Rethinking Antibiotics: Why Your Doctor Might Say No

In recent years, the overuse and misuse of antibiotics have become a growing concern for healthcare professionals. Despite their critical role in treating bacterial infections, doctors are increasingly hesitant to prescribe these medications.

Why won’t my doctor prescribe me an antibiotic?
There are a few really good reasons why you may leave your doctors without a prescription for an antibiotic:

1. Antibiotics are only effective against bacteria. The majority of colds and illnesses with upper respiratory symptoms are caused by viruses and will not respond to antibiotics.
2. Antibiotic resistance is a real concern. If antibiotics are used when they are not needed, this can make bacteria resistant to them. Over time, antibiotics become less useful. It would be very scary to live in a world where antibiotics no longer work!
3. Antibiotics, like all drugs, are not without risk. They commonly cause side effects like nausea, diarrhoea, dizziness, tummy upsets, and vaginal thrush. Some people can be allergic to antibiotics with symptoms ranging from rash to anaphylaxis. Rarer side effects include kidney and liver damage.

Very few antibiotics are being developed by drug companies, so we need to keep our current antibiotics strong and effective. The only way of doing this is by reducing antibiotic use. It is very important that antibiotics are used wisely and only when they are likely to be of significant benefit.

When is it ok to take an antibiotic?
If your doctor thinks you have a serious bacterial infection, you will be prescribed antibiotics. Sometimes the type of infection you have can give the doctor a clue as to whether it is viral or bacterial. Scientists know that bronchitis and sinus infections are generally viral so in these cases your doctor probably won’t prescribe an antibiotic. Sometimes, even with an illness such as a bacterial ear infection, the doctor might have a “wait-and-see” approach. It used to be that antibiotics were almost always used to treat ear infections in children, but we now know that these infections can go away on their own, especially in kids aged over two years old.

Antibiotics are most likely to be reserved for symptoms that have been present for longer than a week, are getting worse, or if a fever is involved.

What will the antibiotic do to my body?
Antibiotics are real wonder drugs when used in the right circumstances – they can literally stop an infection in its tracks within a few hours. They work by either killing the unwanted bacteria that is causing the infection, or making it hard for the bacteria to multiply and grow. Unfortunately, antibiotics also have an effect on the good bacteria present in our bodies, and change the balance and diversity of the bacteria in our gastro-intestinal system. The bacteria normally present in our gut (our “gut biome”) are vital for optimal digestion, immunity, metabolism and brain function. Every time we take an antibiotic, our overall gut diversity changes (the balance between the species of pathogenic (bad) microbes and protective (good) microbes).

It can take one to two months for the gut biome to get back to “normal”. Some studies are even indicating up to six months or longer!

What do probiotics do?
There is increasing clinical evidence to show that taking probiotics during and after a course of antibiotics can decrease the risk of invasion by pathogenic microbes. Probiotics can also:

• decrease the risk of developing diarrhoea during a course of antibiotics
• decrease digestive discomfort from antibiotics
• protect the gut by helping to restore gut bacteria
• remove yeast overgrowth
• aid optimal digestion and nutrient absorption that has been affected by antibiotics
• maintain our populations of good bacteria and as a result maintain digestion and immune function
• support bladder and vaginal health.

There is ongoing research into which strains (or types) of bacteria, and the amounts of bacteria that are most beneficial for certain health conditions.

What probiotic do I choose?
It can be confusing as there are so many types of probiotic products containing ingredients with very long names! Some simple tips:

• choose one that has at least 1 billion CFU (colony-forming units) per dose. CFU indicates how many bacteria are alive per dose
• slow-release preparations are good as not all the contents will end up only in the stomach to be killed by stomach acid
• check if the product is shelf-stable or needs refrigeration – refrigerated products are tricky if travelling
• powder form probiotics can be mixed into cold food or drinks – a good option for kids who can’t swallow capsules.