Do’s and don’ts of antibiotics for common conditions


Do you see antibiotics as a cure-all? A handy cut-and-keep guide to which conditions merit it and don’t.

It’s the start of the cold and flu season and this means local GPs will soon face patients lining up outside their clinics. In more than 80 percent of viral cases in the country, patients are prescribed strong medicines that inhibit the growth of micro-organisms when they can be successfully treated with simple oral rehydration salts, said Dr Abhay K Shah in a talk at the Antimicro Biocon conference in Ahmadabad last month.

The two-day conference also pointed to a study by United States Centres for Disease Control and Prevention that found that over-medication makes patients vulnerable to other infections since bacteria gets resistant to antibiotics.

Yet, antibiotics only treat bacterial infections. There are two problems with this trend; the increasing global problem of antibiotic-resistant bacteria making it harder to treat some infections and the risk of side-effects.

Doctors blame public perception. For instance, research shows that 98 percent of people expect a cough to last, on average, for only eight days when it can last up to three weeks. And 80 percent expect flu symptoms to last only 10 days, when two weeks is the normal duration.

To cut through the confusion about the need for antibiotics for common conditions, here’s a list of dos and don’ts;


When you do: If a patient’s cough is accompanied by a persistent fever, difficulty breathing, pain in the chest or blood-stained phlegm, they should see their GP. A chest infection, which affects the lungs, is different from a normal cough, which is usually due to inflammation in the upper airways and congestion – and is common in young children and the elderly, as well as those who smoke or have a pre-existing respiratory condition.

When you don’t: It’s normal for a cough to last up the three weeks. Although it was thought that a cough producing green phlegm indicated a bacterial infection, antibiotics are no longer prescribed according to the colour of sputum. Again, doctors recommend rest and fluids. The jury is still out on the benefits of over-the-counter cough medicines, he adds. There’s no science to back claims that they help and coughing is the body’s way of clearing the lungs of any infection. But, if a cough medicine provides short-term relief, there’s no harm in taking it.


When you do: Antibiotics are prescribed for infected eczema (a flare-up resulting in skin that’s red and weepy) and cellulitis (an infection of the deeper layers of the skin). Antibiotics are prescribed as a longer term treatment for acne because of their anti-inflammatory effect rather than for the treatment of bacterial infection.

When you don’t: Most skin complaints – dermatitis, eczema, psoriasis, ringworm etc – will see no improvement with antibiotics. Acne and rosacea can be dealt with by using Vitamin A derivatives or hormonal pills.


When you do: If the pain gets worse despite taking age-appropriate paracetamol or ibuprofen, or there is a discharge from the ear, then contact your GP.

When you don’t: Children are prone to ear infections because the narrow air passages in the inner ear can become blocked by mucus. Antibiotics are rarely needed as the cause is usually viral and, even if the infection is due to bacteria, we now know they get better on their own.


When you do: If there is no improvement after a week then antibiotics might be considered because stagnation of fluid in the sinuses may have allowed bacterial infection to develop.

When you don’t: Sinusitis is usually due to a viral infection, so antibiotics won’t help. It can last for up to two-and-a-half weeks. The doctor is likely to advise rest, fluids, and steam inhalations. The steam loosens secretions, making them easier to clear through the nose.


When you do: Vulnerable patients with a weakened immune system may require antibiotics. If symptoms don’t improve or you have associated symptoms, such as drooling and difficulty swallowing, that could indicate a nasty bout of bacterial tonsillitis, see your GP.

When you don’t: Majority of sore throats are caused by viral infections. Even if a bacterial infection is the cause, most get better on their own. Research shows that antibiotics have very little effect on symptoms or recovery time. It’s far more effective to rest, drink plenty of fluids and try home remedies, such as honey, lemon and ginger in a hot drink.


When you do: If the symptoms are severe despite sterile bathing (using cotton wool balls to clean the eyes with cooled boiled water) or last longer than two weeks, see your GP.

When you don’t: GPs used to routinely prescribe eye drops and ointments for eye infections, such as conjunctivitis, often caused by viruses. Even if it is a bacterial infection, it clears up on its own.


When you do: Children and men with symptoms of urine infection should always seek medical advice. Women experiencing symptoms of cystitis for the first time, when symptoms are very uncomfortable or last more than five days, or those who have recurrent bouts (more than three times a year) should also see their GP. Sometimes the symptoms aren’t due to cystitis but a sexually transmitted disease, such as Chlamydia. If symptoms get worse, despite self-help treatment measures, or the patient develops a fever and abdominal or loin pain, this may indicate a kidney infection (pyelonephritis) which would definitely require antibiotics.

When you don’t: Urinary tract infections are far more common in women than men because women have shorter urethras, making it easier for bacteria to invade the urinary tract. A UTI (or cystitis) in women can sometimes be cleared up with over-the-counter treatments and by self-help measures, like drinking more fluids.

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