Following up on the theme established inadvertently last week: I’m still sick, though on the whole, I’m probably not feeling worse, and possibly arguably marginally better. In an effort to avoid the creativity-shattering spiral that happens when I stop writing altogether, this week I will endeavor to present some thoughts on a subject which I have been compelled to be thinking about anyway: Antibiotics.
A lot of concerns have been raised, rightfully, over the appearance of drug-resistant pathogens, with some going so far as to dub the growing appearances of resistant bacteria “the antibiotic apocalypse”. While antibiotic resistance isn’t a new problem per se, the newfound resistance to our more powerful “tiebreaker” drugs is certainly a cause for concern.
In press releases from groups such as the World Health Organization and the Centers for Disease Control and Prevention, much of the advice, while sound, has been concentrated on government organizations and healthcare providers. And while these people certainly have more responsibility and ability to react, this does not mean that ordinary concerned citizens cannot make a difference. Seeing as I am a person who relies on antibiotics a great deal, I figured I’d share some of the top recommendations for individuals to help in the global effort to ward off antibiotic resistance.
Before going further, I am compelled to restate what should be common sense: I don’t have actual medical qualifications, and thus what follows is pretty much a re-hash of what other experts have given as general, nonspecific information. With this in mind, my ramblings are no substitute for actual, tailored medical advice, and shouldn’t be treated as such.
Before you’re put on antibiotics
1) Stay home when you’re sick
This one is going to be repeated, because it bears repeating. Antibiotic resistant strains spread like any other illness, and the single best way to avoid spreading illness it to minimize contact with other people. Whether or not you are currently infected with antibiotic-resistant illness; in fact, whether or not you even have an illness that is treatable by antibiotics; staying at home when you’re sick will help you get better sooner, and is the single most important thing for public health in general.
2) Wash hands, take your vitamins, etcetera.
So obviously the best way to deal with illness is to avoid spreading it in the first place. This means washing your hands frequently (and properly! Sprinkling on some room temperature water like a baptism for your hands isn’t going to kill any germs), preparing food to proper standards, avoiding contact with sick people and the things they come in contact with, eating all of your vegetables, getting your vaccinations, you get the picture. Even if this doesn’t prevent you from getting sick, it will ensure that your immune system is in fighting shape for if you do.
3) Know how antibiotics work, and how resistance spreads
Remember high school biology? This is where all that arcana comes together. Antibiotics aren’t a magical cure-all. They use specific biological and chemical mechanisms to target specific kinds of organisms inside you. Antibiotics don’t work on viruses because they aren’t living organisms, and different kinds of antibiotics work against different diseases because of the biological and chemical distinctions.
Understanding the differences involved when making treatment decisions can be the difference between getting effective treatment and walking away unharmed, and spending time in the hospital to treat a resistant strain. Antibiotic resistance is a literally textbook example of evolution, so understanding how evolution works will help you combat it.
Public understanding of antibiotics and antibiotic resistance is such a critical part of combating resistance that it has been named by the World Health Organization as one of the key challenges in preventing a resistant superbug epidemic.
4) Treat anyone who is on antibiotics as if they were sick
If someone is on antibiotics and still doesn’t feel or seem well (and isn’t at home, for some reason), you’re going to want to take that at face value and keep your distance. You can also kindly suggest that they consider going home and resting. If you become sick after contact with such persons, be sure to mention it to your doctor.
If they’re feeling otherwise fine, you want to treat them as if they were immunocompromised. In other words, think of how you would conduct yourself health-wise around a newborn, or an elderly person. Extra hand-washing, making sure to wipe down surfaces, you get the picture. If they’re on antibiotics preventatively for a chronic immunodeficiency, they will appreciate the gesture. If they’re recovering from an acute illness, taking these extra precautions will help ensure that they don’t transmit pathogens and that their immune system has time to finish the job and recover.
5) Never demand antibiotics
I’ll admit, I’m slightly guilty of this one myself. I deal with a lot of doctors, and sometimes when I call in for a sick-day consult, I get paired with a GP who isn’t quite as experienced with my specific medical history, who may not have had time to go through my whole file, and who hasn’t been in close contact with my other dozen specialist doctors. Maybe they don’t recognize which of my symptoms are telltale signs for one diagnosis or another, or how my immunology team has a policy of escalating straight to a fourteen day course, or whatever.
I sympathize with the feeling of just wanting to get the doctor to write the stupid prescription like last time so one can get back to the important business of wasting away in bed. However, this is a problem. Not everyone is as familiar with how antibiotics work and with the intricacies of prescribing them, and so too often when patients ask for antibiotics, it ends up being the wrong call. This problem is amplified in countries such as the United States where economics and healthcare policies make it more difficult for doctors to refuse. This is also a major issue with prescription painkillers in the United States. So, listen to your doctor, and if they tell that you don’t need antibiotics, don’t pressure them.
Bear in mind that if a doctor says you don’t need antibiotics, it probably means that antibiotics won’t help or make you feel any better by taking them either, and could cause serious harm. For reference, approximately one in five of all hospital visits for drug side effects and overdoses are related to antibiotics.
It should go without saying that you should only get antibiotics (or any medication, really) via a prescription from your doctor, but apparently this is a serious enough problem that both the World Health Organization and the Centers for Disease Control and Prevention feel the need to mention this on their patient websites. So, yeah. Only take the drugs your doctor tells you to. Never take antibiotics left over from previous treatment, or from friends. If you have antibiotics left over from previous treatment, find your local government’s instructions for proper disposal.
If you are prescribed antibiotics
1) Take your medication on schedule, preferably with meals
Obviously, specific dosing instructions overrule this, but generally speaking, antibiotics are given a certain number of times per day, spaced a certain number of hours apart, and on a full stomach. Aside from helping to ensure that you will remember to take all of your medication, keeping to a schedule that coincides with mealtimes will help space dosages out and ensure that the antibiotics are working at maximum efficiency.
Skipping doses, or taking doses improperly vastly increases both the likelihood of developing resistant pathogens, and the risk of side effects.
2) Take probiotics between dosages
Antibiotics are fairly indiscriminate in their killing of anything it perceives as foreign. Although this makes them more effective against pathogens, it can also be devastating to the “helpful bacteria” that line your digestive tract. To this end, most gastroenterologists recommend taking a probiotic in between dosages of antibiotic. Aside from helping your body keep up it’s regular processes and repair collateral damage faster, this also occupies space and resources that would otherwise be ripe for the taking by the ones making you sick.
3) Keep taking your antibiotics, even if you feel well again
You can feel perfectly fine even while millions of hostile cells linger in your body. Every hostile cell that survives treatment is resistant, and can go in to start the infection all over again, only this time the antibiotic will be powerless to halt it. Only by taking all of your antibiotics on the schedule prescribed can you ensure that the infection is crushed the first time.
Furthermore, even though you may feel fine, your immune system has been dealt a damaging blow, and needs time to rebuild its forces. Continuing to take your antibiotics will help ensure that your weakened immune system does not let potentially deadly secondary infections slip through and wreak havoc.
4) Stay Home and Rest
Is this message getting through yet?
If you are on antibiotics, it means your body is engaged in a struggle, and it needs all of your resources focused on supporting that fight. Even the most effective antibiotics cannot eliminate every hostile cell. You immune system plays a vital role in hunting down and eliminating the remaining pathogens and preventing these resistant strains from multiplying and taking hold. In the later stages of this fight, you may not even feel sick, as there are too few resistant cells to cause serious damage. However, unless all of them are exterminated, the fight will continue and escalate.
Ideally, you should stay at home and rest for as long as you are taking antibiotics. However, since antibiotics are often given in courses of fourteen and twenty one days, this is impossible for most adults. At a barest minimum, you should stay home until you feel completely better, or until you are halfway done with your course of antibiotics, whichever is longer.
If you do return to your normal routine while taking antibiotics, keep in mind that you are still effectively sick. You should therefore take all of the normal precautions: extra hand washing, wiping down surfaces, extra nutrition and rest, and the like.
5) If you don’t feel better, contact your doctor immediately
Remember: Antibiotics are fairly all or nothing, and once an illness has developed a resistance to a specific treatment, continuing that line of treatment is unlikely to yield positive results and extremely likely to cause increased resistance to future treatment. Obviously, antibiotics, like any course of treatment, take some time to take effect, and won’t make you feel suddenly completely better overnight. However, if you are more than halfway through your treatment course and see no improvement, or feel markedly worse, this could be a sign that you require stronger medication.
This does not mean that you should stop taking your current medication, nor should you take this opportunity to demand stronger medication (both of these are really, colossally bad ideas). However, you should contact your doctor and let them know what’s going on. Your doctor may prescribe stronger antibiotics to replace your current treatment, or they may suggest additional adjunctive therapy to support you current treatment.
Works Consulted
“Antibiotic resistance.” World Health Organization. World Health Organization, n.d. Web. 28 Apr. 2017. <http://www.who.int/mediacentre/factsheets/antibiotic-resistance/en/>.
Freuman, Tamara Duker. “How (and Why) to Take Probiotics When Using Antibiotics.” U.S. News & World Report. U.S. News & World Report, 29 July 2014. Web. 28 Apr. 2017. .
“About Antibiotic Use and Resistance.” Centers for Disease Control and Prevention. Centers for Disease Control and Prevention, 16 Nov. 2016. Web. 28 Apr. 2017. <https://www.cdc.gov/getsmart/community/about/index.html>.
Commissioner, Office Of the. “Consumer Updates – How to Dispose of Unused Medicines.” U S Food and Drug Administration Home Page. Office of the Commissioner, n.d. Web. 28 Apr. 2017. <https://www.fda.gov/forconsumers/consumerupdates/ucm101653.htm>.
NIH-NIAID. “Antimicrobial (Drug) Resistance.” National Institutes of Health. U.S. Department of Health and Human Services, n.d. Web. 28 Apr. 2017. <https://www.niaid.nih.gov/research/antimicrobial-resistance>.
