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Antibiotics or not:
Jennifer Albrich, PharmD, BCPS
Amayeza Info Centre
SA Pharmacist’s Assistant [ Winter 2007 ]
Understanding the pharmacist’s advice
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When you are coughing, sneezing and
have a runny nose, you automatically think
that antibiotics should cure you, right?
Wrong. Antibiotics are medications used
to treat infections caused by bacteria.
Symptoms like coughing, sneezing and a
runny nose are all non-specific symptoms
that can be caused by many different
things:• Conditions like the common cold or
the flu are caused by viruses.
• Allergies can often cause people to
have symptoms of runny nose or
sneezing, but unlike an infection,
allergies are caused by triggers like dust
or pollen.
So, when should an antibiotic be prescribed
and when is it best avoided?
patient’s allergies, the seriousness of the
infection, possible side effects of the
medication and the cost of the drug. The
doctor may order some laboratory tests to
help identify the cause of the infection.
Mixed infections, where more than one
bacterial species is present, may need
more than one antibiotic as each antibiotic
is only effective against certain bacteria.
Certain infections may require antibiotics
given by injection while other infections
can be treated by oral antibiotics. Combinations of antibiotics are also important
to help fight antibiotic resistance.
Microorganisms are everywhere
We all know that germs or microorganisms
are everywhere. These microorganisms
can be bacteria, viruses or even fungi.
Although they are found throughout our
environment, only a few microorganisms
cause infections or disease in humans.
Some microorganisms are even helpful to
people by protecting our bodies from
other disease-causing bacteria. These
microorganisms, called resident flora, live
on our skin, in the mouth, intestines and
other parts of our body and they live in
harmony with us. These microorganisms
can, however, also sometimes cause disease
when they invade the body, e.g. when
our immune defences are down.
Why must antibiotics be used so
circumspectly?
Like all living organisms, bacteria and
viruses can adapt to changing environments. When antibiotics are used
inappropriately, microorganisms are
excessively and unnecessarily exposed to
the antibiotic. While most microorganisms
die after being exposed to antibiotics,
some survive and develop resistance to
the antibiotic. In other words, the microorganisms are no longer susceptible to
that antibiotic.
Normal healthy people can usually fight off
minor infections, but people who do not
have a fully functional immune system are
at higher risk of infection. Infection occurs
when microorganisms invade the body.
How do antibiotics work?
Antibiotics are used to treat infections
caused by bacteria. There are many
different antibiotics available. These
medicines work by either killing the
microorganism or by weakening it and
then allowing the body’s natural defences
to eliminate it. A doctor will choose an
antibiotic to treat an infection based on
what is the most likely bacterial cause of
the infection. Other factors that are taken
into consideration by the doctor are the
Remember that antibiotics can only
treat infections caused by bacteria, not
viruses.
Microorganisms can develop antibiotic
resistance through various ways and
infections from resistant organisms can be
difficult to treat. For example, stopping
antibiotic therapy too soon, even if the
patient feels better, can lead to recurrence
of the infection or the development of
antibiotic-resistant bacteria.
Using antibiotics improperly can lead
to unnecessary side effects, can result
in the infection coming back and can
increase the risk of antibiotic
resistance.
When are antibiotics used to prevent
infection?
Besides treating an infection, antibiotics
can also be used to prevent an infection
(prophylaxis). People who have been
exposed to other people with severe,
contagious infections, like meningitis
are prescribed antibiotics to prevent
them from getting the infection. Antibiotic
prophylaxis is also used for people who
have abnormal heart valves to prevent
infection of the valves after dental procedures. When used for prophylaxis,
antibiotics are usually given only for a
short time to avoid the development of
resistant bacteria.
People who have a weakened immune
system, like from AIDS or chemotherapy
for cancer, may also be given antibiotics
to prevent infections. HIV-infected patients
are often given co-trimoxazole prophylaxis
against opportunistic infections for an
indefinite period.
Infection - Understanding the inflammatory response
The body has several defences to protect
it against invading microorganisms. Natural
barriers include the skin or mucus
membranes (e.g. linings of the airways
and intestines).
• The skin provides a physical barrier to
invading organisms, but infections can
occur when the skin is broken from
cuts, injuries or burns.
• The mucus membranes are usually
coated with special secretions that
destroy or fight microorganisms. For
example, the lower airways are coated
with mucus that traps unwanted
microorganisms which are then pushed
out of the lungs. Coughing helps the
process of removing these microorganisms from the lungs.
People who have impaired defences may
be at more risk for some infections.
Any injury to the body, including infection,
can cause inflammation. The inflammation
partially serves to direct some defence
mechanisms to the site of injury or
infection. The inflammatory response
includes increasing the blood supply to
the area so that white blood cells can
reach the inflamed area more easily. The
body also produces more white blood
cells to combat the microorganisms that
have invaded the body. Inflammation is
a non-specific response by the body to
injury, and can be overwhelmed by large
numbers of microorganisms.
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Fever is another response by our body to
protect against infection and injury.
Increased body temperature helps the
body’s defence mechanisms. Shivering can
increase heat production through muscle
contractions. Excess heat is eliminated
from the body through sweating and
moving the blood to the skin. Chills can
also occur when the body temperature is
lowered. Although most people would
associate a rise in temperature with
infection, some people can have a drop
in temperature in response to a severe
infection.
When an infection develops, the body
also has specific defence mechanisms. The
body’s immune system can produce
substances that specifically attack the
invading organism. Antibiotics and antivirals
help the body’s defences to fight infection.
Infection - What is safe symptomatic
treatment?
Some of the symptoms from infection are
protective. For example, coughing helps
to clear unwanted microorganisms from
the lungs. Some people may also recover
from mild infection without any medication
at all.
There is some debate about whether or
not to treat a fever routinely. Fever can
help the immune system to fight an
infection, but fever can also cause problems
for some patients. For example, children
who have had a seizure from fever should
be treated. Medicines used to treat fever
are called antipyretics. These include
medicines such as paracetamol (e.g.
Panado®), ibuprofen (e.g. Nurofen®) and
aspirin (e.g. Disprin®). Medicines containing
aspirin, however, should not be given to
children to treat a fever because of the
possible risk of Reye’s syndrome, a
potentially fatal condition.
It is important to check the composition of combination products to
make sure that the patient is not
duplicating treatment with the same
or similar medicines.
Cough mixtures should be used only for
a short time, because lingering symptoms
may be a symptom of a more serious
problem. Refer patients to a doctor if they
have had a cough for more than a week,
if they have chest pain, or if the cough
produces dark sputum.
Infection – The role of probiotics and
prebiotics
There are some microorganisms that are
beneficial to the body and the gut contains
a large number of these resident flora. The
idea behind probiotic and prebiotic therapy
is to improve the gut environment through
the diet and so to improve overall health.
• Probiotics are live microorganisms that
do not cause infection, but rather
provide health benefits to the consumer
when taken in adequate amounts by
improving the balance of gut flora.
Probiotics are found in some dairy
products, like yoghurt and over the
counter supplements.
• Prebiotics are non-live, non-digestable
food ingredients that are metabolised
by gut flora and which help promote
the growth of beneficial bacteria.
Although there is growing interest in this
area, there is still limited evidence for
the use of these products for various
indications. Problems with the studies
include differences in study design and
strains used. There is some evidence that
prebiotics may be beneficial for diarrhoea
and that probiotics may improve lactose
intolerance, boost immunity and prevent
vaginal infections. More research is needed
to determine the role of these agents in
fighting infection.
Preventing infection
Good hygiene such as washing your hands
with soap and water after you cough or
sneeze and avoiding other people who
are sick will help to prevent you catching
and spreading disease to others. Covering
the mouth and nose while coughing or
sneezing and disposing of used tissues
immediately will also help prevent
spreading infections
Vaccination is one way to prevent some
infections. Vaccines contain parts or whole
viruses or bacteria that have been altered
so that they cannot cause an infection.
The body responds to the vaccine by
making immune defences to be used later
to prevent disease if the person is exposed
to the infectious bacteria or virus. Many
vaccines are given routinely in childhood
to prevent disease and some vaccines are
given after an exposure to prevent a
specific disease, like rabies.
Flu vaccination
The flu is a contagious respiratory infection caused by influenza viruses. Unlike
a common cold, the flu can be a serious
disease and lead to death; especially for
high-risk groups such as the elderly, people
with weakened immune systems and other
people with certain health conditions.
One way to prevent the flu is to get a flu
vaccination each year. The flu vaccine is
recommended in autumn for high-risk
groups such as the elderly, health care
workers and people with weakened
immune systems. Viruses can mutate
frequently and different strains are
responsible for flu outbreaks each year. A
new flu vaccine is issued each year
targeting the three most common strains
affecting people in a given year. Since the
flu vaccine is a killed virus, it cannot cause
someone to get the flu. Most people can
be safely vaccinated with the flu vaccine,
however, people with severe allergies to
eggs or a previous flu vaccine, should not
be vaccinated.
Common side effects to the flu vaccine:
• Soreness, redness, or swelling at the
injection site
• Fever
• Aches
Remember that colds and flu are
caused by viruses and, in many cases,
the doctor will not prescribe an antibiotic, unless the patient also has a
bacterial infection. Antiviral medicines are available and are specific for
sapa
certain viral infections.
Major references:
www.cdc.gov
Merck Manual Home Edition
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[ Winter 2007 ] SA Pharmacist’s Assistant
Coughing is the body’s natural response
to something causing irritation in the lungs
and helps eliminate unwanted organisms
and secretions. If someone is coughing
up phlegm as a result of an infection, it
might be better to not suppress the
productive cough as it may be the body’s
way of fighting the infection. It is always
best to use a product with only the
ingredients needed to treat a specific
symptom. A product with only one
ingredient helps to minimise unnecessary
treatment and unwanted side effects.
However, many of the over the counter
cough mixtures contain several medications
to treat different symptoms.
• Analgesics may help relieve the fever
and muscle aches, decongestants will
help relieve a stuffy nose and
antihistamines help dry up a runny
nose.
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