Do you need antibiotics?

A patient comes in, They want to treat it, and they ask the doctor for antibiotics. Antibiotics,

It is something we see all the time. A patient comes in, they have a cough. Its been bothering them for a few days. They want to treat it, and they ask the doctor for antibiotics. Antibiotics, the miracle drug that will cure anything infective, the drug to take for any fever, cold, flu. But is this true? Does this miracle drug really exist?

To understand this, we have to understand what makes us ill. When it comes to infections the two common causes are bacteria and viruses. These microscopic organisms might be the same thing by many people, but that couldn’t be further from the truth. Bacteria covers a group of organisms the same way “plants” describe everything with roots and leaves, from the small grass in the fields to the towering trees of the rainforest.

BACTERIA

A bacterium looks similar to the cells that make up our body but are several magnitudes smaller. They have DNA like us, they have the ability to copy DNA, make proteins, move around their environment. Unlike plants and animals, bacteria can replicate rapidly, producing thousands of copies of themselves within hours. Another property that makes them unique is the ability to share DNA with neighbouring bacteria. They can evolve and share any advantages they have without needing to replicate. If this was possible in humans, we would be able to share the DNA that gives us our hair colour, eye colour or lactose tolerance just by touching the person next to us.

Bacteria vary immensely by species and group, and not all of them are bad bacteria. Indeed, our skin is covered by bacteria, as is the lining of the gut, and often this is beneficial us. The bacteria in our gut is thought to help with our appetite, have a beneficial effect against colon cancer, even have an effect on our mental health and wellbeing.

VIRUSES

Viruses on the other hand are more of a mystery. Unlike bacteria, which function in similar ways to the cells that make up our body, viruses are best described as genetic material inside a protein package. They cannot copy and produce DNA or proteins like our body can and are dependent on host cells for replication. For this reason, some scientists do not classify them as alive. Viruses also have another interesting property. When they replicate their DNA has a high rate of mutation. This allows viruses to quickly develop new strains and become resistant to anti-viral medication. This is why we always have a new strain of cold and flu each year, and why we need yearly vaccines against them.

DO I NEED ANTIBIOTICS

So why is this important to know? The common cold is, as the name suggests, very common. It usually presents as a runny nose, cough, sneezing, ear pain, slightly swollen tonsils and other generic symptoms. 90% of the time these symptoms are caused by a virus, not bacteria. The symptoms usually persist for a few weeks but will often go away by themselves. A doctor will usually recommend paracetamol and ibuprofen and keeping hydrated. They will tell the patient antibiotics are not necessary.

This is because antibiotics work against a bacterial infection. They work against the bacterial cell wall, against bacterial proteins and against the mechanisms bacteria have to replicate DNA. None of these structures are found in viruses. Therefore, antibiotics cannot work against viruses.

In fact, giving antibiotics for a cold can be harmful to someone, as they do not get any benefits from the antibiotics but are put at risk of the side effects. Using antibiotics can destroy the good bacteria in our guts, can cause diarrhoea and in some people can cause an allergic reaction.

An even bigger issues is resistance. The more we use antibiotics, the more bacteria become resistant and this resistance spreads quickly. Every time you use them this risk increases. One day you may need the antibiotics and find they do not work because the bacteria are now resistant. In the near future, we might find ourselves unable to treat the simplest of infections due to the resistance. If this happens it will put cancer patients at risk, as their chemotherapy can stop their body from effectively fighting infections, and even stop our ability to perform the simplest of operations.

SHOULD I USE ANTIBIOTICS

If your doctor believes you have symptoms that are suggestive of a bacterial infection, they might prescribe you a short course of antibiotics. For example this can be if you have an infection in your lung, or if you have symptoms of a very high fever, nodes in your neck and white slime on the back of your throat. In these cases it is important to take the antibiotics. It is very important to take the antibiotics regularly and finish the course that is given to you. Do not stop taking the antibiotics if you feel well, as the infection might not have been treated completely and may come back. If this keeps occurring then there is a high risk the bacteria will become resistant, making the infection difficult to treat.

If your doctor believes you have a viral infection, then don’t ask for antibiotics. They will not work, and can cause you more harm than good. Instead follow the doctors advice, take paracetamol and ibuprofen if required, and let your body fight the infection. A cough can persist for weeks, but it will disappear. In the meantime use cough suppressants and keep hydrated. You can always visit your doctor again if the symptoms are getting worse.

Dr Rajan Choudhary MA, MBChb Cofounder -Second Medic Inc

www.secondmedic.com