When not to take antibiotics

Our appetite for antibiotics is fuelling the rise of superbugs. So why are doctors dishing out so many of the drugs?

Hand holding antibiotics next to glass of water.

Pay a visit to the doctor and about half the time you’ll walk out of the clinic with a prescription for antibiotics. Latest data show 49% of people who go to their GP leave with a prescription for at least one antibiotic.

It’s likely some of these prescriptions were given when there was no need.

Overuse of antibiotics is a major factor in the rise of drug-resistant superbugs. And we’re dishing out more antibiotics here than many other countries – 25.8 daily doses per 1000 people compared with the OECD average of 17.8. Our rate is more than double that of Sweden (10.2 doses).

Prescribing behaviour

Most antibiotics – up to 95% – are prescribed by GPs and other health professionals working in the community, according to figures published by the Health Quality and Safety Commission (HQSC).

Research also shows some antibiotics are prescribed 37% more in winter than in summer. That may indicate they’re being unnecessarily handed out for colds and flu, said Dr Sally Roberts, clinical lead for the HQSC’s infection prevention and control programme. Colds and flu are caused by viruses, not bacteria, and taking antibiotics won’t help.

Worryingly, figures show high use of broad-spectrum amoxicillin (a type of penicillin). It’s one of the mostly widely prescribed antibiotics. Because broad-spectrum drugs work against a wide range of bacteria, they increase the risk of antibiotic-resistant bugs emerging.

“Antibiotics are important but it’s best to avoid prescribing broad-spectrum penicillins where possible. There’s an opportunity to raise awareness that amoxicillin is in fact broad-spectrum, as many GPs seem to be unaware of this,” Dr Roberts said.

Changing practice

Given the high level of antibiotics prescribed by general practices and primary health organisations, they should be looking at their data and asking, “does this pattern of prescribing seem appropriate?” Dr Roberts said.

Consumers also shouldn’t be shy asking their doctor questions about why a medication is being prescribed.

To help you discuss options with a doctor, we’ve compiled advice from our Choosing Wisely campaign on four common conditions that usually don’t need to be treated with antibiotics:

Common conditions: when not to take antibiotics

Colds and flu

Colds and flu are caused by viruses. Antibiotics kill bacteria, not viruses, so taking antibiotics won’t make you feel better or recover faster. Colds usually get better in seven to 10 days. Flu symptoms can last two to three weeks.

What can you do?

  • Rest. Allow your immune system to fight off the virus.
  • Use home remedies. Inhale steam from a bath or shower in a closed room to help relieve a blocked nose. Soothe a sore throat by gargling warm salty water, sucking ice cubes or having a lemon and honey drink.
  • Use symptom-relieving medicines. Take over-the-counter (non-prescription) medicines such as paracetamol or ibuprofen to relieve pain.

When does a sore throat need antibiotics?

In some people, sore throats can have serious complications and do need antibiotics. Sometimes a sore throat is caused by streptococcus bacteria (strep throat). A strep throat not treated quickly with antibiotics can lead to rheumatic fever, which can cause heart damage.


Eczema

Eczema causes dry, itchy, red skin. People with eczema often have high amounts of bacteria on their skin but that doesn’t mean they have an infection. Even so, some doctors treat eczema with oral antibiotics.

Antibiotics don’t help the itching, redness, or severity of eczema. And the skin bacteria usually come back in a month or two.

What can you do?

  • Moisturise often during the day. Use mild unscented moisturisers and skin cleansers. Avoid products with alcohol or dyes.
  • Short, cooler baths and showers are better than long hot soaks. After washing, pat the skin partly dry. Then apply moisturiser right away on your damp skin.
  • Avoid things that make your skin worse. These can include scratchy fabrics, cigarette smoke, strong soaps, detergents and cleaning products.

To relieve itching and swelling, ask your doctor about creams or ointments containing a steroid (also called a corticosteroid) or other medicines.

When should antibiotics be considered?

Sometimes eczema and rashes can become infected with bacteria. Antibiotics should be prescribed when there are signs of a bacterial infection, such as:

  • pus-filled bumps, or cracks and sores that ooze pus
  • honey-coloured crusting
  • very red or unusually warm skin
  • possibly a fever.

Sinusitis

People with sinusitis (congestion combined with nasal discharge and facial pain) are often prescribed antibiotics. But most people don’t need them. That’s because the problem almost always stems from a viral infection, not a bacterial one.

What can you do?

  • Rest. Allow your immune system to fight off the virus.
  • Keep hydrated.
  • Use a warm face pack or compress to help with discomfort.
  • Take over-the-counter (non-prescription) medicines such as paracetamol or ibuprofen to relieve pain. Saline nasal spray or drops, or a sinus rinse, may help relieve congestion.

If your sinusitis is caused by a cold, symptoms will likely clear in about a week or two. However, it can take up to two months.

When should antibiotics be considered?

Antibiotics should usually only be considered when symptoms last longer than a week, start to improve but then worsen again, or are very severe. Worrisome symptoms that can warrant immediate antibiotic treatment include:

  • a fever over 38.6°C
  • extreme pain and tenderness over your sinuses
  • signs of a skin infection, such as a hot, red rash that spreads quickly.

Urinary tract infections

The main symptoms of urinary tract infections (UTIs) are a burning feeling when you urinate and a strong urge to urinate often. Doctors often use antibiotics to treat UTIs. However, many people get UTI treatment even though they don’t have these symptoms.

Why? People often have some bacteria in their urine. This doesn’t mean they have a UTI but doctors may find the bacteria in a routine test and give antibiotics anyway. However, an antibiotic won’t prevent UTIs or help bladder control.

When should antibiotics be considered?

If you have the symptoms of an UTI, antibiotics can help. Common symptoms are a painful, burning feeling when you urinate and a strong and frequent urge to “go”.

Other symptoms in older people may include fever, chills, or confusion.

Along with these symptoms, there is usually pain on one side of the back below the ribs or discomfort in the lower abdomen. There may be a change in the way the urine looks or smells.

If you do have a UTI and get treated, you usually don’t need another test to find out if you’re cured. You should only get tested or treated if your UTI symptoms come back.

Choosing Wisely

Choosing Wisely

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Choosing Wisely

This article is part of our content on Choosing Wisely, a campaign encouraging a change in thinking by health professionals and consumers to avoid unnecessary medical intervention.

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