Are Antibiotics Really Appropriate for What Ails You? Ask Your Doctor
The discovery of penicillin in 1928 paved the way for combating infections, which are a leading cause of death. But today we live in an era of antibiotic overuse.
Contributor: Ronan Factora, MD
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The discovery of penicillin in 1928 paved the way for combating infections, which are a leading cause of death. But today we live in an era of antibiotic overuse, in which these drugs are frequently prescribed to treat various infections and conditions.
The “bugs” targeted by these medications have, in turn, evolved to become resistant to the very antibiotics that have been protecting us.
We now know that use of antibiotics for bronchitis and upper respiratory infections and prolonged use of antibiotics for treating pneumonia and urinary tract infections has contributed to this epidemic of resistance.
This happens because continued exposure of these bugs to the antibiotics kills off the strains that are susceptible, but allows the ones that are not killed to continue to reproduce.
Some bacteria are now resistant to even the most powerful antibiotics available. The shift means health providers need to take care in their use of antibiotics, saving them only for conditions that truly warrant treatment with these drugs.
One commonly encountered condition treated with antibiotics in older adults is urinary tract infections (UTIs).
A doctor may diagnose a UTI if a person has a fever — in older adults, 99 degrees Fahrenheit or higher — and lower abdominal pain, pain or burning with urination, or a change in urinary habits, such as going more frequently or more often feeling the urge to go.
Lab tests may show an elevation in that person’s white blood cells, which is a marker for infection. If a urine test or a urine culture that is consistent with a UTI accompanies these symptoms, then antibiotics are warranted.
Often, though, doctors prescribe antibiotics for older adults merely because of a positive urine test or urine culture without any of the above signs or symptoms supporting a diagnosis of urinary tract infection.
Studies of urine tests in older nursing home patients suggest that up to 50 percent of residents may have bacteria in their urine. This does not mean they have an infection
– it merely means bacteria is present in their urine, but it is not causing any problem.
This condition, called asymptomatic bacteriuria, is harmless and does not require treatment with antibiotics. Despite this understanding, doctors continue to prescribed antibiotics for it.
Aside from fostering bacterial resistance, overuse of antibiotics can have other consequences.
For older adults, the use of antibiotics increases their risk of developing an infection of the gut caused by the bacteria Clostridium difficile. This is especially true for those who have had multiple courses of antibiotics, who are in the hospital, or who reside in long-term care facilities.
C-diff leads to severe diarrhea that could be potentially life-threatening in frailer and older patients. A person who develops C-diff is at risk for developing it again in the future with any antibiotic exposure, and resistance to antibiotics also makes these individuals more susceptible to infections for which antibiotics may no longer be effective.
Antibiotic stewardship, or the concept of responsibly administering medications only when medical evidence supports their use, now is an important part of medical practice. In addition to physicians, it’s also important for the general public to be aware of when antibiotics should –– and should not –– be administered.
Everyone wants to recover quickly when they are sick. But we have to be sure that the medications prescribed are appropriately used, and don’t do more harm than good.