Before You Start Those Antibiotics! (Part 1) | Harmful or Helpful?
What is your reaction when you are prescribed antibiotics?
Some patients outright reject antibiotics, while others outright demand antibiotics. Perhaps you are somewhere in between, or would rather defer to whatever the doctor recommends without second thought?
Whether you have strong opinions or none, I believe it is important to think critically about any medication being prescribed by discussing good quality evidence with your treating doctor. What better place to start than one of the commonly prescribed medications: antibiotics!
Benefit and Harm
The advent of antibiotics in the early 20th century sparked a new revolution in medicine, saving countless lives and preventing complications from what are now easily treatable diseases.
One relevant example is something as common as tonsillitis which can create misery with terrible throat pain and fevers. The actual tonsil infection is usually not a significant issue, as most healthy people can overcome the immediate infection naturally without antibiotics.
However, in a small number of people, if streptococcus bacteria has caused tonsillitis, it can create a reaction in the body many weeks down the track, which can result in long-term issues with the heart (rheumatic fever) or kidneys (post-streptococcal glomerulonephritis).
These serious complications are much more common in remote communities where poor access to healthcare means simple tonsillitis is often left untreated. We are so privileged in Sydney to have easy access to antibiotics for the treatment of common bacterial infections.
Conversely, the overuse and misuse of antibiotics particularly in third-world countries have created terrifying antibiotic resistant organisms. In the community, there is also increasing awareness of antibiotic side effects and their harms on the body. Antibiotics, particularly those that are more broad-spectrum, act indiscriminately to kill usual resident bacteria in the body, causing issues such as bowel related side effects or thrush.
There is a great push in the medical community, particularly among infectious disease physicians, to promote proper antimicrobial stewardship: which is a fancy way of saying to their medical colleagues, "Don't misuse or overuse antibiotics!"
Therefore, in every case of antibiotic prescribing, we must first be very clear about:
How likely is the illness is caused by a bacteria?
How impactful are antibiotics on the natural course of an illness?
In a future post, we will explore these questions further and discuss the factors which guide our decision-making.
Broader Reading: Beyond the Basics
It's not just non-medical communities who are saying the use of antibiotics should be more cautious. This government website explains what it means to use antibiotics in a responsible manner. Particularly relevant is the section on 'Patient resources' which lists many helpful links for you to delve deeper into the topic.