November 4, 2020

When are antibiotics needed?

Often when you're sick with a cold, you just want to feel better as quickly as possible. Unfortunately, the only option may be to ride out the symptoms or use over the counter medications that target specific symptoms for improvement. That's little consolation when a stuffed nose or cough is keeping you awake at night, but there is good reason, said Dr. Barry Fox, a UW Health infectious disease specialist.

"Antibiotics are only effective against bacterial infections they do not work for infections caused by viruses, such as colds, bronchitis, flu, COVID- 19 or most sore throats," he said.

Fox, who is the medical director for Antibiotic Stewardship for the State of Wisconsin, and UW faculty member, explains that when antibiotics aren't needed, they won't help and the side effects could hurt more than just you.

"Taking antibiotics can create resistant bacteria, meaning the bacteria will no longer respond to the antibiotics designed to kill them if needed in the future," said Fox. "Antibiotic resistance is due to the overuse and misuse of antibiotics."

This risk is not only for the individual taking the antibiotic, but there is also a risk of spread of resistant bacteria to close personal contacts.

Antibiotic-resistant bacteria is a growing problem, and one with lethal consequences. Each year in the U.S., at least 2 million people become infected with antibiotic-resistant bacteria and at least 23,000 die as a result.

Reactions to antibiotics are also responsible for one out of every five medication-related visits to the emergency department. And in children, reactions from antibiotics are the most common cause of medication-related emergency department visit.

While it's clear antibiotics should only be used in conditions caused by bacteria, it can seem a little vague. Antibiotics may or may not be used to treat a sinus infection, for example, or a middle ear infection.

"Some of the most common infections, such as sinus infections and bronchitis, are caused by viruses more than 90 percent of the time, but there are cases when it is caused by bacteria," said Fox. "While a patient may have received antibiotics for a previous sinus infection, it may not be warranted for a subsequent one."

It's impossible to tell whether a sinus infection is caused by a virus or bacteria by the symptoms alone. Instead, doctors look at the duration of the symptoms to help determine the underlying cause. If your symptoms start to improve on their own, or with symptom relief medication after 57 days, there's a good chance it's viral. But if your symptoms persist for 10 days, or gets worse after initially improving, there may be bacteria involved that might require a prescription. Even so, there can be a grey area. To help ensure providers are making the best decisions related to antibiotic use, after 18 years of hospital-based oversight, UW Health is continuing to advance its outpatient antibiotic oversight program. Dr Fox is also coordinating State of Wisconsin oversight efforts.

If your symptoms are consistent with a viral infection, you should expect to receive recommendations to buy over-the-counter symptom relief medications. These symptom relief medications may include a nasal decongestant or pain and fever reliever, like acetaminophen. These medications do not treat the virus causing your symptoms and will not result in antibiotic resistance. This means that you feel better without decreasing the effectiveness of antibiotics for you or others in the future.

Based on recent recommendations from the Centers for Disease Control and Prevention (CDC), the outpatient antibiotic stewardship program will help health care providers know when antibiotics should be prescribed or if it would be better to abstain from prescribing them.

"Improving the way we prescribe antibiotics, and the way we take antibiotics, helps keep all of us safe, and healthy now and for future generations," said Fox.