Ana, 5, has been complaining about an earache and has missed two days of school. Her parents took her to urgent care, hoping for a prescription for an antibiotic. Last time Ana had an earache, she got antibiotics and was back to her energetic self the next day.
After carefully evaluating and examining Ana, the urgent care doctor, however, didn’t prescribe an antibiotic. The doctor explained that antibiotics, which kill bacteria, would have no effect on Ana’s earache, which the doctor highly suspected was caused by a virus. Ana’s parents asked for the prescription anyway — just to see if it would work. But the doctor said no.
“As doctors, we want to help people feel better. If there’s something we can do that will help someone feel better quickly, we want to do that,” says Nipunie S. Rajapakse, M.D., M.P.H., an infectious diseases pediatrician at Mayo Clinic. She understands that parents might be frustrated, especially if they’ve had to take a couple days off work to care for their sick child. “Not getting a prescription for an antibiotic may feel unsatisfying for the parents who want their child’s illness to be over and done with as quickly as possible.”
But antibiotics aren’t always the right treatment and, in many instances, can do more harm than good, Dr. Rajapakse explains. By not prescribing antibiotics, Ana’s doctor was helping prevent antibiotic resistance and keeping Ana healthier in the long run.
“The problem is the more antibiotics we take, the more likely we are to encourage the bacteria that live in and on our bodies to become resistant to them over time,” Dr. Rajapakse says.
Antibiotic resistance is a global health threat that is estimated to have caused more than a million deaths worldwide in 2019. It occurs when bacteria become stronger than the drugs designed to kill them. It leaves health care providers with fewer options — or sometimes no options — for treating bacterial infections. Overprescribing antibiotics is one of the major causes.
Some health care providers report feeling pressured to prescribe antibiotics, even when they aren’t appropriate for the infection. When antibiotics aren’t the right choice, parents can help slow antibiotic resistance by asking the health care provider for advice on helping their child feel better rather than asking for an antibiotic prescription anyway. This article explains more about alternatives to antibiotics, how antibiotics affect the body, and how to take antibiotics safely when they are called for.
How do antibiotics work?
Antibiotics are medications that kill bacteria. Health care providers might prescribe them to treat bacterial infections such as strep throat, pneumonia, urinary tract infections and some ear infections. It can be difficult to know if bacteria are the cause of an infection. That’s because viral infections — like the common cold, COVID-19, the flu and some ear infections — can have symptoms similar to bacterial infections, such as a sore throat and runny nose.
Bacterial and viral infections are treated differently. Some bacterial infections can be treated with antibiotics. Antibiotics have no effect on viruses. So even if antibiotics cleared up the last sore throat, they won’t work if the next sore throat is caused by a virus. For most viral infections, the only treatment is to take steps to ease the symptoms while the immune system does its work of fighting the virus. For example, taking a pain reliever or breathing in the comforting steam off a bowl of hot chicken noodle soup. Antiviral drugs are available, but typically only for select situations. They are most effective if taken within 48 hours of the start of infection symptoms.
“I think there’s a sense of ‘If I take this antibiotic, maybe it’ll help me feel better or it might not do anything,'” Dr. Rajapakse says. “But I think people don’t appreciate the serious things that can happen if you take antibiotics when you don’t need them.”
What’s the harm in taking antibiotics?
“Antibiotics can be lifesaving medications when used in the right situations,” Dr. Rajapakse says. For most people, it’s fine to take them short-term to treat a bacterial infection. Taking antibiotics when they won’t work, however, could affect the individual’s health, and it contributes to antibiotic resistance, which is a threat to global health.
Allergies and side effects of antibiotics
Like any medication, antibiotics come with the potential of short-term effects. Some kids are allergic to antibiotics. They might develop hives, rash, or lip or tongue swelling. In more severe cases, reactions could include difficulty breathing or low blood pressure.
More common are side effects that can make a child feel uncomfortable, but they aren’t signs a child shouldn’t use antibiotics.
“Kids can have belly pain, nausea, headaches, diarrhea, those kinds of general symptoms,” Dr. Rajapakse says. “Antibiotics work by killing off the bacteria that’s causing the infection, but they also kill off some of the good bacteria that live in and on our body, especially in our digestive system.”
Humans maintain a balance of bacteria, yeast and other microorganisms. This is called the microbiome. It includes good bacteria that helps keep the body healthy. Killing off some of that good bacteria when taking antibiotics can disrupt the balance of the microbiome. The most common result is diarrhea. But it also can lead to an overgrowth of yeast, which might cause yeast infections in the mouth or vagina.
It might take the body a couple of months to replenish the healthy bacteria that was lost.
Preventing antibiotic resistance
Bacteria cells frequently divide and multiply. At each division, there is the possibility of genetic mutation. Multiply that out to millions, billions, trillions or even more cell divisions — in you, your child or in others — and the potential is there for the emergence of a bacteria that can survive a particular antibiotic regimen. In short, each time antibiotics are used, bacteria have another chance to adapt, potentially leading to antibiotic resistance, where antibiotic drugs become less effective or ineffective for some infections.
“That’s why it is so important to only take antibiotics for bacterial infections when they will help us recover faster, reduce the chances of spreading the infection to someone else, or prevent complications from developing,” Dr. Rajapakse says. It’s estimated that 28% of antibiotic prescriptions in the United States are not needed. Health care providers are working to reduce that number.
Antibiotic resistance is a global problem. People who are carrying resistant bacteria can spread it to others. That can lead to increased need for medical care, extended hospital stays, and costly or toxic treatments. It also means that people are dying because the antibiotics that are available will no longer kill the type of bacteria they have.
Antibiotic resistance could affect the future of joint replacement, organ transplant and cancer therapy since these procedures come with a high risk of infection. Antibiotic use in veterinary medicine and agriculture also are affected by and contribute to antibiotic resistance.
Alternatives to antibiotics
Many common infections, like ear infections and sinus infections, may resolve on their own without an antibiotic — even when they’re caused by bacteria. Ask your child’s provider if your child’s symptoms can be treated without antibiotics.
Mayo Clinic experts offer this advice on treating infections that don’t need antibiotics:
- Give children the recommended dose of acetaminophen (Tylenol, others) or ibuprofen (Advil, Motrin, others) for their pain or fever while they fight off the infection.
- Use a humidifier to help reduce nasal congestion, cough and sore throat.
- Offer ice pops to soothe a sore throat or cough.
- Warm tea with honey can help reduce cough and improve sleep. But honey should not be given to people under age 1.
- Use saline rinses or sprays for a sinus infection or nasal congestion.
“I and other infectious disease physicians would be happy to put ourselves out of business,” Dr. Rajapakse says. The best way to give Dr. Rajapakse an early retirement and cut down on antibiotic use is to prevent infections in the first place. Here are some expert tips:
- Teach your child proper hand-washing skills to help prevent infections. Hint: Singing “Happy Birthday” twice takes about 20 seconds, which is the recommended amount of time to wash.
- Remind your child to use those hand-washing skills before preparing any food or after using the bathroom.
- Cook foods to safe internal temperatures. That’s 145 degrees Fahrenheit (63 degrees Celsius) for whole cuts of pork and beef and 165 F (74 C) for chicken and turkey.
- Teach kids to keep cuts and scrapes clean and covered with a bandage.
- Get recommended vaccines. Vaccines protect against bacterial infections like diphtheria and whooping cough as well as viral infections like influenza and COVID-19.
Do natural antibiotics work?
Some foods like honey, garlic and oregano have natural antibacterial properties. But food sources are not likely to provide the dosage that would be necessary to treat a bacterial infection, Dr. Rajapakse says.
“Things like ginger and honey are safe to consume if you’re eating them in normal quantities, but it’s really the more concentrated forms that are being produced — like a pill or a powder —that you need to be more careful with,” Dr. Rajapakse says. “There’s a misconception that things that are natural cannot be harmful and that’s not necessarily the case. Some of these products also can have interactions with other medications you might be taking.”
If you want to use products labeled as natural antibiotics in your treatment plan, make sure your health care provider is aware. Your pharmacist also can check for interactions with other medications you’re taking.
How long does it take for antibiotics to work?
Generally, someone taking an antibiotic for a common infection like strep throat or a urinary tract infection should start to feel better in 24 to 48 hours. Don’t stop giving the antibiotics to your child just because your child is back to bouncing on the living room sofa. The bacteria can still be present. The course of antibiotics is designed to prevent the bacteria from replicating again — not just to get the little one back to child care.
“If you’re feeling better and wondering if you might be able to stop taking an antibiotic early, I would definitely discuss it with your health care provider and make that decision together,” Dr. Rajapakse said.
Lightning round: Q&A on antibiotics
Can you take antibiotics while pregnant?
Some antibiotics could cause harm to a developing fetus, but others are safe to take while pregnant. Make sure your health care provider knows if you’re pregnant.
Do antibiotics make you tired?
Generally, people taking an antibiotic have an infection of some sort, Dr. Rajapakse says.
“Are they fatigued because they have an infection or are they fatigued because they’re taking an antibiotic? I think its probably more likely to be the infection that’s making them tired rather than the antibiotic,” she says.
How long do antibiotics stay in your system?
How long antibiotics stay in the body depends on the person and the antibiotic. If you need to take a dose a few times a day, that is probably because the body clears it quickly.
“Then we have other antibiotics with a very long half-life, including some that treat a urinary tract infection with a single dose that lasts longer in your system,” Dr. Rajapakse says.
How long an antibiotic stays in your system also varies from person to person. Since your kidneys or liver are often responsible for processing antibiotics, the health of these organs will affect how long the medication lingers.
Are probiotics or prebiotics necessary for reducing infections?
For healthy people, taking probiotics won’t hurt and might help the bacteria in the digestive system. To explain, Dr. Rajapakse suggests thinking of the gut microbiome like a rainforest that has many kinds of trees and plants. Taking an antibiotic is like cutting down many of those trees and plants.
“Taking a probiotic is like replanting all of the same tree,” Rajapakse explains. “So it’s not exactly the same as what you had before because there was a lot of diversity there. Most probiotics have one to maybe four different types of organisms in them.” Probiotics are available as supplements or in fermented foods like yogurt, kimchi or kombucha.
The usual way for gut bacteria to repopulate is through diet. Prebiotics are compounds found in foods like fruits, vegetables and whole grains. Prebiotics contribute to the growth of healthy bacteria. They’re great to incorporate, but you don’t have to do anything special to get them. Just eat a variety of plant foods in your diet.
Do over-the-counter topical antibiotics lead to resistance?
Oral antibiotics are available only with a prescription from a licensed health care provider in the United States. You can purchase topical antibiotics without a prescription. Topicals are ointments and creams that are used on the skin to prevent or treat infections or are sometimes used to treat acne. Bacteria can become resistant to topical antibiotics, but it is less likely to occur, Dr. Rajapakse says. Still, topical antibacterial ointments aren’t necessary for most cuts and scrapes. For most wounds, cleaning with soap and water and applying a bandage is enough.
Relevant reading
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