Stethoscopes, Part 2: Antibiotics

So, a common question we get all the time in clinic is, "Can't I get an antibiotic for that?"  In short, the answer is probably (like 89.999% of the time) no.  No, no no.  Let's explore for a minute how antibiotics work, what they are used for, and how we use them to treat people.  And, what can happen to you (and to society in general) when you take too many too often.  Before you open that bottle of Mexican antibiotics that you bought while on a cruise 3 years ago, or the remnants of a bottle you failed to finish the last time you had a surgery or something...read this.

OMG, I love this

Antibiotics are compounds (natural and synthetic) that destroy bacteria/fungi or inhibit their growth.  Really, that's all they do.  There are lots of different types: penicillins, cephalosporins, fluoroquinolones, sulfonamides, macrolides, tetracyclines...(I could go on and on...and I didn't even hit the antifungals).  Each type does a certain, really specific thing to very specific types of bacteria.  For example:  penicillins (including amoxicillin, methicillin, etc) work by blocking bacterial cell wall synthesis in a select few types of bacteria...so they can't make their house and they die.  Another example: macrolides (like azithromycin, the "Z-pack" drug) works by inhibiting bacterial protein synthesis because bacteria use a different set of enzymes that we don't have to do that.  These are good for some bacterial upper respiratory infections and STDs like chlamydia (yep I said it....chlamydia).

http://webdesigningresources.com/resistance.php 

May people think that any time they get the sniffles or a sore throat, or get the flu really badly and feel like crap that they need an antibiotic.  Let's look at why that just won't work.  MANY upper respiratory infections and upset tummy/diarrhea bouts are caused by viruses.  Viruses!  Not bacteria.  We don't have many antiviral medications, and the ones we do have are not for common colds or sore-throat causing bugs.  So, entertain for a minute that you indeed have a viral illness (low grade fever, feeling icky, throat is sore but there's no pus on your tonsils, headache, runny nose, cough...sound like you?), and then you take an antibiotic, you are killing off good bacteria in your gut and genital area, because they are all that you have to kill.  Meanwhile, your viral illness is laughing in your face and continuing to blow up your cells.  Finally, in a few days to a week, your immune system gets it's act together and deals with the virus.  You now have diarrhea and maybe a vaginal yeast infection (if you can get one of those, that is) because the antibiotic you took did some damage.  I feel like you're in worse shape than if you just left the virus alone and trusted your white blood cells.

Of course, antibiotics have a strong place in medicine.  Ever since Alexander Flemming did his thing, we've prevented quite an impressive amount of deaths.  Historically, however, antibiotics have been grossly overprescribed, and now medicine is seeing the consequence of that.  We have terrible, antibiotic resistant bugs like MRSA and VRE, along with newly emerging strains resistant to our best fighters.  What happens when we continually prescribe and take antibiotics for things that don't need treating, or worse yet, we don't finish our full course of antibiotics (allowing the best and brightest bacteria to become resistant to the drug we half-gave)?  It leaves the possibility of severe, life-threatening infections that we just won't be able to cure.  We're talking about nasty, uncontrollable wound infections, or swift moving, awful sepsis syndromes that sweep people away.

Diagram of a few of the ways that bacteria become resistant to antibiotics.
From http://www.textbookofbacteriology.net/themicrobialworld/bactresanti.html.

If you're sick, and go to your favorite doctor/health care professional with a prescription pad and they decide that antibiotics would help you because you have a BACTERIAL infection, please take it.  Take the WHOLE prescription, even when you start to feel better.  Don't save some for "next time."  Next time you'll need to go to the doctor again, who will again assess your need for antibiotics and determine the correct type, dose and timing.  We've gone to school a LONG time to be able to do this.