Antibiotics: A Balancing Act

A mother brings her 2 year old boy to see their health care provider after the baby has been sick for a day. After examining the baby, the clinician assesses that this is likely a viral illness and recommends rest and fluids. The mother asks if she can have an antibiotic prescription because that had made her feel better when she was sick. The health care provider is initially hesitant….. but ultimately complies and writes an antibiotic prescription. What went wrong?

Unfortunately, antibiotics are not wonder drugs that can cure any ailment. They have specific indications to help the body fight bacterial infections. Viral infections such as the common cold, the flu, and frequent causes of earaches, sore throats, or a wide variety of ailments will not be helped by antibiotics (outside of a potential placebo effect). Worse, improper use of antibiotics can cause real harm.

No medications are without side effects, and antibiotics are no exception. Penicillins and cephalosporins, two of the most common classes of antibiotics used in the outpatient setting, can cause rash or diarrhea. Further, these medications can kill protective bacteria in the gut leaving one susceptible to gut infections by more harmful bacteria. In addition, improper antibiotic use is linked to increasing antibiotic resistance. A real global health concern of the 21st century is that many bacterial infections will not have proper antibiotic treatment due in part to excessive and needless antibiotic use. If we want our antibiotics to be useful for us when we are really sick, we need to be careful not to use them when they will not help.

When your clinician recommends against using antibiotics, they are doing so with careful consideration of a number of factors. They ask not only ‘will this help?’ but ‘how can this harm?’ Balancing the scale between benefits and harms can be a tricky proposition, especially when clinicians and their patients see the potential harms and benefits differently. Health care providers and their patients need to work together to ensure that antibiotics are used appropriately to maximize benefit and minimize the risk of harm to ensure that antibiotics will be effective for many years to come.

By Ross Ehmke, MD, Columbia University 

Dr. Ehmke is the son of Aspire Indiana Health COO Syd Ehmke 

 

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