To have a cold? Take an antibiotic?
Earache? Take an antibiotic.
Acne? Take an antibiotic.
That’s what people think anyway. But is this really the best course of action? Does the short-term gain outweigh the long-term consequences? And is there a short-term gain to begin with? Antibiotics do not help with colds caused by a virus. Most ear infections clear up just as quickly without antibiotics. Sure, severe acne gets better with oral antibiotics, but what about the millions of teens who take them for a few pimples?
Every day doctors see problems related to the use of antibiotics. Here are five reasons doctors try to limit its use, and why you should think twice before taking one.
1. Yeast infection. Patients are often unaware that our bodies are covered in germs, both inside and out. The skin, the mouth, the vagina, the gut all have their own population of bacteria. For the most part, these microbes stay where they belong and do what they are supposed to do. One function of the normal flora (normal population of bacteria) is to keep the bad ones at bay. There are always some bad bacteria around, but they are usually crowded out by the good ones. However, taking an antibiotic often kills off the population of good bacteria and allows a different microbe to take over. Most commonly, yeast is the intruder. Once the bacteria get out of the way, the few yeasts that remain on the skin, in the vagina, or in the colon claim the territory as their own. Yeast overgrowth often leads to vaginal yeast or yeast infection symptoms on the skin, usually in warm areas like the armpits, groin, or under the breasts.
2. Clostridium difficile colitis. Just as yeast overgrowth can occur and lead to an infection when normal bacteria are killed off, harmful bacteria can also occur. Frequently, the normal flora of the intestine is susceptible to an antibiotic that is taken for a disease. However, Clostridium difficile (gold against Diff.) it is not removed by common antibiotics such as penicillin, sulfonamides, or erythromycin. The few against Diff. the bacteria you may harbor in your gut won’t harm you as long as their numbers remain limited. But when overgrowth occurs, foul-smelling diarrhea results, sometimes accompanied by fever, dehydration, or the need for hospitalization. C. diff. Colitis requires a different antibiotic to rid your body of this harmful organism.
3. Resistance. As mentioned above, certain bacteria are already resistant to antibiotics. However, the possibility exists that many bacteria may become resistant to useful antibiotics. What if penicillin becomes ineffective for strep throat? In some cases it already is. MRSA (methicillin resistant staphylococcus aureus) is a harmful bacterium that has emerged in recent years due to the overuse of antibiotics. If you remember genetics from your high school, you may know that when bacteria (or people) multiply by the billions, some mutations are inevitable. In the population of microbes, this often means that when billions of bacteria reproduce, some of the daughter bacteria inherit a mutation that makes them resistant to certain antibiotics. Typically, these mutated bacteria, while stronger in the sense that they could survive a penicillin “attack”, are actually weaker in other ways and die naturally but prematurely. However, if the entire population of bacteria is subjected to a round of antibiotics, the weaker but penicillin-resistant bacteria can live on to repopulate the environment. So the next time penicillin is used, it won’t work. Doctors see antibiotic resistance every day. It IS a real threat and, at least for now, we have no new antibiotics on the horizon to use against these resistant bacteria.
4. Nausea, vomiting and diarrhea. Even apart from killing the normal flora in the body, antibiotics can cause nausea, vomiting, or diarrhea on their own. These are chemicals after all, chemicals that the body can reject as foreign. The erythromycin class of antibiotics is especially notorious for causing gastrointestinal symptoms by stimulating naturally occurring intestinal contractions.
5. Allergies to medications. Any patient can be allergic to any medication and antibiotics are no exception. Although an allergy to antibiotics can often manifest itself only as a rash, true anaphylaxis can occur with the use of any antibiotic. Anaphylaxis is a whole-body allergic response that can include hives, nausea, dizziness, itching, swelling, and shortness of breath, much like a bee sting allergy. Any time you think you are having a drug reaction, call your doctor. If you are having trouble breathing or feel like you are going to pass out, call 911. This is a medical emergency.
Just writing this reminds me to be careful when prescribing antibiotics to my patients. The next time your doctor prescribes a round of penicillin or another antibiotic, ask how necessary the medication really is. They are often prescribed out of convenience rather than necessity. If an antibiotic will only cure you a day faster, perhaps it is better to do without it.
Copyright 2011 Cynthia J. Koelker, MD
