Do You Really Need That Antibiotic?

A number of common illnesses are commonly treated with drugs that won't cure you, and could actually make you feel worse.

January 6, 2011
woman blowing nose cold flu

Coughing? Sniffing? In a general blue funk? Chances are, if you head to the doctor for one of these complaints, he'll hand you an antibiotic and send you on your merry way.

And there's a fair chance that antibiotic will be completely unnecessary. A nationwide survey of antibiotic use published a few years ago in the Journal of the American Medical Association found that as many as 21 percent of prescriptions issued in one year were for upper respiratory tract infections caused by viruses, for which antibiotics are totally useless. Antibiotics are useful only against bacterial infections.


So why are doctors so willing to prescribe antibiotics for these conditions? Because we want them, says David H. Newman, MD, director of clinical research in the Department of Emergency Medicine at Mount Sinai School of Medicine and author of the book Hippocrates Shadow (Scribner, 2009). "Patients often come in seeking antibiotics and asking for them, and both patients and doctors desire some sort of technological or scientific answer," he says. "It's easier to hand out a prescription for an antibiotic than to spend five or ten minutes explaining that our bodies are supposed to fight those things on their own."

And it's partly due to our own misunderstanding of what an infection actually is. "People don't always realize that 'infection' doesn't mean 'bacteria,'" he says. A lot of infections are caused by viruses, and treating them with antibiotics can contribute to antibiotic resistance, as germs develop immunity to overused medication. Inappropriate use of antibiotics can actually hinder your body's ability to stay healthy, too. "You develop antibodies whenever you get sick, and when you take antibiotics, your body stops making antibodies," he says. Therefore, the next time you're exposed to viruses or bacteria, your body is more susceptible to them.

Plus, antibiotics can leave you with some nasty side effects. They can lead to yeast infections and diarrhea, because they kill off the beneficial bacteria in your gut and mucous membranes that keep infections at bay. A study published last September in the Proceedings of the National Academy of Sciences found that taking antibiotics for as little as three to four days changed the levels of beneficial bacteria in people's GI tracts (which can make you prone to diahrrea).

While you may already know not to take antibiotics for things like the common cold or flu, there are other conditions for which doctors sometimes prescribe antibiotics when totally unnecessary. Here a few alternative ways to treat them:

Bronchitis: Bronchitis is caused by the same viruses that cause colds and flu, and along with those two illnesses, Dr. Newman says they're the three most common conditions treated with antibiotics when they shouldn't be. "With bronchitis, there are still 30 to 40 percent of patients who are given antibiotics," he says. Yet, multiple studies have shown that antibiotics do little to even alleviate symptoms of the disease.

What to do: Follow your mother's advice: Get lots of rest and drink lots of fluids. You can try one of these herbal cold and flu remedies, and a bowl of chicken soup never hurts. Then you just have to let your body do the work. "We're sucking in viruses all the time, and our immune system very efficiently and easily fights them off," Dr. Newman says. "A couple times a year, the virus is going to get into us when we're more susceptible. And we handle it. It doesn't become crippling." If, however, your cough is so bad that you're vomiting, that might be whooping cough, which does require prompt treatment of antibiotics.

Sore throats: Most sore throats, as many as 85 percent of them says Dr. Newman, aren't caused by bacteria. They're viral infections caused by the same viruses that cause colds and flu and therefore won't respond to antibiotics. Still, Dr. Newman has found that as much as 70 percent of people with sore throats caused by viruses receive an antibiotic from their doctors.

Even the remaining 15 percent of sore throats that are caused by bacterial infections may not need to be treated with antibiotics. Strep throat is the most common bacterial throat infection that most kids and adults will contract, and the reason it's treated with antibiotics isn't to cure the sore throat. It's to prevent rheumatic fever, which can develop 20 days after you contract strep throat. The problem with that, Dr. Newman says, the disease is extremely rare in developed countries; the last outbreak in the US was in the 1980s . In his research into the statistical risks versus benefits of using antibiotics, he's found that doctors would need to treat 400,000 people with antibiotics in order to prevent one case of rheumatic fever.

What to do:Antibiotics do help alleviate some of the symptoms of strep throat, he says, shortening your discomfort by about a day. But, he says, so will the over-the-counter anti-inflammatory drugs ibuprofin and acetaminophen. "In randomized trials looking at antibiotics versus anti-inflammatory drugs [for strep throat], you can't tell the difference between who got the antibiotics and who got acetaminophen," he says.

Ear Infections: Much like sore throats, ear infections can be cause by either viruses or bacteria, and sometimes both. A Finnish study published in 2006 found that, in 66 percent of ear infections, both a bacteria and a virus were present, and the authors concluded that the presence of a virus can seriously hinder the effectiveness of antibiotics that are used to treat the bacteria.

And like sore throats, those antibiotics will help alleviate some symptoms, but they're really intended to prevent other diseases, not to treat the ear infection itself. In this case, the two diseases are mastoiditis (an infection of the skull bone) and bacterial meningitis, both of which are relatively rare. (Bacterial meningitis is different from meningococcal meningitis, which gets a lot of media attention because of its sudden and fatal nature. The latter affects college students primarily and isn't related to ear infections. There's also a vaccine to prevent it. ) Dr. Newman says the chance that a child will develop either of those conditions is about one in 10,000 to 20,000.

What to do: "It's not unreasonable to see the doctor when your child has an ear infection," says Newman. After all, ear infections (both viral and bacterial) are the number one cause of hearing loss among children so you want to make sure they get treated. "But most doctors will treat with antibiotics," he adds. Some types of ear infections, like Swimmer's Ear, can be helped with antibiotics, but Dr. Newman says those will only relieve symptoms by a half-day or so. "The tradeoff is that the antibiotics will give people diarrhea, nausea or a rash, and that's not a tradeoff that most people want," he says, especially when you can count on just a half-day's worth of relief. He suggests asking if your child's earache can be treated with anti-inflammatory drugs like ibuprofin and acetaminophen. To help ease the pain, try warm ear drops of mineral oil or baby oil.

Sinus infections (sinusitis): Adults are more likely to contract sinus infections than strep throat or ear infections, but these too are usually treated with antibiotics unnecessarily. These are usually triggered by the same upper respiratory viruses that cause colds, flu and bronchitis. However, a small fraction, 0.5 to 2 percent, of viral sinusistis cases can develop into bacterial sinusitis, which can be helped with antibiotics. Usually, you'll know if sinusitis is bacterial if it lasts longer than 10 days. You also may notice more facial pain than you would with viral sinusitis.

What to do: Since sinusitis is mostly a viral disease, "an antibiotic is more likely to make you miserable, adding on side effects, without curing the problems," Dr. Newman says. In this case, the best medicine is simple rest. "Sometimes it is what it is and you just have to work with your body as it fights off the infection and be a little bit miserable." An anti-inflammatory or a nasal decongestant might help your symptoms, he says, and Rodale's Doctors Book of Home Remedies suggests saline nasal sprays and humidity to help drain your sinuses. "But mainly it's just being a little run down, then you get over it, and you get better," Dr. Newman advises.

When You Do Need Antibiotics

There are certain illnesses that nearly always need antibiotic treatment, says Dr. Newman, and those are pneumonia, bacterial meningitis (to treat it, not to prevent it), urinary tract infections and sexually transmitted diseases caused by bacteria (a number are caused by viruses). "Those are the diseases where it's very reasonable to start with an antibiotic from the get go," he adds. Skin infections, too, often don't get better without antibiotic treatment.

In all other cases, though, he suggests having a frank discussion with your doctor and telling him or her that you'd rather go without antibiotics unless you absolutely need them. "That usually opens up the floor and makes it easier for your doctor to discuss other options with you," he says.