Expert Answers: When should I take antibiotics?

Cold and flu season is upon us, and patients are crowding urgent care centers in the hopes of obtaining medication to combat their symptoms. But are antibiotics really the cure for all ills? Or should people be using them more sparingly?  

According to the Centers for Disease Control and Prevention (CDC), more than 2.8 million antibiotic-resistant infections occur in the U.S. each year, leading to the deaths of more than 35,000 people annually. So, how do we know when we should and should not be taking antibiotics? Associate Clinical Professor Elizabeth Covington of Auburn University’s Harrison College of Pharmacy, who studies antimicrobial stewardship and infectious disease in the community hospital setting, explains the basics of antibiotics use and overuse.

Q: I have a terrible cough and congestion, but my health care practitioner didn’t give me antibiotics. Why not?

EC: Antibiotics are often prescribed for respiratory infections even when they’re not necessary. However, antibiotics only work against bacterial infections, not viral ones. Viral infections, such as the common cold, COVID-19, influenza, bronchitis and some ear and sinus infections, cannot be treated with antibiotics. Antibiotics also won’t relieve symptoms from viral infections. For more information on which respiratory infections are caused by viruses or bacteria, the CDC has a helpful chart.

Q: So, antibiotics won’t work if my infection is viral. Why don’t antibiotics work on viruses? And how do I know if my infection is bacterial or viral?  

EC: Antibiotics target bacteria, not viruses, because bacteria and viruses are fundamentally different. While viruses need to invade a host cell to replicate, bacteria are living organisms that grow and reproduce on their own. Antibiotics target bacterial processes, which is why they have no effect on viruses. To determine if your infection is bacterial or viral, your health care provider will consider your symptoms and medical history and may perform laboratory tests, if necessary.

Q: Since antibiotics won’t work, how can I get rid of a viral infection?

EC: For some viruses, such as COVID-19 and influenza, there are antiviral medications that may reduce symptoms and/or shorten the course of illness for some patients. For most other respiratory viruses, we have to let the infection run its course. There are still ways to mitigate symptoms — ask your doctor or pharmacist for over-the-counter remedies that can help alleviate your symptoms.

Q: It won’t hurt anything to take antibiotics. Why won’t my prescriber just give me one in case I have a bacterial infection?

EC: Taking antibiotics when not needed can lead to antimicrobial resistance, where germs like bacteria become able to defeat the drugs designed to kill them. This antimicrobial resistance makes infections harder to treat. Misuse of antibiotics can also cause harmful side effects, like a dangerous infectious diarrhea called Clostridioides difficile (C. diff) infection.

Using antibiotics only when necessary is one aspect of antimicrobial stewardship, which aims to optimize the use of antibiotics to combat resistance. Antibiotic-resistant infections are on the rise and are considered a top 10 global public health threat by the World Health Organization. Misuse and overuse of antibiotics are key factors in the development of antimicrobial resistance. If antibiotic resistance continues to grow, our effective antibiotic options will be severely limited; minor infections will become much harder to treat and could even become life-threatening.

Q: I was prescribed an antibiotic, but I’m feeling better after a few days. What if I don’t feel like finishing the full course of a prescribed antibiotic? 

EC: It’s important to finish the full course of antibiotics, even if you start feeling better. Stopping early can leave some bacteria alive, which can become resistant to the antibiotic. This makes future infections harder to treat. If you experience severe side effects, contact your health care provider for advice on managing them or possibly switching medications. If you are prescribed an antibiotic for a bacterial infection, take it exactly as prescribed. Do not share your antibiotics with others, save them for later or take antibiotics prescribed for someone else. This may delay the best treatment for you, make you even sicker or cause side effects.