taking antibiotics safely

If you don't take your entire prescription of antibiotics, you may still get better. But you can infect someone else, and the common antibiotic you took may not kill the bacteria in subsequent infections. Another, more expensive, antibiotic with more side effects may be required. The concern in the health care community is that the "back up" antibiotics are not as effective as they once were, and there are fewer back-ups to choose from. Eventually, there may be "super bugs" that no antibiotic will kill.

In fact, an article published in Nature Medicine reported on research on a strain of strep bacteria (Streptococcus pneumoniae) that commonly causes sinus infections, ear infections, bacterial meningitis, and pneumonia all over the world. Researchers were able to project that by July 1, 2004, 41% of these bacteria will be resistant to penicillin and erythromycin, meaning more expensive antibiotics that tend to have more side effects will be needed to treat what were once simple infections.

In addition, some strains of staph bacteria (Staphylococcus aureus), a common bacteria we have on our skin that can cause infections, particularly after surgery, can't be treated with a type of penicillin. And, there are strains of tuberculosis that are resistant to many antibiotics. If we don't change our ways -- and fast -- we will soon have infections that do not respond to antibiotic treatment at all. 

Bacteria or Virus?

You can help reduce the risk of bacterial resistance for all of us. First, understand what antibiotics will treat and what they won' t. Antibiotics kill bacteria, not viruses. The common cold, influenza and many illness that predominate at this time of year are caused by viruses, and antibiotics won' t cure these infections. In general, if you have a bacterial infection, symptoms tend to be limited to one area of the body. For example, strep throat will cause sore throat and fever. If you have a viral infection, such as the common cold or influenza, you will have symptoms all over: sore throat, headache, body aches, low grade fever, runny nose, congestion, and maybe a cough.

If you are concerned that you might have a bacterial infection, contact your health care provider. A test called a culture should be done to determine which bacteria, if any, are responsible for your illness. A companion test, the sensitivity test, then determines which antibiotics are most effective against that particular organism. More and more experts strongly recommend that a culture and sensitivity test be done for every patient before antibiotics are prescribed.

Without a culture, your health care provider must choose an antibiotic based on an educated guess of what bacteria are most likely to be causing your illness. Sometimes, those educated guesses are wrong.

What You Can Do

First, find a primary care provider with whom you can develop a relationship. This can be a physician or a nurse practitioner. When you feel ill, you should contact this person and discuss your condition.

Next, don' t assume that antibiotics are the proper treatment for every illness. Many health care providers admit that they often write antibiotic prescriptions to satisfy their patients -- more as a customer service than good medical practice. Many patients are convinced that antibiotics are the answer to every illness and health care providers don' t want to argue.

Instead of demanding that prescription, start a dialogue with your primary care provider to discuss if antibiotics are appropriate for your current condition. A recent study in the Journal of the American Medical Association found that 21% of all antibiotic prescriptions -- about 2.5 million -- were written for patients with colds and bronchitis, when there was no solid evidence of bacterial infection. The researchers recommend a partnership between health care providers and patients to reduce inappropriate antibiotic use.

If your health care provider offers to call in a prescription without examining you, ask if a culture and sensitivity test should be done first. Sometimes patients need to take the lead in this matter. Yes, it can be a bit more inconvenient to go to the office or the laboratory, when you could simply stop at the pharmacy, but you will be better off if the test is done. If your health care provider does not want to do this test, ask why not.

If antibiotics are prescribed, take all of the pills exactly as they are prescribed. Never, ever save antibiotics for later use. The first problem with this approach is that you won' t treat your current infection completely, so the illness may come back with heartier bacteria that will be harder to kill. The second problem is that the antibiotics you' re saving may be completely inappropriate for a subsequent illness. Antibiotics are not the same, and a drug that may be ideal for one type of infection may be harmful for another type. In addition, if you take antibiotics on your own, don' t get better and finally see a health care provider, that partial antibiotic treatment can make it much more difficult to get reliable results from a culture and sensitivity test.

One hundred years ago, before antibiotics were discovered, infections were the leading cause of death in the United States. By 1990, pneumonia and TB were responsible for only 4% of all deaths. Antibiotics are truly wonder drugs. But, you shouldn't wonder about whether antibiotics are right for you. Work with your health care provider, and understand that if you have a common viral infection, what you really need is time, sleep, and some hot chicken soup.

Tips for Safe Antibiotic Use