Is There a Time to Be Anti Antibiotics?

It has probably happened to you or someone you know: A fever develops, you go to your doctor, and insist on an antibiotic. After all, antibiotics are the miracle drugs of our age.

Of course, if it's a virus that made you ill, antibiotics have absolutely no effect. Instead, time becomes the main healer. Still, taking an antibiotic, just to be on the safe side, can't hurt. Right?

No, it's not right. And in the long run, it's not safe, say experts. In fact, so many of us are taking antibiotics when we don't really need them that doctors fear bacteria are building up a dangerous resistance to the drugs.

"The concern is that using an antibiotic frequently or improperly helps breed germs resistant to it," says Mohammad Y. Chaudhary, M.D., a Chicago pediatrician.

A little background

During the World War II era, the use of antibiotics and other antimicrobial drugs became widespread. Now, however, after more than 60 years on the market, many antimicrobials are not as effective as they once were. According to the National Institute of Allergy and Infectious Diseases, tuberculosis, gonorrhea, malaria, and childhood ear infections are now more difficult to treat than they were just a few decades ago. Our overuse and misuse of antibiotics has led to the proliferation of tough, new, drug-resistant bacteria.

Infectious organisms can adapt quickly to new environmental conditions. Bacteria that survive antibiotics can develop the ability to resist that antibiotic in the future.

According to the American College of Physicians, more than 133 million courses of antibiotics are prescribed by doctors each year. Fifty percent of these may be unnecessary, because they are being prescribed for colds, coughs, and other viral infections.

Lack of understanding

Part of the reason for the misuse is that we, as patients, pressure our health care providers to prescribe antibiotics because we think we know what's best for ourselves. The trouble is, as the American Lung Association (ALA) found out in a recent poll, too many of us don't really understand antibiotics at all.

The ALA study found that most Americans take antibiotics improperly. More than half, for instance, don't finish a prescription. This group simply takes the drug until they feel better. More than half admit that they forget to take a scheduled dose at some point. Both instances of misuse not only can lead to a recurrence of the infection, but can also cause the bacteria to build up a tolerance to antibiotics. This tolerance eventually means the antibiotic is no longer effective against the bacteria.

Antibiotics kill the most sensitive bacteria first. If you don't take all your medication, the most resistant bacteria that caused your infection might not be killed and your illness might not improve. Some bacteria could become even more resistant, causing an infection that is more difficult to treat.

"Any antibiotic [if not used properly] can leave behind some of the infectious bacteria," says Wafaa G. Hanna, M.D., a Chicago-area pediatrician.

Building immunity

Much like when a person builds up immunity after being vaccinated against the flu, leftover bacteria can mutate into a strain that becomes immune to the effects of the antibiotic. After a repeat exposure to the antibiotic, the bacteria are able to recognize the antibiotic they have seen before—and defeat it. A steady increase in the use of antibiotics has speeded up the evolution of stubborn new strains of bacteria. These multiply quickly, creating a new generation every few hours.

As hard-to-kill super-germs become more common, antibiotics become less effective.

For the most part, stubborn strains of bacteria can usually be treated with stronger antibiotics. But using a stronger drug when a weaker one should do the job—if taken properly—encourages bacteria to become resistant to both antibiotics, Dr. Chaudhary says

Smart medication use

Scientists are working feverishly to develop new classes of antibiotics. But health officials warn that if we want to count on our future ability to conquer infection, we also ought to become more antibiotic-conservative.

For patients, that means using antibiotics as instructed. Doctors, too, need to become more judicious in choosing antibiotics, and prescribing them only when they're sure an infection is bacterial. Colds and the flu, for instance, are caused by viruses. Antibiotics are ineffective against them.

"Doctors are in a difficult position," says Dr. Hanna. "Many patients view antibiotics as a cure-all and demand them, even though the doctor may suspect or confirm an infection is viral."

We need to stop regarding antibiotics as a pill that can be popped with impunity, says Dr. Hanna.

Proper use of antibiotics

• Always complete the full course of your prescription even if you start to feel better before it's finished. Usually this is seven, 10 or 14 days. Some infections, like sinus infections and prostatitis, can take up to four weeks to treat. Serious infections, such as tuberculosis, may require six months to a year of treatment.

• Always take your medication exactly as prescribed. Remember, more is not better.

• When your health care provider prescribes an antibiotic, always ask why you're getting it. Don't request an antibiotic if your provider thinks it's not needed.

• Always ask questions about side effects and whether the medicine should be taken on an empty or full stomach. Most pharmacists put lots of stickers on the bottle about these things.

• Never share your medicine with your child, spouse, friend, or neighbor whose symptoms appear to be the same as yours. Everyone has different infections and different doses.

• Never save some antibiotics for the next time. Over time, some antibiotics actually become poisonous.

• Never skip doses. Doing so causes the level of antibiotic in the bloodstream to drop, providing bacteria with a "breather." As a result, some bacteria may survive.