Antibiotics: More harm than good?

by Dr. Shane Speights

Okay, I’ve been asked to write a “blog”.  This is a bit new to me, so bear with me as I stumble through the syntax.  I’m more of a personal writer, not really one who would put out a book chapter, so here goes…

The raw numbers say that 8 out of 10 Americans take at least one antibiotic a year.  Amoxicillin and the infamous Z-Pack take the top spots. The number is higher for infants and children due to the multiple prescriptions per year they often get.  As usual, it’s worse in the south.  Make no mistake…you are harming yourself by taking an antibiotic if you don’t really need it.  We recognize it in the medical field as well, and there is a nationwide push for better “antibiotic stewardship”. I’m looking forward to seeing some positive headway on that front.

Let’s start with a typical scenario:

You wake up Monday morning, and you have a cough, runny nose, sore throat, “feel hot”, mild headache and just plain don’t feel good.  You tolerate it as long as you can, which usually equates to about 12-36 hours (gender specific of course) and then run to the ED, Urgent Care or local clinic to get the coveted Z-pack +/- a steroid shot (don’t get me started on that one).  You start said Z-pack and take this medication exactly as your doctor has prescribed (as opposed to your diabetes, heart or blood pressure medications). You finish taking the miracle drug on day 5, knowing it is “still in your system” for another couple of days.  By day 7-9 you’re feeling much better and thankful that your very wise healthcare provider gave you that lifesaving medication.

Sound familiar?  So here’s what really happens:

Your body has an immune system (the system in the body that responds to and fights disease), and on a day-to-day basis your body does an amazing job of fighting off infections.  There are several types of infections that cause you to become sick, but mostly they are either bacterial infections or viral infections.  You need to know that the vast majority of the time it is a viral infection that causes the symptoms mentioned above. Antibiotics (i.e. Z-pack) don’t work for viral infections.  Antibiotics are used for bacterial infections.  I know what you’re thinking, “Okay, smarty pants, then why does it work every time I take it?”  That’s a fair question here’s the answer:

The normal “life span” of a virus that causes symptoms like this is about 7-10 days.  Sometimes it’s shorter, sometimes it’s longer, but usually you are over it by day 7.  Now, in our scenario, you felt bad on Monday (day 1) and got your miracle drug about 24-48 hours (days 2-3) after your symptoms started.  Anyone who has taken a z-pack remembers that it’s either a 3-or-5 day “pack”, and once you’re finished with the pack, the medication “stays in your system” several days beyond that.  That puts us at days 5-8, depending on which pack you took.  Do you remember earlier on what the average life cycle of a virus is?  Your symptoms would have resolved regardless of what you did.  That’s right, you could’ve just as easily taken a tic tac everyday and achieved the same result.  While you are thanking the z-pack gods, the real hero in your getting better was…you.  Yes, your body mounted a response and fought off the virus.  Now, it doesn’t always happen that way but a large percent of the time that’s exactly what happens.  So what’s the big deal about taking an antibiotic if you don’t need it?  What can it hurt?

Actually, it really can hurt you.  Quick fact: there are more bacterial cells in your body than human cells (about 10x more).  You have “good” bacteria that your body needs to help keep things in check.  Antibiotics can throw off that balance.  Unfortunately, when you take an antibiotic, it doesn’t “go to” specific areas in your body.  For example, if you have strep throat (a bacterial infection) and are appropriately given an antibiotic, it certainly fights the bad bacteria causing the infection in your throat, but it also travels throughout the rest of your body killing other bacteria, even your good bacteria (in the stomach, small intestine and colon).  Strep throat can move beyond the throat and affect other areas that can be life threatening so the “risk vs. benefit” of taking the medication is in favor of taking the antibiotic.

Please don’t take this as a rant against the z-pack (azithromycin).  It is a great medication that truly heals people when it is used appropriately, but it does absolutely nothing for a viral infection.

So why do healthcare providers write prescriptions for it if they know what I just told you?  Honestly, that’s a whole other issue that we’ll tackle another time, but for the time being, please feel free to question your provider (you should feel comfortable doing that) if you really need an antibiotic or if this is likely a viral infection that will runs its course in about a week.

Remember, your health is your responsibility.

Dr. Shane Speights is the Associate Dean of Clinical Affairs for NYIT in Jonesboro and serves as Director of Medical Education for St. Bernards Medical Center. Dr Speights was previously the Vice President of Medical Affairs at St. Bernards Medical Center.  Dr. Speights earned his medical degree from the University of Health Sciences College of Osteopathic Medicine in Kansas City, Missouri. He then completed his residency at UAMS Northeast Family Medical.

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