Today’s guest post is written by my husband, Mike Dalliday. Mike is a Physician Assistant (PA) in the Emergency Department of a large, tertiary care teaching hospital in Toronto, ON. Over the course of his time working in the medical field, Mike has come across the controversial subject of antibiotic use countless times.

Thus, he was inspired to write this article in order to educate more people on the use of antibiotics and explain why they aren’t necessary a lot of the time.

I might also add that he spent a lot of time researching to write this post – although, he probably wouldn’t want me to share that with you haha.

I know this post is a bit different than my usual content and I debated wether or not to post it. But then I realized, I take a lot of Mike’s knowledge for granted (haha) and if my sole mission is to help you achieve your best health possible, then empowering you with knowledge on such an important health topic only makes sense.

I hope you enjoy. Please feel free to reach out if you have any questions for Mike or myself.

Why You Might Not Need Those Antibiotics – By Mike Dalliday

Antibiotics are one of the greatest discoveries in the history of medicine, if not the greatest. Countless numbers of lives have been saved thanks to their disease curing properties and many more people have avoided significant morbidity and improved quality of life thanks to antibiotics.

So, what’s not to like?

Why shouldn’t we all have access to all the antibiotics we want?

Because, unfortunately, with great reward comes great risk.

Antibiotics are literally a wonder-drug, when used appropriately – when the right drug is given to the right patient for the right infection. However, more and more in our current medical culture physicians and patients are relying on and over-using antibiotics in the wrong circumstances.

There are a number of factors contributing to this problem, but ultimately it can lead to life threatening complications – both for the patient taking the antibiotic and the population as a whole. I hope to clarify some of these issues in this article by discussing some basic antibiotic principles, and hopefully make you think twice before expecting or, God forbid, demanding an antibiotic prescription at your next physician visit.

Where did they come from anyway?

Let’s start with how antibiotics got started. Certain natural substances (like molds or plant extracts) have been used as far back as ancient civilizations to fight infections. In the late 1800’s it was discovered that certain molds (Penicillium glaucum, used to make blue cheese!) did not allow for bacterial growth to occur. A lot more sciencey stuff happened after that, culminating in the early to mid 1900’s when the actual compound of penicillin was identified and isolated (there is a whole other story for the development of synthetic antibiotics, but I won’t bore you with more history). Essentially since then antibiotic use has been widespread and, not surprisingly, the development of antibiotic resistant organisms and “superinfections” has followed.

So, here’s the rub

As I said, antibiotics are great, when used properly. But recently we are running into issues with their use and overuse, leading to adverse outcomes and even death.

I’m sure you’ve heard of the surge in antibiotic resistant organisms.

Some infections (and more specifically, some bacteria) that used to be susceptible and easily treatable with antibiotics are now, well, not.

Examples include certain strains of E. Coli (a common cause of urinary tract infections), Staph Aureus (a common cause of skin infections), multi-drug resistant Tuberculosis (ya, Tb is still a thing! And more common than you might think), among others.

Not only that, even if antibiotics are used for the right reasons, there is still a chance of unwanted, potentially life-threatening complications.

You may have heard of conditions like C. Difficile colitis, a condition that develops when antibiotics kill a lot of the bacteria in your gut, allowing C. Diff (a bacteria resistant to many antibiotics) to thrive, causing colitis (inflammation of the colon) and a variety of other problems. While C. Diff colitis is relatively rare in young, healthy individuals, there are less extreme (but nonetheless troubling) changes to your gut microbiome that develop with antibiotic use.

Another potentially life threatening outcome and one that is more common, is allergic reaction. With any drug there is the potential to have or develop and allergy, which, in its most extreme form can cause anaphylaxis. Wouldn’t it be a shame to have to be rushed to the Emergency Department and resuscitated from the brink of death because you insisted on an antibiotic you didn’t need?

Within a similar realm to allergy is the concept of drug interactions. Many people are already on a drug or multiple drugs that they consume daily for chronic conditions. Each of these drugs, and many of them in combination, will interact with antibiotics differently, potentially causing a number of adverse events.

Physicians often don’t have or take the time to check all of the meds you are on to ensure the antibiotic they prescribe is safe. Therefore, it’s often left to the pharmacist to ensure all your drugs will get along. And while they do a very good job of it, sometimes things get missed.

And when things get missed, bad things happen.

So the best way to avoid these outcomes is to use antibiotics sparingly, only when they are required.

So, when are antibiotics necessary?

There are many instances in which antibiotics should be used. This is definitely not an exhaustive list, but rather some of the more common indications for their use.

There are a number of infections in which they are not only necessary, but life-saving. Such infections include:

• bone infections (osteomyelitis), tuberculosis, pneumonias, meningitis, joint infections (septic arthritis) among others. 

Antibiotics are also often necessary for more common, mild infections like:

• urinary tract infections, soft tissue and skin infections (cellulitis), certain sexually transmitted infections, ear infections (acute otitis media) and certain types of infectious diarrhea, in the right setting.

Of course, if any of these infections spread to the bloodstream (deemed septicemia, or sepsis) antibiotics would be even further warranted and again, potentially life-saving.

However, all too often antibiotics are being requested by patients and/or prescribed by physicians in the wrong scenarios, perpetuating the problems of antibiotic resistance and other serious complications.

So, when should antibiotics be avoided?

This is a tricky subject to address; one certain to garner significant backlash from patients and even some physicians who feel entitled to the use of antibiotics, even if the only benefit they are providing is a placebo effect.

I think it should go without saying that infections caused by viruses do not require antibiotics.

This includes many upper respiratory tract infections such as:

• the common cold, influenza, acute sinusitis (unless the illness is prolonged and not responding to conservative treatments) and almost all cases of pharyngitis (sore throat).

Yes, even Strep pharyngitis (Strep throat).

There is good evidence to support withholding antibiotics even in proven Strep throat in most North American populations as the risks of antibiotics often outweigh the benefits (http://rebelem.com/patients-strep-throat-need-treated-antibiotics/).

Other infections that usually don’t need antibiotics include:

• conjunctivitis (pink eye – most are viral), gastroenteritis (inappropriately dubbed the “stomach flu” – most are viral and even those that are bacterial don’t typically require antibiotics) and most abscesses (usually only need to be drained).

But treating infections that don’t require or respond to antibiotics is not the only way they can be misused.

People will often take them without the advice of a physician. Perhaps they have an old prescription from a previous illness or order them online or picked them up in another country where they are available over-the-counter.

Or antibiotics are prescribed or taken prophylactically before or during travel. Don’t get me wrong, this is sometimes necessary, but at the very least you should have a conversation with your physician or someone who is competent in travel medicine before going this route.

Other misuses of antibiotics can be pinned squarely on the physicians prescribing them. They may choose the wrong antibiotic for the condition, the wrong dose, the wrong frequency or duration, any or all of which could lead to inadequate treatment and ultimately poor outcomes for the patient and the population as a whole.

As a patient it is really hard to safeguard against this. The only advice I have is to have a conversation with your physician about the risks and benefits expected when an antibiotic is prescribed so you can make an informed decision.

Also, when visiting your physician, keep in mind that studies show doctors are more likely to prescribe antibiotics if patients appear to expect them, often when they aren’t necessary.

So keep an open mind and have an open conversation about your illness and how it should be addressed.

As you can tell, this is not a straight forward, black and white topic. It is the source of ongoing controversy and debate in medical literature and in public health, a debate that is not likely to come to a conclusion any time soon.

So I’ll leave you with only 2 pieces of information to take away from this post.

1. Think twice before you take your next antibiotic – talk to your doctor or pharmacist and get the information you need to make an informed decision.
2. If you’re going to take an antibiotic, take a probiotic with it – your gut will thank you 😊.

Thank you so much Mike for sharing your insight on this topic. We appreciate you speaking out about this controversial topic and providing us with the tools we need to better our health. <3 

Again, if you have any questions for Mike or myself, please feel free to reach out by commenting below, using the contact form or on social media!

xoxo