Can Antibiotics Be Harmful?

Antibiotics are one of the great advances in medicine.  They have allowed us to treat infections and do surgeries like cesarean sections that would most likely have resulted in death from infection in the past. That being said, there are definitely times when antibiotics can be helpful, but there are also situations in which they aren’t.  To help explain the difference, here’s a quick overview.

First, what do Antibiotics treat?  Germs consist of bacteria and viruses.  Bacteria are living organisms that exist as single cells.  Bacteria are everywhere.  Some cause disease, some do not, and some are even beneficial like the ones that line your intestines and help with breakdown of food.  Viruses are not alive and invade our cells and use them to replicate.  Viruses are generally harmful.  Antibiotics only work against bacteria because they are living organisms.  They do not work against viruses. 

Antibiotics are great at treating bacterial infections that can cause pneumonia, ear infections, or sinus infections, and they can prevent infections during surgery.  However, if these infections are caused by viruses like the common cold or the flu, antibiotics will not help and are only likely to stir up all sorts of issues:

1. First, antibiotics can have lots of side effects!  The most common side effects of antibiotics include vomiting, nausea, diarrhea, bloating, and abdominal pain.  Notice how the most common symptoms are GI related.  The reason for this is there are lots of bacteria in your intestines- some are good and help with the breakdown of food and some are bad.  In the process of killing bad bacteria, antibiotics may inadvertently kill some good bacteria in the stomach as well, and this is what causes these side effects.  Other symptoms include hives (a scaly itchy rash), coughing, and wheezing.  In fact, some individuals even have trouble breathing (this is an emergency that requires an urgent visit to the ER). 
2. The overuse of antibiotics to treat things like the common cold have led to antibiotic resistance.  As bacteria get exposed to antibiotics, they find a way to thwart the effects of the antibiotics on their cells.  This is how they become superbugs.  They find ways to combat the effect of antibiotics and survive despite being bombarded by different types of antibiotics.  What many physicians are worried about is as more bacteria become resistant, we will run out of antibiotics to treat common bacterial infections because they will be resistant to all the antibiotics currently available. 
3. Another side effect of antibiotics is a common complaint from patients to their gynecologist- vaginal yeast infections.  Antibiotics cause yeast infections in the vagina for the same reason they cause GI side effects.  There are many good bacteria in the vagina. Antibiotics can kill off these beneficial bacteria and cause an overgrowth of yeast in the vagina causing a cottage cheese like discharge and severe itching.  Alternatively, they may also contribute to bacterial vaginosis. 
4. Using antibiotics can cause other infections like clostridium difficile (c. diff).  C. Diff is a bacterium that can cause symptoms that range from diarrhea to a life-threatening inflammation of the colon.  When you take antibiotics to treat an infection, it can destroy some of the normal, beneficial bacteria in the intestines and cause an overgrowth of c. diff. 

There are lots of other theories out there as well that frequent antibiotic use in childhood may be a precursor to chronic diseases like asthma and obesity.  While the evidence for this is limited, we should be very wary of taking antibiotics when not necessary.  The best way to prevent these issues is by being a good steward of our current available antibiotics. 

In closing, here are a few quick tips for making the most of your antibiotics.

1. Please take antibiotics if your doctor encourages you to take antibiotics for illnesses or procedures.  Only take antibiotics that were prescribed by your doctor for you, take them as directed and do not skip doses in an effort to save them for later.   This often kills only the weak bacterial cells while leaving the stronger ones, which can cause your symptoms to return with a vengeance AND be harder to treat.
2. Trust your doctor if they feel your symptoms are more consistent with a viral illness and that antibiotics are not necessary. 
3. Consider probiotics foods while on antibiotics to help regenerate the beneficial bacteria of the gut.  This may help decrease the GI side effects, vaginal yeast infections and other issues caused by antibiotics. 

Dr. Pam