Antibiotics: Are You Misusing Them? Dr. Ronald Krull Weighs In

Medically reviewed by Ronald Krull, MD

Antibiotics are chemical compounds that help fight bacterial infections. While they have no impact on viruses or fungi, they assist people in combating bacterial infections. Most antibiotics do not kill bacteria. They, instead, limit how the bacteria can reproduce and grow, so the immune system can catch up and get rid of the infection. 

Are antibiotics a source of growing concern?

Antibiotic overuse has become a growing problem that poses significant challenges to public health globally. Antimicrobial resistance (AMR) is a phenomenon that occurs when bacteria evolve and develop the ability to withstand the effects of medications designed to kill them. The result is a concerning scenario in which common infections, once easily treatable with antibiotics, have become life-threatening due to an inability to effectively combat these pathogens.

The consequences of antibiotic misuse extend beyond individual health risks; they also place immense pressure on health care systems. Hospitals across the globe are increasingly facing longer patient recovery times, higher medical costs for treatment of resistant infections and a greater burden on health care workers. As antibiotic resistance spreads, the success of significant medical procedures, such as surgeries and chemotherapy, is threatened, as these interventions often rely on effective antibiotic prophylaxis to prevent infections. 

Why has the problem of antibiotic resistance grown over the years?

Over-prescription and inappropriate use of antibiotics in both human medicine and agriculture are at the root of the problem. These challenges are multifactorial, leading to an alarming rise in antibiotic-resistant bacteria. 

During the COVID19 pandemic, telemedicine visits significantly increased. Providers prescribed antibiotic medication without in-person patient evaluations. 

Because it isn't immediately evident whether an illness is viral or bacterial without in-person rapid tests for the influenza, COVID, strep throat or respiratory syncytial virus (RSV), providers prescribed antibiotics for various respiratory illness, many of which were viral. The concern was for those who may have had more risk during COVID-19 of developing serious secondary infections, such as pneumonia. This increase in prescriptions for respiratory infections helped fuel antibiotic resistance. 

Another challenge has been patients feeling a bit better but not completely well, so they seek antibiotics. Yet, a cough will often linger one to two weeks after a common cold. It is not uncommon for a cough to linger two or three weeks after influenza or COVID19 infections. In many cases, people will often say they “don’t feel sick anymore” but are frustrated their cough won’t go away. In these situations, antibiotics do not make the cough go away any faster.

Yet another challenge is patient demand for antibiotic prescriptions at the outset of illness. Even when a provider doubts the illness is bacterial, patients will often insist on a prescription for an antibiotic. Patient must understand that medical providers would not purposely withhold antibiotics from patients who need them. They simply need to be careful about prescribing them.

Is it important to take the full dosage of antibiotics prescribed by a provider?

For many bacteria that traditionally cause common infections, the antibiotics no longer are as effective due to misuse and overuse. This is in large part due to patients not finishing the total dosage, resulting in a twofold outcome, both of which lead to antibiotic resistance. 

• In one scenario, patients save and then use leftover antibiotics later on for health concerns that don't require antibiotics. With this regular exposure in the body, the bacteria can become resistant. Then when a patient truly needs them for a bacterial infection, the antibiotics are not effective to fully treat the illness. 
• In the second scenario, resistance happens when patients do not complete the dosage, so the bacteria gain resistance.

When are antibiotics not indicated? 

Obviously, patients should not take antibiotics for viral and fungal ailments. 

Signs of common viral respiratory illness are as follows: 

• Coughing

Many patients fear they need antibiotics with a lingering cough. Yet, it will take between 18 to 21 days for a cough to go away following many viral illnesses. 

• Congestion
• Runny nose
• Low-grade fever
• Improved symptoms after eight days
• Body aches
• Sore throat (About 85 percent of all upper respiratory infections are caused by viruses.)

Even when white spots appear in the throat, only one in three of patients have a bacterial infection, yet the Review on Antimicrobial Resistance shows between 70 and 80 percent will walk out of a provider's office with an antibiotic prescription because they say they have a sore throat.

When is the illness likely bacterial?

Bacterial infections usually showcase these symptoms:

• Worsening illness after seven to eight days
• High fever
• Poor oxygen levels
• Shortness of breath
• Localized illness (throat, stomach, etc.) where harmful bacteria is growing 

Can improper antibiotic usage cause harm beyond resistance?

Improper antibiotic usage can cause significant harm. The National Institute of Health estimates that half a million or 500,000 people last year contracted clostridium difficile colitis (CDC), a bacterial infection. They estimated that about 30,000 people died last year as a result of complications from this illness. This illness is a serious side effect of antibiotic use, leading to severe colon damage and death.

In Europe, the National Institutes of Health found that incidents of irritable bowel syndrome (IBS), are proportional to the amount of antibiotics that children were exposed to in utero and received in childhood. They studied siblings in the same household and found an increased rate of irritable bowel syndrome in the siblings that took more antibiotics or even took a higher dose of antibiotics in childhood.

It is clear, and the evidence is compelling that there can be long-term harm from taking antibiotics too often.

What is WakeMed's policy on safe antibiotic usage and administration?

WakeMed has a strong commitment to antibiotic stewardship. When patients are ill, and it is unlikely that they have a bacterial infection that would need antibiotic therapy, we do not provide antibiotics. In short, we do not prescribe antibiotics just to see if they will help.

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About Ronald Krull, MD

Dr. Ronald Krull is a board-certified family medicine physician with clinical interests across a broad range of urgent and chronic conditions. He attended medical school at the University of Texas in San Antonio, University of Texas system and went to residency at the Corpus Christi Family Medicine Residency in Corpus Christi, TX. He completed his internship at the University of Texas Tyler Residency program in Tyler, TX. With more than 20 years experience, Dr. Krull welcomes patient visits and works primarily at WakeMed Urgent Care - Garner.