Antibiotics Are Not Always the Answer

A scratchy, sore throat is common this time of year, but chances are you won’t need to treat it with an antibiotic.

Most sore throats are caused by a virus or allergies, which do not respond to antibiotics. An exception is strep throat, which is caused by bacteria and does respond to antibiotics.

“Only 10 to 20 percent of sore throats are strep,” says UNC Health pediatric infectious diseases specialist Zach Willis, MD. “The more antibiotics we take, the more likely it is that resistant bacteria will develop.”

Antibiotics are lifesaving medicines. But it’s important not to take them when we don’t need them. Misusing antibiotics contributes to the development of antimicrobial resistance, when germs are able to outmaneuver the drugs that are supposed to kill them.

The result is antibiotic-resistant infections, of which there are more than 2.8 million in the United States each year, killing more than 35,000 people.

“People should know that antibiotic resistance is common both in the hospital and out,” says UNC Health infectious diseases specialist Nikolaos Mavrogiorgos, MD.

Why Overuse of Antibiotics Is a Problem

When we take antibiotics, resistant bacteria (either already in the body or acquired) are not killed like more susceptible bacteria. They can then proliferate and cause infections that can be hard to treat. Bacteria that are resistant to multiple antibiotics include C. diff and MRSA. People with compromised immune systems or who spend a long time in the hospital are at especially high risk. An out-of-control infection can lead to sepsis, which has a high mortality rate.

Some foodborne bacteria, including salmonella and campylobacter, are becoming resistant to antibiotics. If animals that we eat carry bacteria that are resistant to antibiotics, these superbugs may be passed along to humans if the meat is not properly handled and cooked.

Don’t Always Ask for Antibiotics

You can help by working with your doctor to find appropriate treatments when you or your children get sick, Dr. Willis says.

“If you bring your child to the doctor because they have a fever and sore throat, and the doctor says they don’t need an antibiotic, be glad,” he says. “That’s a good outcome. It means your child probably has a virus and most viruses pass in a few days.”

Colds, flu, COVID-19 and most stomach bugs are caused by viruses. Remember, when you have a viral infection, antibiotics won’t help, but you still may experience the side effects from the medicine, which could include rash, dizziness, nausea, diarrhea or yeast infections.

Doctors distinguish between bacterial and viral infections by using tests, such as swabs for COVID-19, the flu, RSV and strep throat, along with physical exams and asking the patient about their symptoms.

“A bacterial ear infection looks very different from a viral one,” Dr. Willis says. “Someone with a viral sore throat will often have a runny nose or a cough, but someone with strep throat almost never has those symptoms.”

Antibiotics Are Not Needed for Many Common Infections

Even though bacterial infections like ear infections, strep throat and bacterial sinusitis are common, most upper respiratory infections are caused by viruses. In most cases, a health care provider can determine if antibiotics are needed by asking some questions and doing an exam. In some cases, it can be difficult to tell, and providers can recommend close follow-up with a plan to prescribe antibiotics if symptoms get worse or don’t improve.

Antibiotics saved lives when they were discovered in the 20th century. Before these medicines were available, people often died from infections that are easily treatable today. But as old antibiotics become less effective, new ones haven’t taken their place.

“Back in the 1960s and ’70s, infections became much less of an issue, and development of new antibiotics waned,” Dr. Mavrogiorgos says. “While we have had some new antibiotics over the last few decades, the rate of antibiotic development has not caught up with the level of antimicrobial resistance.”

That makes it extremely hard to treat certain infections, and the problem is expected to get worse, he adds.

Leading the Way in Antimicrobial Awareness

It is important to be good stewards of the antibiotics we have and prevent resistance whenever possible. Both Dr. Mavrogiorgos and Dr. Willis are part of the Carolina Antimicrobial Stewardship Program (CASP). Along with other antimicrobial stewardship programs throughout the world, CASP provides research and educational programs aimed at helping practitioners prescribe the right drug, at the right dose, for the right length of time. (Antimicrobials include antibiotics, antivirals and antifungals.)

“We’ve had a lot of success from our efforts over the past several years to prevent antibiotic resistance,” Dr. Willis says. “This is a worldwide problem, and we’ve seen less success in some other parts of the world. Antibiotics are even available over the counter in some countries where there aren’t enough providers or patients don’t have the money to go see a provider.”

The World Health Organization and other international groups are addressing the global risks. Meanwhile the CDC is providing information for patients and providers in the United States.

“We all have a role to play,” Dr. Willis says.

Avoid Medications by Preventing Infection

Of course, the best way to safeguard antibiotic efficacy is to use them less, and the best way to do that is to need them less. You can’t prevent every infection, but we can prevent many.

“We’re all more aware now of how infections can spread and how to protect ourselves,” Dr. Willis says. “If we don’t get sick, we won’t need antibiotics. The extent to which we use that knowledge can make a huge difference in how we feel and in how well-protected our communities are against resistant bacteria.”

Vaccines are vital tools for preventing infections, he says. Even vaccines for viral infections, like COVID-19 and the flu, are important because when people have viruses, they are more likely to get secondary bacterial infections.

Other simple, but powerful, weapons against infection? Wash your hands properly and frequently, avoid people who are coughing or seem sick, and don’t spread any infections you have yourself—if you are sick, stay home and wear a mask if you must be around others.

Talk to your doctor about appropriate use of antibiotics. If you don’t have a doctor, find one near you.