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Antibiotics are the Answer, Right?
In short – no. That’s probably one of the most common questions people have when seeing the doctor. They expect they need something for their cough, cold, or flu, and antibiotics surely must be the answer. However, if your doctor or medical provider does not give you antibiotics, consider yourself lucky because you have a well-intentioned, up-to-date, well-educated doctor with excellent judgment. You should be thankful and write them a note telling them how fortunate you feel to have a doctor looking out for you.
How Antibiotics Work
There are multiple classes of antibiotics that work in different parts of the cell. For example, some destroy the bacteria’s cell membrane, thereby killing it, like the penicillins. Others interfere with DNA replication, inhibiting reproduction, like the macrolides; famous examples include erythromycin and azithromycin. Antibiotics that kill bacteria are bactericidal agents. Drugs that inhibit reproduction are bacteriostatic drugs. They require an intact immune system to finish up the job of wiping out the bacteria.
Why are antibiotics not being prescribed as much as before? Antimicrobial stewardship has been around for the last 25 to 30 years as an effort to better utilize antibiotics. It has taken off in the last 10 to 15 years. As we do more and more research into how to treat different conditions, we learn more and more that antibiotics often don’t work and may be entirely unnecessary.
Three Types of Infections
First of all, you should realize that there are three basic sources of infections, bacteria, viruses, and parasites. Antibiotics attack bacteria by destroying the cell wall or inhibiting their ability to reproduce and make more baby bacteria. On the other hand, viruses are not living, breathing organisms like bacteria, and they do not respond to antibiotics. Viruses are terrorists that hijack your cells for their own purposes to reproduce themselves with your cellular machinery in order to torment you. Some antivirals are available but just for a select few viruses. They are not all that effective and tend to shorten the illness by just a day or two, such as anti-flu and anti-chickenpox/shingles drugs. We now have antivirals for COVID, which are much more effective than previous antivirals. Parasites take a whole different class of antimicrobials. One of the most famous ones is Ivermectin and was placed on the WHO list of essential medications
. The inventor won a Nobel Prize. How it was developed is quite fascinating; see this link here. It works against parasites and has saved millions of lives. One of its most common uses is for battling Strongyloides, a worm that can actually kill you if left untreated. Ivermectin is a powerful drug that has potent activity against Strongyloides. Ivermectin does not work against the Coronavirus, despite what you may have heard. However, it does seem to help those who have COVID and Strongyloides. These are essentially people who live in warm, humid tropical climates where strongy ( as some call it) is endemic, meaning it lives there and will do so forever.
Antibiotics & Ear Infections
Many parents expect to receive antibiotics for ear infections. However, we now know that, in general, many ear infections will be better in one week with or without antibiotics. It is tough to resist the pleading of a mother for her child who has a bright red eardrum and expects to get antibiotics. Thankfully for
those who do need antibiotics, we’re learning from research that shorter courses of antibiotics are just as good as more prolonged courses. Decades ago the old standard of 10 to 14 days of treatment was chosen, but not scientifically. It was chosen empirically. New research has shown that sometimes 3 to 5 days is just as good as 10 to 14 days and often better due to less resistance developing and a lower incidence of side effects.
Head Colds, or Upper Respiratory Infections
The CDC estimates that most adults get two to three head colds per year and children get more than that. Now, I know that many never get them, but if we assume everyone gets at least one, that’s over 300 million head colds per year in the United States; as you might anticipate, head colds/viruses do not respond to antibiotics. But they can evolve into sinusitis or bronchitis, complete with thick, green, and yellow mucus.
Indeed, you might say, surely this deserves antibiotics? Sometimes yes, but typically they are caused by viruses that…wait for it… do not respond to antibiotics. Sometimes an upper respiratory infection can become complicated by developing a secondary bacterial infection, and that’s when antibiotics can be helpful. Otherwise, your best bet is to use over-the-counter symptom relief medications. Practice good hand hygiene, and wash for at least 20 seconds (did you know your smartwatch can time this automatically? Look here), and keep your hands away from your face.
Tooth Abscesses
Another malady where people expect to receive antibiotics, and often do, has to do with tooth pain. It’s assumed to be due to an abscess or infection, but is frequently due to irritation and inflammation of the nerve. Anti-inflammatory agents in that case help reduce pain, inflammation, and swelling. But often, people get antibiotics, and I must confess that I’m just as guilty as the next doctor.
Antibiotic Side Effects
So just why is your doctor resistant to giving you antibiotics for everything you think you need them for? That’s a great question, and I assure you it is not a vast conspiracy to deprive you of healing drugs or to enrich your doctor. Antibiotics are powerful medicines that are lethal to bacteria and have significant side effects and specific indications for use. They can have substantial drug interactions that cause many serious complications and side effects that must be weighed when choosing an antibiotic.
Antibiotics Resistance
A big reason for curtailing antibiotic use is because of the development of bacterial resistance. When an antibiotic is used either inappropriately or for too short of a time, bacteria can develop resistance without getting killed in the first round. Subsequently, when bacteria see that antibiotic again, they can develop resistance, and you will no longer get any help from that antibiotic. Probably the best known example is MRSA, or methicillin resistant Staph aureus. Resistance is a significant issue when it comes to the use of antibiotics. This is one of the biggest challenges for doctors when prescribing antibiotics appropriately for you. The sad truth is bacteria are evolving much faster than we can develop antibiotics to kill them. If this were an arms race, we would be losing. Some bacteria require multiple drugs to kill them, such as Helicobacter pylori, also known as H. pylori which causes ulcers. This requires two antibiotics and an acid-reducing medicine twice daily for two weeks to kill it. Other infections require multiple drugs due to high resistance, such as tuberculosis. TB requires multiple drugs taken over 6 to 9 months—the reason is because of the development of resistance by the tuberculosis bacteria. One last point on this matter: bacteria develop resistance; YOU DO NOT. You do not become “immune to amoxicillin.” You were prescribed antibiotics for a VIRAL infection, and that is why it didn’t work. See this article on antibiotics used for COVID and the disastrous consequences.
Antibiotic Diarrhea
Perhaps you have heard of the so-called “good bacteria” in your gut? When you wipe them out with antibiotics, sometimes you leave bacteria in your intestines that now have no competition. They can flourish and cause significant painful diarrhea, colitis, and even bloody diarrhea. This profound side effect is known as antibiotic-associated colitis. It’s usually due to Clostridium difficile, also known as C. diff. This is not an allergy or side effect of the medicine, but it’s a complication of the medication doing its job. This can occur with any antibiotic, but certain ones tend to have it more often. This is a big reason why you should try to avoid antibiotics unless there is a clear indication for it.
Severe Heart Side Effects from Drug Interactions
Some antibiotics interfere with your heart function by causing a prolonged QT. This can cause ventricular tachycardia, which can be fatal unless you walk around with shock pads on your chest, ready to shock yourself immediately. Your doctor must review your current medicines before prescribing antibiotics that can lead to a prolonged QT. It’s not guaranteed to happen, but minimizing the risk is best.
Other Antibiotic Side Effects
Other antibiotics can cause hallucinations, delusions, and suicidal ideation. Some even weaken your tendons to the point where you can rupture a tendon under the right circumstances and physical activity. These are all strong reasons why your doctor wants to avoid antibiotics. They are not just trying to torture you and give you substandard care. They are giving you excellent, up-to-date, superior care if they avoid antibiotics.
Influenza and Head Colds
Let’s talk about some of the most common infections, head colds, and the flu. These often come on at the most inconvenient times of our lives and cause significant symptoms such as head congestion, headaches, sinus pain, postnasal drip, coughing, body aches and pains, fevers and chills, and the list goes on. People often complain that their mucus is green or yellow; why doesn’t that need antibiotics? If it would help, then yes, that would be great. But understand that viruses can also cause colored mucus. The flu is a virus, and all head colds are due to about 30 different viruses, including the Coronaviruses, Rhinoviruses, and Adenoviruses. COVID does belong to the coronavirus family, but I doubt our COVID antivirals will work against the common cold, unfortunately for humanity. However, because of the research into treating COVID, someday we may develop an antiviral that works for the common head cold. Wouldn’t that be great? Better yet would be an effective head cold vaccine.
We do have influenza vaccines, but some years they are not very good and are just so so in other years. The most commonly used flu vaccines for the 2021-22 flu season were only 16% effective, which is an abysmal failure. The Department of Defense is working on a universal COVID vaccine; maybe they will also develop a universal head cold vaccine and universal flu vaccine. That is the holy grail of vaccines right now. The vast majority of vaccines are very effective in preventing disease or severe disease.
You Mean My Doctor Actually Cares About Me?
So, when your doctor asks you to come in to be checked before giving you a second course of an antibiotic or even a first course, realize that they are not just trying to collect your co-pay and get richer.
They’re so busy they’d just as soon not have to see you that day, but they’re looking out for your best interest. If they were just to call in the antibiotics you might not even need, you may suffer some of the serious consequences listed above. Sometimes after infection, there is still cellular debris and inflammation that the body has to clean up long after the bacteria are dead. This can give you ongoing symptoms, but that doesn’t mean you still need more antibiotics. Sometimes it does, but frequently not. Help your doctor help you by asking questions and following advice.
To Your Good Health,
Kevin McCurry, MD
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