiotics less effective.

We have many types of bacteria in our bodies when we are well. Most are harmless, some are beneficial and a few are potentially harmful. Usually the harmless bacteria are in the majority and help keep the bad bugs from growing out of control. Antibiotics, especially "broad spectrum" types, easily kill the harmless bacteria. With the competition out of the picture, the bad bacteria are free to grow and cause disease. Moreover, we can spread these bad bacteria to other people.

When we use the wrong dose or the incorrect antibiotic—someone else's antibiotic used to fight a different infection—not only do we kill the good bacteria, the bad bacteria can "learn" to develop resistance to these antibiotics. Bacterial resistance can develop through genetic mutations which change its chemistry so that the antibiotic no longer affects it. Other times, bacteria can develop processes to pump the antibiotic out. To make matters worse, often these bacteria can "teach" other types of bacteria to be resistant by sharing DNA among themselves.

It can be difficult to determine exactly when an antibiotic is needed for common respiratory infections. Doctors have been debating this in medical journals for decades. One thing is agreed - indiscriminate use of antibiotics is becoming a serious problem. Research has shown that through conscientious effort to use fewer antibiotics, we can restore the proper balance of bacteria in our communities.

As patients, we can help by working with our physicians to use antibiotics only when they are likely to help. Symptoms of colds and viral respiratory infections are worst for the first two or three days then they get slowly better over the next 10-12 days. Unless your symptoms are increasing, an antibiotic is not likely to help. If your doctor does prescribe an antibiotic, be sure to take it as prescribed and finish the entire prescription. Because the inflammation and congestion of our sinuses may take a couple weeks to resolve even though the infection is gone, do not assume you need more antibiotic. Discuss the situation with your doctor.

Do not use left over antibiotics from your or another person's prescription. It may be the incorrect antibiotic, the wrong strength, and it will very likely be too short a course. Plus it may not be necessary so taking it may cause a worse infection with a resistant bacterium.

Doctors sometimes assume their patients want an antibiotic so they prescribe one to satisfy them. Recent studies have shown that this is not as common as doctors once thought. You can help by telling your doctor you do not want an unnecessary antibiotic. If none is prescribed, ask what symptoms you should report that would suggest the need for an antibiotic later in the course of the illness.

Working together, we can preserve the effectiveness of antibiotics for years to come. For more information on antibiotic resistance, go to: http://www.niaid.nih.gov/factsheets/antimicro.htm

Last Updated March 20, 2009