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    Antibiotics – What, When, Why (and Why Not)

    Christi Pagett, MD Deaconess Clinic West Family Medicine 11/03/2020
    Antibiotics are a marvel of modern medicine and have saved millions of lives.  However, not all illnesses benefit from antibiotics, and the overuse of antibiotics is harmful.

    I want to share information about proper use of antibiotics, preventing illnesses, and how to treat illnesses that don’t require antibiotics.

    I’m glad to be talking about this topic because it’s something I encounter every day in my practice.  When someone comes in not feeling well, they are often hoping for a prescription for an antibiotic that will make the infection go away.

    However, patients frequently have an illness that an antibiotic won’t treat, and giving the antibiotic could cause more harm than good.

    What are antibiotics?
    Antibiotics and similar drugs have been used for the last 70 years. Since the 1940s, these drugs have greatly reduced illness and death from infectious disease.

    However, these drugs have been used so widely and for so long that the organisms [the antibiotics are designed to kill] have adapted to them, making the drugs less effective.

    According to the CDC, each year in the United States at least 2 million people become infected with bacteria that are resistant to antibiotics, and at least 23,000 people die each year as a direct result of these infections.
    That’s why the correct use of antibiotics is so important. 
    What illnesses should be treated with antibiotics?
    Antibiotics are used to treat bacterial infections. Bacterial infections that I see most commonly in my patients include:
    • Strep throat
    • Urinary tract infections
    • Many skin infections
    • Some ear and sinus infections
    • Some gastrointestinal infections, such as diverticulitis
    • Some types of pneumonia
    Other types of bacterial infections can require hospitalization so that the patient can receive more advanced care and IV antibiotics.  Some examples include meningitis, sepsis, serious wound infections, or common infections that became more severe. Again, only bacterial infections respond to antibiotics.
    Which infections and illnesses should NOT be treated with antibiotics?
    Many illnesses are caused by viruses, and viruses do not respond to antibiotics. 
    Some of the common viral infections I see in my office include:
    • Colds
    • Sore throat/pharyngitis
    • Many GI bugs that cause vomiting and diarrhea
    • The flu (influenza)
    • Some ear and sinus infections
    • Some types of pneumonia
    • Hand, foot and mouth disease (which is starting to go around right now especially in young children)
    In all of these illnesses, the most important treatment is symptom management, which always includes adequate fluids and rest.
    How to tell the difference between bacterial and viral infections
    When it comes to GI bugs (vomiting and diarrhea), there are a couple of clues to help you know if you have a viral or bacterial infection; for example, if you have blood or mucus in your stools, see your doctor as this may be a sign of a bacterial infection.  Otherwise, these types of viruses tend to clear themselves after a few days.  The keys are to stay hydrated, and to wash your hands really well with soap and water to prevent the illness from spreading.

    If you have symptoms related to cold/sinus, such as runny nose congestion, coughing, sinus pain, etc., they are often viral in nature; however, you should see the doctor if your symptoms haven’t improved after about 7-10 days, as you could have a bacterial infection.  In the meantime, managing symptoms is key to feeling better.

    Managing Symptoms
    When you’re caring for yourself or a family member who is ill, here are some helpful tips.
    • Keep pushing fluids—especially water. Sports drinks or Pedialyte can be good, but do contain a lot of sugar so use in moderation.
    • Don’t force anyone to eat if they don’t have an appetite. The fluid is more important.
    • Over-the-counter medication, such as ibuprofen or acetaminophen, can help with aches and fever. Note:  If you use a multi-symptom medication, be careful that you’re not overdosing on acetaminophen, as it can result in liver damage.  And if you have kidney disease or are pregnant, talk with your doctor about best medication choices.
    • Other medications that are offered over-the-counter really can be helpful in controlling symptoms such as cough and congestion. For adults, these can be cough syrups, combination medications like DayQuil/NyQuil (again, watch labels to be sure you’re not getting too much of any one ingredient), and medication that loosens congestion.
    • Some cough medications may not help if the cough is caused by drainage.
    • A humidifier in a bedroom or other frequently-used space can make breathing more comfortable.
    • Get lots and lots of rest.
    How To Avoid Illness
    Most people would prefer to avoid getting sick than to figure out how to treat an illness, so I’ll focus on the most important ways to prevent infections from bacteria AND viruses.
    • There are immunizations (vaccines) that prevent many viral and bacterial illnesses. Talk with your doctor about which vaccines you and your family need, and when.  This site from the CDC offers excellent information about vaccines for children, adults, travelers and more. 
    • WASH.YOUR.HANDS. Cleaning your hands well and often is one of the most effective ways to prevent illnesses—both bacterial and viral.  When soap and water aren’t available, hand sanitizer is a good option.  As a doctor and mom, I keep hand sanitizer with me and use it regularly.
    • Do your part to help prevent the spread of illnesses.  If you’re not feeling well and have a fever, stay home.  If you’re getting over a cold or cough, try to avoid exposing other people.  This is especially true for very young children, the elderly, and anyone with a compromised immune system.
    • Also, I want to note:  We’re all taught to cover our mouths when we cough or sneeze.  However, using your hand to do so can lead to all kinds of other things being contaminated.  Teach your kids to cough into their elbow, and to use a tissue properly.
    In Summary
    When you’re sick and go to see your provider or visit an urgent care, know that if the provider decides not to give you an antibiotic, they’ve evaluated you and believe that you don’t have a bacterial infection.

    Proper use of antibiotics helps treat illness, but using antibiotics when they’re not needed causes many problems.

    If you’d like to read more about this topic, the CDC has an excellent resource page, and includes topics such as protecting your family, protecting the food supply, and more. 
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