Health Tips

To some people, antibiotics are the ‘rockstars’ – Feeling sick? Pop in some antibiotics. Headache? Get some antibiotics. Have body aches? Antibiotics to the rescue!

We can’t pinpoint when and why exactly antibiotics became synonymous to ‘magic bullet’ for some, but here we are.

Don’t get us wrong, antibiotics are one of the best medical innovations from humanity – it saves many lives and prevents countless, unnecessary sufferings. However, just like everything else, too much of a good thing is a bad thing. Misusing antibiotics can bring tremendous harms, and its impacts extend far beyond the individual level.

Here is what you should know about antibiotics.

1. Antibiotics are used to treat or prevent some types of bacterial infection. They do not work for EVERYTHING.

Sorry to disappoint, but as we have alluded earlier, antibiotics are not a cure-all. In fact, antibiotics are only used to treat or prevent certain types of bacterial infections. Let’s repeat: Antibiotics only work against the bacteria. 

Some common bacterial infections that are treated with antibiotics include:

• Strep throat

• Pneumonia (an infection of the lungs) *Note: Pneumonia can be caused by bacteria, virus or fungi. Although bacterial pneumonia is far more common, the recent rise of COVID-19 can lead to pneumonia also, which is an example of viral pneumonia.

• Bladder infections

• Infections you catch through sex, such as gonorrhea and chlamydia

If you have a scheduled surgery, your doctor may prescribe you with antibiotics to prevent potential bacterial infections. If you are a pregnant woman , and the doctor found that there are bacteria present in your urine through a urine test, he or she may prescribe you with antibiotics too. 

Now, here are the cases when antibiotics are NOT helpful:

• Common cold, because it is caused by a virus.

• Flu, because again, it is caused by a virus.

• Sore throat, because most of the time sore throat is caused by a virus. The exception is strep throat, in which case sore throat is one of the symptoms. Your healthcare provider is trained to distinguish a sore throat that is caused by a virus or by bacteria (strep throat). It’s best that you leave the diagnosis with the professionals and do not attempt to self-diagnose.

• Most cases of sinusitis, because sinusitis is usually caused by a virus. Sinusitis that starts out as a viral infection can turn into a bacterial infection, but that takes time. If you have had sinusitis symptoms for less than 10 days, you should not take antibiotics unless you also have a high fever.

• Antibiotics are not helpful for most cases of acute bronchitis (an infection in the airways leading to the lungs, and coughing is one of the symptoms), because bronchitis is usually caused by a virus. If you have bronchitis and cough up green mucus, that does not mean you have a bacterial infection. 

But last time when I felt sick, I took an antibiotic and got better! So I’m gonna get antibiotics again whenever I feel sick.

Even though antibiotics don't work on infections caused by viruses, people sometimes believe that they do. That's because they took antibiotics for a viral infection before and then got better. The problem is that those people would have gotten better with or without an antibiotic. When they get better with the antibiotic, they think that's what cured them, when in reality the antibiotic had nothing to do with it.

2. Overuse of antibiotics leads to antibiotic resistance.

Okay, so what’s the matter if you get better regardless of taking antibiotics? It is not like you cannot afford them. You should take antibiotics no matter what – it is better to be safe than sorry, right? That’s what many doctors thought too, at least in the past. 

However, as we deepened our understanding about antibiotics use, we found a startling truth: the antibiotics do not work as effectively as before. Or to put it in another way, the bacteria has become ‘stronger’ and more resistant towards the antibiotics that are used against them. The bacteria do not die off easily, and humanity is running out of antibiotics that can work against them. 

This is known as antibiotic resistance, and it is one of the biggest public health challenges of our time. Antibiotic resistance does not gather as much news headlines and attention as the COVID-19 pandemic, but its threat is indeed very real. Each year in the U.S., at least 2.8 million people get an antibiotic-resistant infection, and more than 35,000 people die.

When antibiotics are needed, the benefits usually outweigh the risks of antibiotic resistance. However, too many antibiotics are being used unnecessarily and misused, which threatens the usefulness of these important medications. Antibiotic resistance makes bacterial infections harder to treat, and as a result many people suffer from its health and economic consequences.

How can taking antibiotics contribute to antibiotic resistance?

Anytime antibiotics are used, they can contribute to antibiotic resistance. This is because scientists found that increases in antibiotic resistance are driven by three factors:

• Bacteria exposed to the antibiotics

• Spread of those bacteria

Image credit: https://www.cdc.gov/antibiotic-use/community/about/antibiotic-resistance-faqs.html

• Their mechanism of resistance – Bacteria aren’t stupid creatures. Each time humans use antibiotics against them, they try to develop tools and workarounds that can stop the antibiotics from killing them. Occasionally, they hit a ‘jackpot’ and successfully found a way to protect themselves against the antibiotics. If you are interested in the nitty gritty of how the bacteria do that, read here.

Everyone has a role to play in improving antibiotic use. Appropriate antibiotic use helps fight antibiotic resistance and ensures these lifesaving antibiotics will be available for future generations.

3. Antibiotics cause side effects.

Most of the side effects caused by antibiotics affect the digestive system, which happen in around 1 in 10 people who take antibiotics. They include:

• vomiting

• nausea (feeling like you may vomit) 

• diarrhoea 

• bloating and indigestion

• abdominal pain

• loss of appetite

These side effects are usually mild and should pass once you finish your course of treatment. If your doctor prescribes you with antibiotics, you may need to expect some of these mild side effects. If they become unbearable, consult your doctor for advice.

Antibiotic-associated diarrhoea (Clostridium difficile infection)

In healthy people, many different species of bacteria live inside the bowel. Many are harmless or even helpful to the body, but a few have the potential to be aggressive troublemakers. Under normal circumstances, the "bad" bacteria are far outnumbered. So, the bowel's natural balance keeps them under control.

This can change dramatically when a person begins treatment with an antibiotic. This is because antibiotics cannot tell friends from foes – it can go on a killing spree that destroys large numbers of the bowel's normal bacteria, altering the delicate balance among the various species. In most cases, the result is only a mild case of short-term diarrhea that goes away quickly after the antibiotic treatment ends. Occasionally, however, an antibiotic eliminates so many of the bowel's "good" and harmless bacteria that the aggressive "bad" ones are free to multiply out of control. 

"A medical illustration of Clostridioides difficile bacteria, formerly known as Clostridium difficile. Original image sourced from the US Government department: Public Health Image Library, Centers for Disease Control and Prevention. Under US law this image is copyright free, please credit the government department whenever you can”." by Centers for Disease Control and Prevention is marked with CC0 1.0

One type of “bad” bacteria in particular, a species called Clostridium difficile (or ‘C.diff’ for short), can overgrow inside the bowel, producing irritating chemicals that damage the bowel wall and trigger bowel inflammation, called colitis. This can cause abdominal pain, cramps, watery diarrhoea, and fever. In some cases, high-volume diarrhea is so frequent that the person develops dehydration.This is when the body loses too much water. 

To help yourself get better, you can:

• Drink a lot of liquids that have water, salt, and sugar. Good choices are water mixed with juice, flavored soda, and soup broth. If you are drinking enough, your urine will be light yellow or almost clear.

• Try to eat a little food. Good choices are potatoes, noodles, rice, oatmeal, crackers, bananas, soup, and boiled vegetables.

• Ask your healthcare provider if you should take probiotics. Probiotics are bacteria that are good for the intestines.

You should see a doctor if you have:

• Many runny or watery bowel movements in a day

• Blood or pus in your diarrhea

• Fever

• Severe belly pain or a swollen belly

• Nausea

• Signs of dehydration: dark yellow urine and feel thirsty, tired, dizzy, or confused.

Prudent use of antibiotics

If you have read up until this point, we hope we managed to change your view about antibiotics. Antibiotics are double-edged swords: use it wisely then it is a lifesaving medication; misuse it then it can bring harm.

Remember:

• Wash your hands regularly and keep a good personal hygiene to prevent infections, so that you do not even need antibiotics in the first place.

• You should take antibiotics only when a doctor prescribes them to you. 

• You should never take antibiotics prescribed to someone else, and you should not take antibiotics that were prescribed to you for a previous illness. When prescribing an antibiotic, doctors and nurses have to carefully pick the right antibiotic for a particular infection. Not all antibiotics work on all bacteria. 

• If an antibiotic did not work for you before, that does not mean it will never work for you. If you have used an antibiotic before and it did not work, tell your doctor. But keep in mind that the infection you had before might not have been caused by the same bacteria that you have now. The "best" antibiotic is the right one for the bacteria causing the infection, not for the person with the infection.

• If you are prescribed antibiotics, finish all of the medicine and take it exactly as directed. Never skip doses or stop taking the medicine without talking to your doctor. Stopping the antibiotics on your own may give rise to antibiotic resistance.

• Do not pressure your doctor for antibiotics when they do not think you need them. 

• Antibiotics are a Prescriber Category B item in Malaysia, meaning you can’t get them without a doctor’s prescription. You should not buy them at any pharmacies without a doctor’s prescription (and it is also against the law for the pharmacy to sell their customers antibiotics without prescription).

References

1. UpToDate - Patient education: What you should know about antibiotics (The Basics)

2. UpToDate - Patient education: Antibiotic-associated diarrhea (C. difficile infection) (The Basics)

3. CDC - Antibiotic Use Questions and Answers

4. CDC - Antibiotic Do’s & Don’ts

5. CDC - Antibiotic Resistance Questions and Answers

6. NHS - Side effects (antibiotics)

7. CDC - What is a C.diff

8. Harvard Health Publishing - Antibiotic-Associated Diarrhea: What Is It?

Cover image credit: "Mycobacterium tuberculosis Bacteria, the Cause of TB" by NIAID is licensed under CC BY 2.0

Written by

Ms Joyce Toh