Inappropriate Use of Antibiotics May be Harmful


The sniffles. A runny nose. A cough. That's right the cold season is upon us. But before you head off to your doctor demanding antibiotics to lessen your symptoms, be aware that those drugs don't always work and can have serious side effects, say two physicians at Washington University in St. Louis.

"People need to remember that antibiotics are used for bacterial infections. A common cold is a virus. Antibiotics simply won't work on viral infections," says David C. Mellinger, MD, associate director and chief physician at the university's Student Health Service. "Antibiotics are drugs prescribed to kill bacteria, not viruses."

Each time an antibiotic is administered, there is a very slight risk of a serious reaction, says Mellinger. But more importantly, with the overuse of antibiotics, bacteria can become resistant to the antibiotic.

"We all have bacteria in our bodies," he says. "If they are constantly exposed to antibiotics, the normal bacteria can become resistant. Those bacteria can then end up actually causing more infections."

This resistance factor can cause the emergence of strains of bacteria that can no longer be killed by a particular antibiotic.

"Penicillin, one of the first antibiotics created, killed many of the bacteria that existed during the last century," says Mellinger. "But over time, bacteria have built up resistance to penicillin. Now, it is really only prescribed for streptococcus, the organism that causes strep throat, and a few other select infections."

Bacteria that are resistant to antibiotics are showing up more and more frequently in hospitals around the United States. Steven J. Lawrence, MD, instructor of medicine in the Division of Infectious Diseases at Washington University's School of Medicine, says the overuse of antibiotics is making it more and more difficult for infectious diseases specialists to manage bacterial infections.

"The discovery and production of penicillin marked the beginning of the antibiotic era, where we finally gained the upper hand in managing bacterial infections," Lawrence says. "But over the last 10 to 20 years, it is becoming more challenging to treat infections caused by bacteria, particularly those that are transmitted in hospitals, because the bacteria are becoming resistant faster than we can develop new antibiotics. In some instances, we have to resort to using toxic medications with potentially serious side effects because they are the only options available to treat infections from the multi-drug resistant bacteria. The inappropriate use of antibiotics for example prescribing them for colds or the flu contributes to the problem."

There are several urban myths revolving around bacterial infections, Mellinger says. One is that if you have yellow or green mucus in your nose it means you have a bacterial infection.

"Actually, it turns out that the body is having a white cell response. That causes the coloration. But it doesn't necessarily point to a bacterial infection, it could be a viral infection as well. With time, the mucus normally thins and clears up. If it doesn't, it might mean antibiotics are a good course of action," he says.

Another myth is that if you have a sore throat, it must be strep throat. The only way to tell if it is strep is to do a throat culture, says Mellinger. "If you have a sore throat, there's no need to demand antibiotics from your doctor. In fact, in adults, strep throat is not very common. It's usually isolated to sore throat and fever and doesn't normally include a cough or runny nose. If you have those symptoms, odds are you don't have a bacterial infection."

Mellinger says he sees many patients who come in with symptoms of a cold and want to be put on antibiotics.

For a cold, it's better to drink plenty of fluids, get rest and maybe try an over-the-counter cold remedy. If your symptoms don't clear up or get worse, by all means, see your physician.

If it turns out you have a bacterial infection, antibiotics may be prescribed.

"Antibiotics are like a lock and key," Mellinger says. "You have to pick the right key for the lock. It doesn't make any sense to give someone a very broad spectrum antibiotic if it won't cover the type of bacteria we think is there."

By changing antibiotic prescribing practices and using them only for bacterial infections in which they are truly indicated, Mellinger hopes doctors can stay ahead of the bacteria and decrease the risk of even more resistant strains in the future.

"Patients need to stop putting pressure on their physicians to automatically prescribe antibiotics. The next time you have a cold, remember colds are caused by viruses and antibiotics won't help; they could actually even hurt you."

Source: Washington University

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