Antibiotics: Understanding the Pros and Cons

Our country likes to split into teams over just about everything--from the broad swaths of political beliefs and religion to the narrowest minutiae of our favorite athletes. On the topic of medicine, the divisions are no less plentiful. Some prefer Western medicine and others Eastern; some are pro-vaccine and others anti; some are antibiotic enthusiasts and some are medication refusers. Ultimately, these beliefs guide what people put (and don't put) into their bodies.

Next week begins "Get Smart About Antibiotics Week," a three year old invention of the Centers for Disease Control. The goal, simply, is to educate people. You see, when it comes to medical notions, it's not okay just to pick a side. If you hail antibiotics as silver bullets or if you categorically reject them, neither approach is exactly right--or healthy. How did we wind up with such strong emotions about medication?

The antibiotic over-enthusiasts came by it honestly. When I was young, just after oral penicillin had become widely available, a pink, bubble gum flavored version 2.0 arrived in the form of amoxicillin. Most of us in our 30s, 40s and 50s can vividly remember the taste of that perfectly sweet, slightly chalky liquid going down. It seemed like whenever there was a sore throat or the slightest runny nose in our house, amoxicillin rushed to the rescue.

Apparently, I wasn't alone. Antibiotic enthusiasm was in full swing through the 1970s and 80s. Doctors admittedly overused the drugs and, as newer more potent variations were developed, they overused those too. We are seeing the repercussions today in the form of antibiotic resistance. It turns out that these drugs aren't magic bullets at all: when you have a common cold you are infected with a virus--not a bacteria--and as a result antibiotics have no benefit.

Though antibiotics do wipe out certain bacterial infections--like the bugs that cause sinusitis, pneumonia, urinary tract infections, and other ailments--whatever doesn't kill you does make you stronger and this goes for bacteria too. So when a patient is given an antibiotic, a series of things must go right: the infection needs to be susceptible to antibiotics, the doctor has to prescribe the right drug at the right dose, the patient has to take the entire course (which usually goes well beyond when he feels better), and all of the targeted bacteria must die. If one of these steps is missed, the bacteria residing in your body can build resistance to the very antibiotic you are taking. So much for over-enthusiasm.

The antibiotic rejecters generally understand the concepts of inappropriate antibiotic use and resistance, but their rationale isn't completely right either. This group will do anything possible to avoid the use of antibiotics. They will stay home from school or skip work in order to rest and hydrate and heal. These are terrific solutions, don't get me wrong, because the very act of staying put limits the spread of the infection. But the majority of antibiotic-rejecters will also pump themselves full of over-the-counter drugs, vitamins, supplements or herbs that promise non-pharmaceutical-grade remedies.

The problem here is that over-the-counter medicines are exactly that: medicines, just sold without a prescription. And because you can buy these straight off the shelf (the label usually replete with medicinal looking flowers or claims of "organic" or "natural" healing powers), consumers believe they are less dangerous. But it's actually the reverse that is true. Over-the-counter medicines are not subject to the rigorous testing that prescription drugs are--there is no agency assigned to make sure that your therapeutic concoction really includes what is promised. Add to this that no one is studying the safety of its "all natural" ingredients. It actually takes consumer advocacy groups and vigilant individuals to identify the problems in vitamins, nutritional supplements, and other over-the-counter cures.

Antibiotic refusers also run the risk of rejecting the one treatment that can make them better. In many cases, the body gets through an illness and all ends well. But not infrequently enough, the bacteria organize a coup in the body and they take over. Infections that go untreated can cause grave illness, sometimes even death. If you need an antibiotic, refusing to take one can be life-threatening.

So in the end, neither group is right and neither group is wrong. When we get sick, we should absolutely take good care of ourselves. That includes vigilant hand washing and pulling ourselves out of circulation so that we don't spread our illness to others. But we also need to rely upon the help of our doctors rather than using a self-diagnosis to demand or refuse particular treatment. Next week, educate yourself a-la CDC and learn a bit more about why and how particular antibiotics really work.