When Are Antibiotics Actually Necessary?

If you’re feeling under the weather for long enough, you may head to the doctor’s office with the intent of picking up a medical prescription to help speed up your recovery. If this sounds familiar, know you’re not alone in this demand for a quick Rx fix: About one in eight people who visit their primary care doctor come out with an antibiotic prescription, according to a recent study published in the Journal of the American Medical Association. The problem with this get-better game plan is that one in three of these prescriptions do absolutely nothing to improve your health, according to the same report.

Researchers at the Centers for Disease Control and Prevention (CDC), in partnership with Pew Charitable Trusts and other public health and medical experts, found that the majority of these unnecessary antibiotics are prescribed for respiratory problems like common colds, viral sore throats, bronchitis, and sinus and ear infections. The reason the Rx doesn’t work: Antibiotics are only effective against bacteria, not viruses.

So why are doctors handing out ineffective medications? One, doctors don’t always know whether an infection is bacterial or viral—and don’t always have immediate access to lab testing—so many err on the side of prescribing an antibiotic, explains Leila Kahwati, M.D., senior research analyst at the research institute RTI International and attending physician at Durham Veterans Affairs Medical Center in North Carolina. Plus, if it’s not your usual doc, he or she doesn’t have your patient history to contextualize your level of distress, and they might be worried you won’t seek follow-up care if your symptoms worsen.

Another reason why doctors may hand out excess prescriptions: They’re responding to pressure from patients. In a 2004 study published in Family Practice, 50 percent of patients who went into the doctor’s office with symptoms expected to come out with a recommendation for antibiotics. Sir Alexander Fleming, the famed bacteriologist who discovered penicillin, called it back in 1945 when he warned that the “public will demand [the drug and] … then will begin an era … of abuses.”

“Some patients do pressure providers for antibiotics either for themselves or their child,” Kahwati confirms. In some cases, this is based on anticipation from their own past experience, like having a bacterial sinus infection develop following a cold. “In other cases, the pressure stems from the inconvenience of having to make a second visit if things don’t improve, or a singular focus on ‘curing’ the infection as opposed to relieving the symptoms that the infection is causing,” she says.

If taking unnecessary antibiotics were harmless to your health, then this wouldn’t be such a big deal. But epidemiological studies have shown a direct relationship between antibiotic consumption and the emergence of resistant bacteria strains. Bacteria have evolved over time to evade the effects and attacks of antibiotics, Kahwati warns. It’s like a dangerous version of survival of the fittest: Antibiotics remove the drug-sensitive bacteria, leaving the resistant strains behind to reproduce more resistant strains. They’re becoming a new class of bacteria known as “superbugs” that we don’t have the science to treat. This has actually become enough of a public health threat that the White House released a national plan of action last year to combat antibiotic-resistant bacteria, setting a goal of reducing unnecessary antibiotic use by at least half by 2020.

In addition to creating an army of bacteria that’s evolved beyond our science, taking a needless Rx can also make you more sick. “Inappropriate antibiotic prescribing subjects patients to harms of antibiotics but none of the benefits—and this is a serious patient safety issue,” Kahwati says. Side effects of antibiotics can range from a mild rash to gastrointestinal upset to vaginal yeast infections and anaphylaxis, which is a serious allergic reaction that can be fatal. Antibiotics are actually responsible for the largest number of medication-related adverse events and are implicated in 1 in 5 emergency room visits for adverse drug reactions, she says.

If you’re physically active, you may need to be extra cautious. The Federal Drug Administration released a warning last month that antibiotics from a specific class called fluoroquinolones, commonly prescribed for upper respiratory tract infections, can raise the risk of tendonitis and even a full-blown tendon rupture for those who participate in high-impact sports, like running, boxing, and plyometrics.

So when is it actually a good idea to get a prescription? Conditions that benefit from an antibiotic include bacterial sinus or ear infections, pneumonia, whooping cough, and strep throat. “Treatment of true bacterial infections with antibiotics will typically reduce symptoms and shorten the course of illness—as long as the bacteria is not resistant to the antibiotic being used,” Kahwati explains. What’s more, these bacterial infections probably won’t resolve on their own without the drugs. This does not apply to the common cold. “All colds are viral and will not get better with antibiotics,” Kahwati says. Same goes for many sinus and ear infections (ones caused by viruses), sore throats, and coughs, which will typically resolve on their own within five to 10 days, she adds.

When in doubt, have a conversation with your primary care physician. “Establishing an accurate diagnosis is key to determining whether antibiotics are necessary,” Kahwati says. Your best bet is to always talk to your doctor and let them size up your symptoms. A 2015 review from Cochrane research group found that doctors were less likely to prescribe an inessential prescription when patients suffering from acute respiratory infections had a chat with them about whether an antibiotic was needed. That doesn’t mean that you should overplay or underplay symptoms to leave with the Rx you want. Just be open if your doctor suggests a follow-up visit instead of a prescription for right now.