Everything you need to know about antibiotics

We’ve all been there- that relentless pounding in your head, stuffiness in your nose, and the coughing fits that keep you tossing and turning at night. Often, the symptoms are so bad they drive you to an urgent care or community clinic, where you may wait a couple of hours only to be told to “rest, and wait for the symptoms to go away.”

Talk about frustrating! In this situation, it’s easy to see an antibiotic as a quick fix. Perhaps you have friends and family who tell you of penicillin-fueled speedy recoveries, or even had the same experience yourself after taking antibiotics in a past infection. After all, who wouldn’t pass up the prospect of rapid relief, courtesy of a Z-pak?

As a physician, I have the same goal as you. I’m committed to helping you feel better and heal well, quickly and safely. It’s easy for me to pull out my prescription pad and order a course of antibiotics. Sometimes, this is absolutely the right thing to do. But let me explain why I don’t always for the sake of my patients’ best health.

For a whopping 98% of colds, coughs, bronchitis, and sinusitis, viruses (not bacterial) are the culprit. Antibiotics only kill bacteria, so “treating” a viral infection with an antibiotic doesn’t work. If a patient feels better, it’s likely because time heals with a touch of the placebo effect. Unnecessary antibiotics aren’t just ineffective, they’re harmful, razing down innocent “good bacteria” which help your body function like a well-oiled machine. Good bacteria help you digest food, extracting nutrients and vitamins. They’re also your body’s first line of defense, boosting your immune system and quietly helping you fend off would-be infections before they trouble you with symptoms. And, more research highlights the role of good bacteria in preventing inflammation, heart disease, cancer and obesity. In other words, good bacteria are true wellness superheroes!

Studies show that it takes 6–8 months to completely rebuild your body’s stores of good bacteria after a single course of antibiotics. During this period, it’s common for people to experience digestive difficulties, including bloating, cramping, heartburn, sluggishness, and alternating constipation and diarrhea. This set of symptoms even has a medical name- “Post-Antibiotic Irritable Bowel Syndrome”. Thankfully, when your body’s stores of bacteria right themselves, the symptoms usually go away. But in someone who repeatedly uses antibiotics, the state of poor digestion and malabsorption can be more chronic.

Some antibiotics like Ciprofloxacin are shown to cause tendon problems when taken by the elderly and very young. They’re often not used in these populations. In addition, one of the more notorious consequences of repeated antibiotic use is a potentially serious diarrhea caused by the “super-bacteria”, C. difficile. Infections with C. difficile used to occur primarily in hospitals, where antibiotics are heavily used. Now, with the overuse of antibiotics in primary care, more C. difficile infections are cropping up in the community.

Let me emphasize that I firmly believe in using antibiotics in the right situations. Antibiotics are a safe and effective means to cure bacterial infections, saving millions of lives every day. When you’ve got a curable infection, the benefits of killing bad bacteria outweigh antibiotics’ risks. Whenever I prescribe antibiotics, I make sure to give my patients detailed advice on how to rebuild good bacteria quickly through diet and probiotics. One common example of a time when you’ll need antibiotics is when you come down with “strep throat”. Strep throat has telltale signs; a doctor can tell if you’ve got it by looking at your throat and, if necessary, ordering a test for confirmation. When you have strep, it’s vital that you completely finish the entire course of antibiotics prescribed. This protects your body from heart complications that can arise later on from untreated strep lingering in your body.

If you think you need an antibiotic, it’s important to talk with your doctor and understand whether this is the best option for you. Unfortunately, in today’s rushed system of medical care, you might only have 10 or 15 minutes with your doctor. Rushed doctors are prone to taking the easiest approach to “customer satisfaction”; it’s quicker to prescribe antibiotics than to spend time with a patient discussing antibiotic appropriateness, risks and benefits. Last October, JAMA Internal Medicine published a study showing that two-thirds of patients seen in Boston primary care practices received unnecessary antibiotics for colds and coughs. Of note, the probability of a physician prescribing an unnecessary antibiotic increased 26% by the last hour of the workday, precisely the time when a growing backlog pushes physicians to rush through the last few patients.

Luckily, when you’re a Heal patient, you won’t be treated by a rushed physician. When I provide medical care in your home, I get to see you as more than a “sore throat” diagnosis. I can spend time understanding your symptoms and your goals for the visit, carefully explain various treatment options, and work with you in creating a customized and evidence-based plan of care. This approach avoids unnecessary “knee-jerk” antibiotic prescriptions, promotes patient awareness, and ultimately leaves patient and doctor happier. In fact, the freedom to practice quality, patient-focused medicine is one of the main reasons I love working for Heal!

Dr. Janani Krishnaswami

After finishing her undergraduate education at Southern Methodist University and Oxford University, Dr. Janani Krishnaswami attended the University of Michigan Medical School. She then completed her residency at Kaiser Permanente & UC San Francisco and has a Masters of Public Health from UC Berkeley. Janani is now a Fellow at Kaiser Permanente & UCLA.

Any views or opinions expressed in this blog post are solely those of the author, an independent physician, and do not necessarily represent those of Heal. You should not assume or construe that this blog post represents the opinion of Heal. In addition, although this blog post provides information concerning potential medical issues, it should not be relied upon as medical advice. It is not a substitute for consultation with a qualified, licensed physician and does not replace a physician’s independent judgment about any given patient’s condition or appropriateness or risks of any treatment or procedure. Rather, this blog post is solely for general educational and informational purposes. Your reading of this blog post does not create any physician-patient relationship between you and the author.

Originally published at blog.getheal.com.

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