Just-In-Case Antibiotics: A Good Idea?

Sometimes they’re not just what the doctor ordered.
Asian adult woman takes prescription antibiotic medication from pill bottle

It’s a startling statistic: according to the Centers for Disease Control and Prevention (CDC), more than one-quarter of the time antibiotics are prescribed – and perhaps as often as one-third of the time – the prescription is inappropriate. It’s the wrong drug, the wrong dose, or the wrong duration, according to Lindsay Smith, MD, an infectious disease expert at The University of Vermont Medical Center.

And then there’s the problem of doctors prescribing antibiotic for someone’s cough or cold “just in case.” Antibiotics are only effective against bacteria – they won’t do anything to treat viruses, explains Dr. Smith.

“When you take antibiotics for a virus, like a cold, an upper respiratory tract infection, or COVID-19, they won’t make you feel better,” says Dr. Smith. And they can actually be harmful. They act against “bad” bacteria that causes infection, but also against “good” bacteria our bodies need to stay healthy. Losing good bacteria can then lead to more infections – and more prescriptions.

One Problem Leads to Another

According to John Ahern, PharmD, a pharmacist clinician for infectious disease at UVM Medical Center, the overprescribing of antibiotics has led to an even bigger issue: a concerning increase in antimicrobial resistance, or AMR, in which antibiotic-resistant bacteria or “superbugs” are given the perfect conditions to grow.

When someone becomes infected with antibiotic-resistant bacteria, “there’s nothing we can do to treat that patient’s infection,” warns Ahern. “They have essentially returned to the pre-antibiotic era, and they may die.”

Help Solve the Problem

AMR is not a new concept. “There have always been antibiotic-resistant bacteria. But it’s gotten alarmingly worse in the last 30 to 40 years.”

According to the CDC, 2.8 million Americans were infected with a multi-drug-resistant organism (MDRO) in 2019, resulting in 35,000 deaths. These MDROs may go on to develop resistance to all available antibiotics.

Fortunately, clinicians in Vermont and northern New York rarely have patients with MDRO infections, but they have seen some situations where only one or two antimicrobials remain available for treatment. “This is a big concern among the infectious disease team,” says Ahern. “We’re doing everything we can to prevent that from happening.”

The bottom line? Try not feel frustrated or ignored if your doctor doesn’t immediately prescribe an antibiotic when you’re sick, says Dr. Smith. “Remember that our bodies have had hundreds of thousands of years of evolution to help us overcome infections, and they’re pretty good at it.”

Instead, Ahern recommends asking your provider, “When should I reach back out to you if I haven’t improved?”

“Antibiotics are a resource we really don’t want to lose,” Ahern continues. Without antibiotics, it would be difficult to perform surgery, give cancer chemotherapy, and take care of premature infants. “That’s why we’re doing everything we can to help preserve that resource for everyone, both now and in the future.”

Tips for Appropriate Antibiotic Use

Lindsay Smith, MD, an infectious disease expert, and John Ahern, PharmD, a pharmacist clinician, lead the Antimicrobial Stewardship Program, a program required at all hospitals across the United States, for UVM Medical Center. They offer three important recommendations for taking antibiotics to help prevent drug resistance:

  1. Only take antibiotics when absolutely necessary. Antibiotics are designed to supplement the work of our normal immune systems. Only when the infection overwhelms our immune system do we need the help of antibiotics. Also, some infections, such as small skin abscesses, can be treated in other ways, like drainage.
  2. Take the right antibiotic for your infection. For patients in the hospital, the laboratory works to identify the bacteria causing the infection, explains Ahern. Once identified, the bacteria is tested to see which antibiotics are effective. The patient’s provider then takes their patient’s allergies and other medications into account and chooses one to prescribe. The provider tries to choose an antibiotic that just treats the bacteria causing the infection so it will not harm other beneficial bacteria in the body. For patients seeing their provider in a practice or clinic, the provider often makes an “educated guess” on the bacteria causing the infection and chooses an antibiotic that is most likely to work.
  3. Take just enough, and no more. “We don’t want to overtreat,” says Dr. Smith, adding that the proper duration depends on the organism, the drug, and the location of the infection. Some prescriptions require just three days, while others may be needed for a week or more. “For some of the most common infections, such as urinary tract infections, studies show that less is more,” she says.

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