Antibiotics: When you need them, when you don’t

Antibiotics should not be given to children with ear infections; treatment should be limited to paracetamol and ibuprofen, say new guidelines from UK’s health watchdog, the National Institute for Health and Care Excellence (NICE).

It found that 60% of children with a middle-ear infection (acute otitis media) felt better within a day without antibiotics, and most others got better on their own.

The UK warning comes a few days after the US Centers for Disease Control and Prevention warned parents that antibiotics were not effective against viral infections like the common cold, flu, most sore throats, bronchitis, and many sinus and ear infections.

Here’s when to say yes and when to say no to antibiotics for common infections.

NO: Cold, flu, sore throat (except strep)

Antibiotics treat bacterial infections and are useless against infections caused by viruses, such as the common cold (runny or stuffy nose, sneezing) or seasonal flu that causes fever and body ache. Steam inhalation works much better than any medication to improve symptoms of cold and a scratchy throat, while paracetamol does wonders for pain and fever.

Seasonal flu, including H1N1 or swine flu, are caused by viruses that remain unscathed by antibiotics. All viral infections are self-limiting, lasting for five days to a week. The flu vaccine taken annually protects against infection and severe disease.

YES: Strep throat, whooping cough

You need antibiotics if you have strep throat, which is caused by infection of the streptococcus bacteria, which makes the throat feel raw and makes swallowing painful. The rawness and pain in the throat begin suddenly and are accompanied by high fever of over 101°F without cough, sneezing, or other cold or flu symptoms. Some people may develop swollen lymph nodes in the neck and white or yellow spots or coating on the throat and tonsils.

The B. Pertussis bacterial infection causes whooping cough, which starts with a runny nose, fever and mild cough and slowly progresses to weeks of coughing fits, which may be accompanied by a whooping, gasping sound or vomiting.

The coughing fits becomes increasingly frequent and more severe as the illness continues, occurring more often at night. It’s a highly contagious, vaccine-preventable infection.

MAYBE: Sinus infection, bronchitis, ear infection

About 90% of all common sinus and chest infections are viral or low-acuity bacterial infections, with the infected person feeling better without antibiotic treatment in three to five days.

Antibiotics for sinus infection may be needed if infection is severe with high fever, nasal drainage and a productive cough, or if it lasts for more than a week.

Most coughs, sore throats and acute bronchitis cases in otherwise healthy adults also don’t need antibiotic treatment – only about 10% of people with a sore throat or bronchitis need antibiotics to get better.

Only ear infections with discharge from the ear caused by a burst ear drum should be prescribed antibiotics — if symptoms do not improve within three days, or if there are symptoms of a more serious illness, recommend the NICE guidelines.

The larger threat

Misuse and overuse of antibiotics have made once-treatable common bacterial infections more difficult and even impossible to cure, because bacteria have evolved to evade antibiotics, leading to drug resistance.

Earlier this week, the World Health Organisation (WHO) released a report that described antimicrobial resistance as a global health emergency because the world was running out of antibiotics to treat potentially fatal infections such as tuberculosis, acute diarrhoea, pneumonia, and urinary-tract infections.

Over the past few decades, scientists tackled drug resistance with more powerful antibiotics and drug combinations., but with the last new class of antibiotics (excluding variations on existing ones) discovered in 1987 and the few new ones in development not ready for market, the world is running out of choices.

India is the world’s largest consumer of antibiotics, followed by China and the US. Global antibiotic use rose 36% in the decade ending 2010, with Brazil, Russia, India, China, and South Africa accounting for 76% of this surge.

In India, as around the world, what’s fuelling use is low awareness on the potential harms, non-prescription sale of antibiotics, a poorly regulated private hospital sector, high rates of hospital infection, frequent infectious disease outbreaks, rising incomes and use of antibiotics to boost livestock growth.

While there is no data for India, antibiotics cause one in five emergency department visits for drug reactions in the US. Apart from raising your risk of getting an antibiotic-resistant infection, antibiotics kill healthy bacteria in the intestines and often cause nausea, bloating, stomach ache, appetite loss and vomiting. So just, you know, say no.