Antibiotics: How often should you take them?

Research indicates that South African doctors are prescribing 50% more antibiotics to patients than they should, especially when it comes to common ailments like sore throats, sinus and ear infections. This over-prescription hampers the immune system’s ability to respond to future infections, and heightens the risk of dangerous antibiotic resistant superbugs. Moneybags investigates the dangers of unregulated antibiotic prescription, and finds out how you can protect yourself and your family from the associated health risks.

Why are doctors over-prescribing?

Shortly after antibiotics were discovered they were thought to be a miracle cure. This created the opinion among both patients and doctors that they should be prescribed for the large majority of illnesses.

“Today, we realise that antibiotics should only be prescribed with caution, but it’s difficult to change both patients’ and doctors’ opinions of the matter,” says Dr Rosalind Pengelly. “As a result, antibiotics are being prescribed for minor infections (where they are not actually needed) and viral infections (where antibiotics have no role to play).”

According to the director general of DAPS Global and BMJ Clinical Adviser, Dr Imran Qureshi, the vast majority of malprescription happens as a result of patients exerting significant pressure on doctors to ‘fix’ their illness with antibiotics.

“Patients are paying their doctors to provide them with a service, so when they simply recommend rest, plenty of fluids and paracetamol, the patient may feel a poor service has been rendered,” says Qureshi. This difficulty is compounded by our hectic modern lifestyles, and the stigma attached to taking sick leave from work.

What effect do antibiotics have on your immune system?

“Taking antibiotics regularly does not harm the immune system as such,” says Qureshi. “Rather, it doesn’t allow the immune system to respond as fully as it would and develop the antibodies necessary to fight future infections.”

Antibiotics can also have a negative effect on your digestive system. Tetracycline can cause erosion of the gut lining, and broad spectrum antibiotics can wipe out the normal flora in your gut, which play a vital part in strengthening your immune system. An example of this is the organism Clostridium difficile (C. difficile), which sits in the human bowel and is kept at bay by our good gut bacteria. Broad spectrum antibiotics such as Augmentin can, in certain situations, eradicate the good bacteria which are keeping C. difficile in check. This results in severe diarrhoea and dehydration.

“About 10 years ago we were seeing four to five hundred cases of C. difficile per annum in the UK,” says Qureshi. “Now doctors have recognised the issue, they have vastly reduced the amount of high-risk antibiotic prescriptions. Today, we seldom exceed 15 cases of C. difficile in a year.”

When should we take antibiotics, and when should we avoid them?

This is dependent on the type of illness you are experiencing, as well as your current health situation and the country you live in (certain bacteria are endemic to certain areas).

“Antibiotics come with their own risks and side effects, and these just increase the more you take them,” says Pengelly. “If possible, avoid taking antibiotics for minor infections if you are generally in good health and not suffering from any other chronic illness. They should only really be saved for situations where your symptoms are unbearable and you aren’t getting better.”

It is also important to note that antibiotics are aimed at treating bacterial and not viral infections. “The ultimate delineator is not how often we should be taking them, but rather for what types of illnesses,” says Qureshi. “Treating chronic bacterial infections with antibiotics is an effective method of healing the body.  The issue we are dealing with is the incorrect prescription of antibiotics for minor viral illnesses.”

How can you tell the difference between a viral and a bacterial infection?

For an experienced physician, there are certain markers on the journey to diagnosis which clearly differentiate whether the patient is suffering from a viral or bacterial infection. For example, if your fever is brought down by an anti-pyretic e.g. Panado, then it is likely you are only experiencing a viral infection. Bacterial infections are more likely to keep the fever at a constant, and tend to be more visible e.g. pus and swelling on the throat for tonsillitis. Viruses are more contagious than bacteria, although they can sometimes build an environment for bacteria to become active.

“We refer to this as a super-imposed infection,” says Qureshi. “Which is why it is so important to rest and allow your immune system the opportunity to respond to your viral illness before medicating with antibiotics.”

Is antibiotic over-use responsible for superbugs?

Yes, it is most definitely a contributor. Unregulated prescription and poor adherence to recommended courses have resulted in powerful and highly dangerous superbugs.

“If you stop taking your antibiotics before the course is over, the remaining bacteria often becomes resistant to the antibiotics, so that in the future they may not be effective,” says Qureshi. “We see this most often in developing countries, where illiteracy may contribute to poor compliance. Should there be the prevalence of a particular disease and poor adherence to medical treatment, there is a very real danger of an antibiotic resistant bug developing.”

Perhaps one of the most dangerous antibiotic resistant superbugs to have developed in South Africa is Multi-drug-resistant tuberculosis (MDR-TB). More recently, Extremely Drug-Resistant TB (XDR-TB) has emerged as an even more ominous threat.

How can I find out whether the antibiotics being prescribed to me or my children are really necessary?
Don’t be afraid to question your doctor: Ask them why they suspect you have a bacterial infection, and if they are certain that antibiotics are the only solution. “Doctors are used to making sure they can justify their decisions and cover themselves, so they should be able to give you a reasonable response,” says Pengelly.