How to navigate the antibiotic highway

As many as 50% of the antibiotics prescribed in the United States may be unnecessary or inappropriate. This contributes to antibiotic resistance, avoidable side effects, and increased cost of care.

Like driving on a multilane highway, using antibiotics appropriately can be complex. But like driving, it’s made easier by following some basic evidence based rules, while unexpected events may intervene to change the route.

this post updated October 28, 2022

Most medical experts believe we need to STOP using unnecessary antibiotics. (photo from Pixabay)

As many as 50% of the antibiotics prescribed in the United States may be unnecessary or inappropriate. This contributes to

  • antibiotic resistance ,
  • avoidable side effects of the drugs, and
  • increased medical cost without benefit.

The best source of medical advice for you personally is your own doctor, or one who talks to and examines you.

Exceptions to rules exist, every medical situation is unique.  So although these recommendations are firm, they are not absolute. This is just a partial list which includes most but not all common infections.

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STOP- don’t treat these with antibiotics

Most upper respiratory infections including

Acute viral gastroenteritis, aka stomach flu, with nausea, vomiting, and/or diarrhea

Some of these may be treated with anti- VIRAL medication, not antibiotics.

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SLOW DOWN- these may not need an antibiotic, at least not immediately

Ear infections -otitis media

Sinusitis– sinus infections

spider or tick bites– many of these are not bites at all, but are other skin diseases, including bacterial infections (see below)

sore throats– pharyngitis or tonsillitis

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GO- these infections usually need antibiotics to resolve successfully

Urinary tract infections- this includes the kidney, bladder, prostate

Skin infections including animal and human bites

Pneumonia (although can can be due to viruses, especially in children)

Whooping cough –pertussis

Lyme disease and Rocky Mountain Spotted Fever- these are both transmitted by tick bites; but not all tick bites result in infection

Sexually transmitted diseases caused by bacteria – gonorrhea, chlamydia, syphilis

Any infection severe enough to require admission to a hospital- including infections of any internal organ, bones, joints, brain; included here are infections which develop during a hospital stay

Check out the links for more info.

(By the way, I hope you enjoyed the photos. I took them at a Veterans Day parade.)

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exploring the HEART of responsible antibotic use

Thank you for  viewing  the advertisements and visiting my resources page for services that fund this blog; with your continued help, we can grow, reach more people, and support worthy causes that bring health and wholeness to people around the world.

Dr Aletha

6 smart facts about antibiotics

You may think of antibiotics as safe, harmless drugs with no potential for serious effects. Usually antibiotics are well tolerated and safe. But serious side effects are possible and dangerous, though rare.

Antibiotics save lives.

“The discovery of penicillin in 1928 by Alexander Fleming was one of the greatest scientific achievements of the 20th century. It’s hard to imagine a world before the development of what many consider to be miracle drugs; however, just 90 years ago antibiotics weren’t available.”

CDC website

Prior to the discovery of penicillin, infectious diseases frequently caused death, probably the most common cause prior to the mid-20th century.  Now they have been surpassed by heart disease, cancer and trauma.

We are less likely to from an infectious disease because of immunization, improved hygiene, sanitation, safe food and water, improved nutrition, and antibiotics. However, changes in our environment and genetic changes in bacteria and viruses create opportunity for infectious diseases to become new and deadly threats.

digitally colorized photomicrograph, of a number of Streptococcus pneumoniae bacteria
This digitally colorized photomicrograph, reveals the presence of a number of Streptococcus pneumoniae bacteria in cerebrospinal fluid (CSF) after the patient had begun treatment with 5 units of penicillin. public domain courtesy CDC/ Dr. M.S. Mitchell

Antibiotics are used to treat infections caused by bacteria.

In a broad sense, the word antibiotic could refer to any drug that kills or stops germs, or in other words, organisms that cause disease. But we usually reserve it to refer to bacteria type organisms. There are many families of bacteria; two of the most common are the Streptococci, or Strep and the Staphylococci, or Staph (pronounced staff). There are different drugs that work on other infections caused by viruses, fungus, and parasites.

Prevalence of High Level Penicillin Resistance in Streptococcus pneumoniae, United States.
This image was produced, by the Centers for Disease Control and Prevention (CDC) in 1997, It lists the percentages of penicillin resistant S. pneumoniae infections, during 1987, 1991, and 1993-94, based on data collected by both the Morbidity and Mortality Weekly Report (MMWR), The Journal of Infectious Diseases. Note how over this 8-year period, there was a steady increase in the occurrence of high level penicillin resistance. public domain

Ear infections may or may not need treatment with an antibiotic.

Ten years ago we thought all ear infections must be treated with antibiotics. Now we know that some resolve spontaneously, so antibiotic prescribing is not automatic. In some circumstances, they are still recommended

  • Infants less than 6 months old
  • Toddlers under 2 years old with both ears infected
  • A ruptured ear drum (perforated tympanic membrane) with pus draining

In other cases, it may be safe to wait 2-3 days before giving an antibiotic if symptoms have not resolved.

6 smart facts about antibiotic use
graphic created by the Centers for Disease Control,

A sore throat usually gets better without an antibiotic.

Unless it is due to an infection with the Streptococcus bacteria, “Strep throat”. Greater than 90% of sore throats are caused by viruses, including those which cause colds and influenza. Mono, the “kissing disease”, (infectious mononucleosis) is also caused by a virus called Epstein-Barr. None of these are treatable with antibiotics, although influenza symptoms can be lessened with an anti-viral drug.

Strep throat is usually treated with penicillin but symptoms may not get better any faster than without. The goal in using an antibiotic is to prevent rheumatic fever, a complication of strep which is now rare in the United States.

a man taking his temperature
Photo credit Lauren Bishop-CDC/ National Center for Emerging and Zoonotic Infectious Diseases (NCEZID)

 The color of mucus, pus, or drainage does not determine the need for an antibiotic.

Some infections may cause characteristic colors or odors, but that alone is not used to diagnose or treat bacteria. If there is pus or other drainage, a sample may be collected and sent to a lab for a culture- attempting to grow any bacteria present. Sometimes this is misleading, since our bodies harbor lots of bacteria normally.

a woman taking her temperature
This photograph depicted a woman who was using a modern, battery-powered oral thermometer, in order to measure her body temperature. In order to return an accurate reading, this particular type of thermometer needed to be placed beneath the user’s tongue, for a set amount of time, beeping when the ambient, sublingual temperature was reached. Photo credit-James Gathany, CDC, public domain

Like all drugs, antibiotics have potential risks.

You may think of antibiotics as safe, harmless drugs with no potential for serious effects.  Usually antibiotics are well tolerated and safe. But serious side effects are possible and dangerous, though rare.

Here are some of the potential serious risks of popular frequently used antibiotics

  • Penicillin- anemia (loss of red blood cells), injury to kidneys and nerves
  • Cephalexin- seizures, liver problems leading to yellow jaundice
  • Sulfa- increased sensitivity to sunlight, inflammation of the pancreas
  • Azithromycin (Z-Pak) irregular heart rhythm, injury to liver and pancreas
  • Ciprofloxacin- seizures, depression, rupture of tendons

exploring the HEART of using antibiotics wisely

Dr Aletha

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