Q: Why can’t I get antibiotics for a cough?

Infectious Diseases

A: Taking an antibiotic when it’s not needed contributes to antimicrobial resistance and can put you and others at risk of more severe infections.

TLDR: Antimicrobial resistance occurs when bacteria, fungi, parasites or viruses mutate in ways that make common treatments ineffective. More and more antibiotics are losing their effectiveness due to antimicrobial resistance, so it is something we should all be aware of and take steps to prevent.

We’ve all been there. Your child/partner/couchsurfer has been coughing for what seems like weeks and NO ONE is sleeping. You head to your clinician, but they tell you it’s “just a virus” and send you home without any parting gifts. Ughhhhh, now what?

It is very satisfying to receive a prescription from your clinician and have your symptoms improve. But chances are, you would get better just as fast without them. A review of studies looking at sinus infections found that only 5-10% of people had faster recovery after antibiotics. Another review of sore throats found that antibiotics helped people recover faster–but by less than one day. A third review of ear infections in children over two showed that more than 60% improved without antibiotics, and that initial therapy did not decrease pain scores. It can seem like antibiotics help because by the time most folks seek care, they are already at the peak of their illness and on the verge of getting better anyway.

Antibiotics also carry their own risks. Side effects can range from mild stomach upset to severe allergy, drug-resistant infection, or infection with Clostridium difficile (C. diff for short). One study found that 1 in 5 hospitalized patients who received an antibiotic when they did not need one had an adverse event such as severe allergy or organ system dysfunction. C. diff, which can affect anyone who has taken antibiotics, causes watery diarrhea, and recurs about 20% of the time. In some folks it can cause damage to the large intestine.

🚨 Nerd alert: C. diff infections are sometimes treated with fecal transplantation (transfer of poop from donor to recipient).

Over time, antibiotics used to treat common infections lose their effectiveness. Some antibiotics that used to work well are no longer effective to treat sepsis–an infection of the blood. Sepsis can affect people of all ages, but newborns are particularly at risk. Some infection-causing bacteria and fungi, often called superbugs, have few treatment options, or none at all. Each year, antibiotic-resistant bacteria and fungi cause at least an estimated 2,868,700 infections and 35,900 deaths. More than 60% of these deaths are caused by superbugs.

How does this happen?

Bacteria are constantly making copies of themselves–that is what they do. Each replication comes with the chance of random mutations, some of which help the bacteria survive. When bacteria are constantly exposed to antibiotics, the bacteria most likely to survive and reproduce are the ones with mutations that evade those antibiotics. Over time these resistant strains will out-compete their ancestors who were easily killed by the antibiotics. If we use antibiotics sparingly, there is much less opportunity for this type of resistance to develop and thrive.

Overuse of antibiotics is common in medicine and agriculture. In medicine, well-meaning clinicians prescribe with the intention of helping people feel better, but these folks may not be up to date with the latest evidence and/or bend to the will of an assertive patient or family.

In livestock farming, antibiotics are often added to animal feed or water, leading to runoff into the environment. Giving communal antibiotics to livestock can lead to multiple resistant strains from just one dose, because each animal receives a different amount of drug.

There have been no major breakthroughs in new antibiotics since 1984. Fortunately, targeted vaccines have reduced the number of bacterial infections (and antibiotic prescriptions). Global health organizations are working on drug discovery and development, but here’s what you can do:

➡️ Don’t demand antibiotics if your clinician says you don’t need them.

➡️ Only use antibiotics when and as prescribed.

➡️ Talk to your pharmacist or clinician about ways to treat the symptoms of viral infections.

➡️ If possible, purchase meat that was raised without the use of antibiotics.

➡️ Prevent infections by regularly washing hands, avoiding close contact with sick people, practicing safer sex, and keeping vaccinations up to date.

Additional Reading:

Treat Yourself Better UK: Managing Symptoms at Home and What to Watch Out For

Antibiotic Use Q+A from the CDC

HealthDay: Many Antibiotics No Longer Work Against Common Childhood Infections

Link to Original Substack Post