Antibiotics are the go-to treatment for many types of infections. Doctors prescribe them, and/or patients demand them, for a wide variety of ailments. But are antibiotics helpful or harmful? That’s not an easy question to answer because antibiotics are helpful, but they also cause harm. Certainly, they help many patients overcome infections. But sometimes antibiotics don’t help patients recover and/or they make patients sicker. Finally, and most importantly, antibiotics collectively are causing great harm as they lead to the spread of dangerous antibiotic-resistant superbugs. Why is this happening? What can you do?
Are antibiotics helpful or harmful?
Antibiotics treat or prevent some (but not all) bacterial infections, by either killing the bacteria or preventing them from reproducing and spreading. Doctors starting using the first antibiotic in 1910. In the 100+ years since, antibiotics have dramatically improved modern medicine and extended the average human lifespan by 23 years.
But it’s not all good news. Read on for information on the helpful and harmful aspects of antibiotic use.
Antibiotics are helpful for certain conditions.
Antibiotics can help patients fight infections. Doctors use antibiotics to attack many types of infections, ranging from mild to serious, including strep throat, whooping cough, urinary tract infections (UTI), E. coli, and sepsis. (Importantly, antibiotics don’t work on viral infections, such as the common cold, flu, most coughs, and sore throats.)
Additionally, antibiotics allow doctors to perform invasive surgeries and prescribe chemotherapy drugs, relying on antibiotics to treat any potential infections that may follow.
Antibiotics can cause harm.
Although antibiotics have been a literal lifesaver for so many, there are serious downsides as well.
Potential side effects range from mild to serious.
As with any medication, antibiotics can cause side effects, some of which can be quite dangerous. Common side effects include rash, nausea, diarrhea and yeast infections. Additionally, it’s possible for patients to develop more serious side effects, including:
- C. diff infection, which causes diarrhea that can lead to severe colon damage and death.
- Severe and life-threatening allergic reactions.
- Antibiotic-resistant infections.
Antibiotics can harm hospitalized patients.
A study of almost 1,500 patients at Johns Hopkins found that 20% of patients developed at least 1 antibiotic related adverse drug event (ADE). These events include abnormalities or harm to the gastrointestinal, skin, musculoskeletal, blood, kidney, cardiac, and neurological systems.
The research also found that 20% of those who developed an ADE received antibiotics that were not clinically necessary. Seven of these patients developed a dangerous C difficile infection.
Researchers found that each 10-day course of antibiotics increased the risk of patients getting an ADE by 3%. The longer patients take antibiotics, the greater their risk of developing a dangerous adverse reaction.
Fortunately, none of the patients in the study died from their ADE. However, it is possible for serious harm or death to occur from these types of events.
Antibiotic-resistant superbugs pose great danger.
The overuse of antibiotics has led to the rise of antibiotic-resistant superbugs that, as the name suggests, do not respond to treatment. There is speculation that antibiotic-resistant superbugs may kill more people than cancer in the coming decades.
The Centers for Disease Control (CDC) estimates that in the US, “more than two million people are sickened every year with antibiotic-resistant infections, with at least 23,000 dying as a result. The estimates are based on conservative assumptions and are likely minimum estimates.”
The root of the problem? Doctors prescribe too many antibiotics.
Why do doctors prescribe unnecessary antibiotics?
So many reasons! Experts believe there are many factors that lead doctors to prescribe unneeded antibiotics, including doctors who:
- Falsely believe antibiotics are “risk free”.
- Practice defensive medicine, with a fear of malpractice.
- Lack confidence in their diagnostic skills.
- Find it easier to write a prescription compared to the time and effort required to explain why an antibiotic is not needed.
- Undervalue long-term risks such as antibiotic resistance and overvalue the short-term risk of inaction.
Additionally, sometimes patients pressure doctors for antibiotics, even after doctors tell them antibiotics won’t be helpful.
How often do doctors prescribe unnecessary antibiotics?
An evaluation of antibiotic use for hospitalized COVID-19 patients found that 52% of COVID-19 hospitalizations resulted in antibiotic prescribing. However, only 20% of those patients were diagnosed with suspected or confirmed bacterial pneumonia, and only 9% were diagnosed with a urinary tract infection.
Another study, published in 2021, showed that almost 56% of antibiotic prescriptions written in hospitals in 2015 were inappropriate.
Furthermore, similar research examined the medical records from 2016 for over 19 million patients. The researchers classified the appropriateness of an antibiotic prescription as related to diagnoses. Unfortunately, the results are troubling:
- 23.2% of antibiotic prescriptions were likely inappropriate — given for diagnoses that almost never justify the use of antibiotics.
- 35.5% potentially appropriate — given for situations in which antibiotics could be appropriate.
- 12.8% were considered appropriate — given for conditions that almost always respond well to antibiotics.
- 28.5% had no diagnosis code in the record on which to base any judgment.
And the numbers for “likely inappropriate” or “potentially inappropriate” are probably conservatively low since the researchers were lenient in their categorizations. The study’s lead author, Dr. K. Chua, thinks these numbers are “likely just the tip of the iceberg.”
Lastly, researchers evaluated hospital records from 2011 and found that about 1/2 of all hospitalized patients receive antibiotics during their stay. Moreover, these researchers found that “a substantial proportion of antimicrobial use in US acute care hospitals may be inappropriate, based on factors such as lack of indication or incorrect drug selection, dosing levels, or treatment duration.”
Children often receive antibiotics that are not helpful.
The wrong antibiotic, or getting an unneeded antibiotic, can cause harm, sometimes quite serious, to children. In a recent study, children who received inappropriately prescribed antibiotics were several times more likely to develop adverse drug events, including life-threatening complications, than children who received appropriate treatment.
Researchers examined claims for 2.8 million children and found in many cases, doctors prescribed antibiotics for viral infections, which don’t respond to these drugs. In other cases, doctors prescribed powerful, broad-spectrum antibiotics to treat bacterial infections even though medical guidelines recommend more targeted treatments.
Frighteningly, children who took broad-spectrum antibiotics for bacterial ear, throat, or sinus infections were 3-8 times more likely to develop potentially life-threatening C diff infections or severe allergic reactions than children who were prescribed a more targeted medication.
Can pharmaceutical companies help this crisis?
New antibiotics could help with the rise in antibiotic-resistant superbugs, but pharmaceutical companies are reluctant to do so. In fact, the last time a new class of antibiotics was discovered was the late 1980s.
Why? Discovering and bringing new antibiotics to the market is often not a profitable endeavor for pharmaceutical companies. Interestingly, in 2017, experts estimated that it would cost around $1.5 billion to to develop a new antibiotic. And the potential income is roughly $46 million per year.
Typically, a drug company can be the exclusive seller of a new medication for 5-10 years. After that, other companies can produce generic versions. This makes it almost impossible for the creator of the antibiotic to cover their huge development costs. Simply put, the math just doesn’t make sense.
Overuse of antibiotics is a global issue.
The overuse of antibiotics is an international concern. The World Health Organization (WHO) released guidelines that provide advice on “which antibiotics to use for common infections and which to preserve for the most serious circumstances.”
The goal of these new guidelines is to “ensure that antibiotics are available when needed, and that the right antibiotics are prescribed for the right infections.”
Can the antibiotic overuse problems be solved?
WHO expects their guidelines will improve patient outcomes, reduce the development of drug-resistant bacteria, and maintain effectiveness of “last resort” antibiotics that are essential when all other options don’t work.
Of course, it could be a while before we see improvements in this regard. Doctors and other clinicians will have to change their prescribing habits. Furthermore, patients will have to stop demanding antibiotics even when advised against it.
The authors of the Johns Hopkins article sum up the problem in their statement: “Although antibiotics may play a critical role when used appropriately, our findings underscore the importance of judicious antibiotic prescribing to reduce the harm that can result from antibiotic-associated ADEs.”
What can you do?
Follow these recommendations to reduce your risk of antibiotic related problems and to help reduce global antibiotic resistance:
- First of all, you can take steps to reduce your risk of getting infections, so you won’t need antibiotics. According to the CDC, you can prevent drug-resistant infections by:
- Receiving recommended immunizations (talk to your doctor).
- Safe food preparation.
- Regular handwashing with soap and water.
- Using antibiotics as directed and only when necessary.
- When prescribed an antibiotic, ask if it is necessary, or if the doctor is prescribing it as a precaution. If the doctor is giving an antibiotic as a precaution, ask if there are other options.
- Use antibiotics only as prescribed – take the appropriate dosage each day and be sure to take all the medication.
- If you are taking antibiotics and miss a dose, ask your doctor what to do.
- Never take leftover antibiotics or another patient’s antibiotics.
- Don’t pressure your doctor to give you an antibiotic. If your doctor doesn’t think you need them, ask for advice for managing your symptoms.
- Choose foods, such as chicken and beef, that are raised without antibiotics.
Because all medications carry a degree of risk, it’s important to take them as prescribed. Therefore, I recommend you read these blogs to help you minimize your risk of medication-related issues:
- What’s an Adverse Drug Reaction?
- Reduce Your Risk of Medication Errors in.
- Is Off-Label Medication Safe?
- Tips Take Medication as Prescribed.
- Dangers of Black-Market Medications – More Common Than you Think.
- Doctors Prescribe Too Many Medications.
- Are Medications Safe?
NOTE: I updated this post on 11-1-22.