Picking the Right Battles for Antibiotics

By Priya Nori, MD

HEALTH - Doctors have been busy with RSV, a common virus that hits young children and people over 65 especially hard. Flu cases have been climbing earlier than usual, and COVID-19 infections continue to spread in our community. All of the above can create sneezing, congestion, sore throat and fever – so a lab test is the best way to determine the cause. 

These symptoms can be truly exhausting – leading people to visit their doctor in hopes of getting a prescription for an antibiotic.

We’ve come to think of these medicines as wonders for a quick cure – and they can be when they quickly resolve a difficult bacterial infection.

When Antibiotics Cause Harm 

While antibiotics can be helpful for bacterial infections, they do not kill viruses, which are the cause of the common cold, the flu, RSV, and COVID. When you have a virus, antibiotics will not work – and they can cause harm without benefits. 

Common antibiotic side effects can include rash, dizziness, nausea, diarrhea, and yeast infections. More serious side effects can sometimes include a severe life-threatening form of diarrhea. Antibiotics kill bacteria including the good bacteria we need to be healthy - and rounds of unneeded antibiotics have been associated with the development of inflammatory bowel disease.

Who Decides if Someone Needs Antibiotics?

Our team at Montefiore Health System is dedicated to making sure antibiotics are used when needed – and only when needed. We work to ensure that the right medication at the most effective dose is given in each person’s case.

Outside of hospitals things are different. 80% of the antibiotics we use are taken at home and prescribed outside of hospitals. Half of these prescriptions aren’t optimal or sometimes they aren’t needed at all.

Preparing for your Appointment

Like all aspects of health, it’s important for each of us to advocate for what we need. Approach your doctor with an open mind about the steps to help you feel better. Rest and taking time off work when possible, can be the best approach to healing in some cases. Remember that antibiotics can kill the bacteria that cause infections, but they do nothing to stop viruses. 

Priya Nori, MD, FSHEA, FIDSA, is Medical Director of the Antimicrobial Stewardship Program at Montefiore Health System / Albert Einstein College of Medicine

The next step is to have open conversations with your doctors about whether antibiotics are really needed. Following your doctor’s advice for managing symptoms with things like cough suppressants or ibuprofen is more helpful in many cases than an antibiotic. In other cases, a plan for ongoing monitoring and evaluation, sometimes called “watch and wait,” is better than getting an antibiotic “just in case.”

It is also important to ask your doctor whether you can get better on your own and whether any other medicines or supplements you are already taking could interact in a bad way with antibiotics.

What happens if we over-use antibiotics? 

Over time, some infections can become antibiotic-resistant when the bacteria develop the ability to resist the medicines used to kill these microbes. In fact, many antibiotics are becoming less effective at treating illnesses. If you take these medicines when they are not helpful, antibiotic-resistant bacteria can grow in your body, and these resistant bacteria can spread to others. 

Antibiotics can be lifesaving when used correctly – they are the best tool we have to fight off a bacterial infection. We need to remember these medicines are a resource to be guided responsibly for our own health and to make sure these life-saving drugs are available for the future.

Staying Healthy

To stay healthy this season, make sure you are up to date on your flu and COVID vaccines. Staying home when you are feeling sick, wearing a mask if someone in your household is sick and washing your hands often are important steps that are proven to keep yourself and others well.

Priya Nori, MD, FSHEA, FIDSA, is Medical Director of the Antimicrobial Stewardship Program at 

Montefiore Health System / Albert Einstein College of Medicine