Do You Really Need That Antibiotic?

The decision on whether to take an antibiotic medication has never been more important, especially for older adults. In fact, by being a careful health care consumer regarding antibiotics, you are not only helping yourself, but your community, country and even the world.

Credit: Adobe Stock

That might seem like an overstatement, but the Centers for Disease Control and Prevention (CDC) and the World Health Organization say antibiotic resistance is a serious global, public health threat. It’s the reason why antibiotic stewardship programs (hospital-based programs to improve antibiotic use) have been ramping up across the U.S. and world.

The CDC estimates that each year in the U.S., at least 2 million people become infected with antibiotic-resistant bacteria and at least 23,000 die as a result of those infections.

“It’s very important for people to understand that antibiotics are critical to modern medicine as we know it,” says Dr. Katherine Fleming-Dutra, deputy director of the CDC’s Office of Antibiotic Stewardship. "Antibiotics allow us to do these complex medical treatments — like chemotherapy for cancer patients, surgeries and transplants — because we know that we can prevent and treat bacterial infections in our vulnerable patients. So, having effective antibiotics is very important to medicine."

Carefully weighing the decision to take an antibiotic is especially vital for older adults because in addition to their benefits, antibiotics pose risks such as potential side effects and clostridium difficile (C. diff), a dangerous bacterial infection that is resistant to many antibiotics.

C. diff. causes inflammation of the colon and severe diarrhea, fever, loss of appetite, nausea and abdominal pain. It can be fatal.

People age 65 and older are more vulnerable to C. diff because of weakened immune systems and the increased likelihood of underlying health conditions. Older adults in a hospital or other medical facility who’ve recently completed a course of antibiotics are even more at risk for C. diff for two reasons:

1. C. diff is shed in feces and can be transmitted by people who don’t wash their hands after touching contaminated surfaces. This is one reason why hand washing is so important for all of us, and especially for health care providers and staff.
2. When we take antibiotics, much of the “good” bacteria in our intestines is killed off, leaving the more resistant C. diff an opportunity to take over. If you’re in a hospital or visit a medical clinic after taking antibiotics, you’re more vulnerable to picking up C. diff from contaminated surfaces or health care providers’ hands.

One of the best ways to avoid having to take antibiotics is to get vaccinated to prevent influenza and other illnesses that could lead to the need for these drugs.

“When you get ill, even if it’s a viral disease like the flu, you can get an (additional infection) with, say, bacterial pneumonia, and then you’re back to the need for antibiotics,” says Janet Haas, president of the Association for Professionals in Infection Control and Epidemiology.

Being a knowledgeable health care consumer is also important. The CDC estimates that at least 30 percent of antibiotics prescribed in health care clinics are not needed — such as in the case of viral respiratory infections. This is sometimes due to doctors feeling pressured from patients to prescribe antibiotics even when they know that’s inappropriate, Fleming-Dutra says.

If you think you’re allergic to penicillin, the most popular class of antibiotic, it’s a good idea to get tested to learn if that’s really true. While about 10 percent of U.S. patients report a penicillin allergy, fewer than 1 percent actually have one, according to the CDC.

Also, approximately 80 percent of patients with a penicillin allergy lose that hypersensitivity after 10 years.

“Many hospitals are starting to offer testing to people who report a penicillin allergy, before they really need an antibiotic,” Haas says. “Most of the time, people actually are not allergic and they can use penicillin-based drugs safely, and not have to go to the ‘bigger guns,’ so to speak,” she says.

Those bigger guns are broad-spectrum antibiotics, which are more likely to kill off more of the good intestinal bacteria, leaving a person more vulnerable to C. diff.

Edie Grossfieldis the former health and caregiving editor at Next Avenue, where she reported on the information people need to make sound decisions about caregiving, their health and the health of their loved ones. Read More