October 25, 2018

Antibiotics: friend or foe?

By dryeongs

Photo by pina messina on Unsplash

Spring is a strange time, isn’t it? One day it’s 30 degrees and we’re grabbing our summer clothes and getting ready for beach days, the next it’s plunged to 18 degrees and the jumpers are back on. With this temperamental weather, as well as the advent of hayfever symptoms, I’ve been seeing a lot of coughs and colds lately. So I thought I’d write a little about antibiotics.

As we probably have heard, the overuse of antibiotics for minor infections has resulted in an increasing problem of antibiotic resistance. This is because overusing antibiotics can result in mutations in bacterial strains making them resistant to the medicine. That means if you try to use the antibiotic for the same bacterial infection again, it won’t work. Worse, you can actually pass these resistant bacteria on to other people, rendering the medication useless for them as well.

A great source about antibiotics and antibiotic resistance is NPS MedicineWise, a not-for-profit, evidence-based organization that aims to improve awareness and facilitate the responsible use of medicines, tests and health technology.

This article does a great job of exploring antibiotic resistance and why we should be saving antibiotics for major infections. In a nutshell:

  • antibiotic resistance is an increasing problem in our community
  • only 1 new antibiotic has been produced over the last 50 years
  • antibiotic resistance is promoted by using antibiotics unnecessarily and not completing the whole antibiotic course

I guess the real point to drive home is that if antibiotic resistance continues the way it has been going, eventually a virulent superbug may emerge that is resistant to all available antibiotics, ultimately resulting in widespread disease and infection.

But of course, that’s a difficult thing to think about when you’ve been at home coughing all night, and you’re feeling horrible and feverish and you’re missing work. Or when your 3 year-old has kept you up all night with his coughing and crying, and you’re completely exhausted.

Let’s explore this a little further.

What do antibiotics do? 
Antibiotics basically act to kill or suppress bacteria.

What don’t they do?
They don’t act against viruses. Most of the coughs and colds in your every day otherwise healthy patient are caused by viruses. This is true whether you have a fever, green snot, green phlegm, body aches, or chesty coughs. While it is true that having a high fever, chest pain, trouble breathing or very thick phlegm when you cough potentially indicate an increased likelihood of bacterial infection, the large majority of these will get better on their own anyway.

Who should definitely have them?
Anyone who is immunocompromised or has some sort of other chronic respiratory condition- such as emphysema, bronchiectasis, conditions like cystic fibrosis, medical conditions that require immunosuppressant medication such as severe rheumatoid arthritis. In these patients with immune systems that may already be slightly suppressed, bacterial infections are much more likely, and are also much more likely to become severe.

Patients who are also getting sicker, not better, or have very severe symptoms may also warrant antibiotics. Having a viral infection can increase your susceptibility to having a bacterial infection, so you should still see your GP if your symptoms concern you. And of course, always go straight to the hospital if you are having chest pain or trouble breathing, or feeling severely unwell.

What problems can they cause?
We have already mentioned antibiotic resistance, but I also wanted to write a bit about gut inflammation, prompted by a query by one of my patients. When you take antibiotics, they affect not just the bad bacteria but also the good bacteria. Your gut contains millions of beneficial bacteria that help you with your digestion, metabolic processes and with your immune system. That is why some people get diarrhoea or stomach problems when they have antibiotics.

Usually these side effects are temporary. But if there is repeated antibiotic use over a long period of time, this may result in problems with the microbiome of your gut, which may contribute to problems such as IBS. This is a developing area of research with only small studies so far, so it’s hard to say anything conclusive. But the main point is, using antibiotics is not as simple as you might think. It is still a medical treatment with risks and benefits, and like every medical treatment, it is your doctor’s job to work together with you and explain the risks and benefits, and decide if the risks are worth it.

So taking antibiotics won’t always get rid of your infection, help you get better faster or prevent a worsening infection. Most of the time you’re getting better because of your own immune system addressing the virus. The most important thing to do is to prepare yourself and help your immune system to stay in shape to prevent you from getting sick in the first place.

So the next time you see your GP for a cold, please keep this in mind and don’t just ask for antibiotics hoping it’ll get you better faster. Remember antibiotics are not the cure-all, and by taking them when you don’t really need them, you might be doing yourself (and others) more harm in the long term.