Antibiotics are one of the greatest innovations of the 20th century, but as we are learning, overuse of antibiotics is now one of the biggest threats facing medicine. Some have called the current overuse of antibiotics the global warming crisis of medicine. Many are still in denial, but the ultimate impact on our health is likely to be enormous.
Antibiotics continue to play a key role in the medical care of sick people, preventing spread of infectious and reducing the complications of diseases. But we are seeing a big increase in the number of bacterial infections that do not respond to standard antibiotic treatments, what we call antibiotic resistance. This occurs when the bacteria change in a way that stops the drug from working. Bacteria that change in this way are sometimes able to pass this ability on to other bacteria.
Antibiotic resistance has resulted because we use antibiotics more than is necessary. One example is when we treat infections that are more likely to be caused by viruses, such as cold, flu, bronchitis, most sore throat, and some ear and sinus infections. Another is when we treat less severe bacterial infections such as some forms of ear infection; sinusitis or strep throat infections that are caused by bacteria, but are self-limiting, meaning that are immune system will fight them off often without needing antibiotic treatment. Antibiotics can be helpful in these situations because they reduce the duration of illness by a day or two, but this is a small benefit that comes at the expense of possibly making the antibiotic less useful when it is really needed.
Why do we overuse antibiotics?
- Test results may show that the infection is most likely to be caused by bacteria.
We sometimes take a throat swab or carry out a test for an inflammatory marker called CRP. This can shows that the infection is more likely to be caused by a bacteria and it may be useful to receive treatment.
- We are often impatient and want to get better quickly to return to work or be healthy for our holiday
Doctors sometimes feel under pressure to prescribe antibiotics to keep their patients happy, especially if they feel they need to recover as quickly as possible. This may be desirable, but comes at substantial costs to our future health as well as the health of others when antibiotic resistance develops.
- Sometimes people start antibiotics leftover from a previous prescription
- Sometimes we feel that if we do not use an antibiotic the infection always goes onto our chest and lasts longer than we would expect.
Infections often spread from one part of our body to another, such as from our nose or throat to our upper chest (bronchitis). This is quite typical of viral infections. Sometimes we have had antibiotics prescribed after a week or two of symptoms and notice that our symptoms get better and think that the antibiotic has helped rather than the infection was just at the end of its course.
- People sometimes buy antibiotics abroad or over the internet
What if the doctor has not prescribed antibiotics and I am not getting better?
We often expect infections get better more quickly in us than they take on average to resolve. Here is a list of the average duration of infections and you will see that cough and bronchitis takes on average around 3 weeks to resolve.
- Ear infection (otitis media): 4 days
- sore throat/pharyngitis/ tonsillitis: 1 week
- common cold: 1½ weeks
- sinusitis: 2½ weeks
- cough/ bronchitis: 3 weeks
If you have an illness that is becoming worse and you have a persistent high fever (for longer than 3 or 4 days), breathlessness, chest pains or you are generally becoming more unwell, then please see your doctor as soon as possible for a review.