Dr. Dylan Wyatt, an emergency medicine physician at Aspirus-St. Luke’s, shares the do’s and don’ts of antibiotics.

What are Antibiotics? When do we need to use them?

Dr. Dylan: Antibiotics are medications that are used to treat bacterial infections. They either kill bacteria or make it harder for them to grow. They’re usually administered by mouth (such as a tablet) or intravenously – though some are given intramuscularly.

We give antibiotics to patients to treat bacterial infections that are not able to be cleared by the body on its own. Something as simple as a skin infection or urinary tract infection up to very complicated infection such as sepsis (a bloodstream infection) or bacterial meningitis (an infection in the brain). The key to this, however, is that these only work against bacterial infections.

What does this have to do with upper respiratory infections?

Dr Dylan: Whenever we see a higher volume of upper respiratory infections – think runny nose, sore throat, coughing, and low-grade fever – there is also a significant uptick in the number of antibiotic prescriptions. There are forms of upper respiratory infections that need antibiotics such as bacterial sinus infection or bacterial bronchitis. However, most upper respiratory infections are caused by viruses which antibiotics have no effect against.

The National Institutes of Health state that around half of antibiotic prescriptions are written unnecessarily for people who have upper respiratory infections. Most people will get better on their own.
I can understand why people want antibiotics, however. Upper respiratory infections feel awful. It makes sense that we want symptoms to go away as soon as possible. There’s just not good evidence that antibiotics help symptoms unless it’s a bacterial infection. In fact, one of the best treatments for certain symptoms is far simpler and safer: for instance, warm honey water for cough has good scientific evidence behind it as does chicken soup for sore throats and colds. This is one of those times that generational or folk remedies can go a long way in helping us feel better.

What’s the harm if we use antibiotics when we don’t need them?
Dr. Dylan: Antibiotics are a medication – and like any substance we put into our body there are effects and side effects. When we talked a few months back about healthy germs in the body we mentioned the gut microbiome, a series of helpful bacteria that have been found to have multiple health benefits. Taking antibiotics wreaks havoc on our gut microbiome – killing off the good bacteria to be replaced by potentially dangerous bacteria.

There are of course additional side effects such as rashes, nausea, diarrhea that are quite common. There’s also the small risk of allergic reaction.

Healthcare professionals and Infectious disease experts are most concerned about the overuse of antibiotics due to antibiotic resistance. Most people have probably heard of this, but don’t realize the risk posed not just themselves but the whole community.

For instance, someone who uses antibiotics frequently is more likely to develop a bacteria that is resistant to those more commonly used antibiotics. We often choose to use “common” antibiotics due to lower side effect profiles – they’re essentially safer. When you induce resistance in bacteria towards these common antibiotics you’re setting yourself up for an infection that requires a more significant type of antibiotic. These often come with higher risks in their side effect profile or sometimes cannot be given by mouth and require hospitalization to be given intravenously.

Sometimes these infections become resistant to multiple antibiotics or even a whole family of antibiotics and are very hard to treat. You probably know the name of at least one of these: MRSA – methicillin-resistant strep aureus. We do have different antibiotics we can use to treat MRSA but the problem is MRSA is now becoming resistant to those antibiotics leaving us less and less means of defense against these quite dangerous pathogens. This is happening across multiple bacteria families and multiple types of infections.

How do we know when we should seek medical attention for antibiotic prescriptions?

Dr. Dylan: When you first start to feel ill, think about what came first: a localized symptom or a general symptom. For most healthy people who start to feel ill from an upper respiratory infection or other viral infection, the first symptoms are feeling tired, achy, or feverish – General symptoms that are felt throughout the whole body. This is in contrast to localized infections that can more often be a sign of bacterial infection “setting in”. For example, a urinary tract infection starts with burning with urination or pressure in the lower abdomen while pneumonia first presents with coughing – especially with a thick dark mucus production. This is not a hard and fast rule, and if you have any doubts or concerns I do recommend you talk to your physician or provider for additional assessment.