Did you know that:
- Antibiotic abuse in the United States is widespread. We have only 4.6% of the global population but we have 46% of the global antibiotic market?
- 95% of clinicians prescribe antibiotics even when they are not absolutely sure they are needed?
- 1 in 10 doctors will write a prescription for an antibiotic even though they know it’s not needed, just because a patient asks for it?
- At least 10% of doctors think that it doesn’t matter if antibiotics are given unnecessarily because they don’t cause any harm?
- Almost half of all doctors don’t counsel their patients against unnecessary antibiotic use?
Yet MOST of the antibiotics we are being prescribed by our doctors are unnecessary and even harmful!
Antibiotics, Microbiome Damage, and Your Health
We’re hearing a lot about the importance of the microbiome these days – and we’re going to continue to hear more as research into this fascinating intersection between our lives and the world of the microorganisms that live in, on, and around us evolves. What we do know already is that healthy communities of flora in our gut help regulate everything from our weight, mood and mental health to our immunity and hormones. A healthy micobiome contributes to how many calories we extract from our food – with too little of the good kind predisposing us to being fatter – and determines how well we detoxify excess hormones we produce due to dietary imbalances or that we pick up from environmental exposures.
One of the most certain ways to do damage to your gut flora, and along with it your health, is take antibiotics. Of course, an antibiotic is occasionally necessary and even life saving, but the hard truth is that most often they are unnecessary and even inappropriately prescribed.
In my Functional Medicine practice so many of the patients I see with chronic health problems, and especially digestive, allergy, hormonal, and autoimmune problems, share the common denominator of having had a lot of antibiotics as babies, children, or young adults – the former usually for ear infections, supposed strep throat, and bronchitis, and as young adults for acne – sometimes for years at a time.
We know that damage to the gut flora from early exposure to antibiotics – or frequent exposure at any time – can permanently damage the microbiome. There is strong evidence showing that even a single course of antibiotics in the first year of life increases our risk of developing gut problems and autoimmune conditions including Ulcerative Colitis and Crohn’s Disease, to name just a very few. Leaky gut, a common reason for most food intolerances and many inflammatory health conditions, including autoimmune disease, can also be triggered by damage to the microbiome as a result of antibiotics.
Antibiotic Resistance: What’s the Big Deal?
Antibiotic misuse is a problem for more than just to our gut flora. We are experiencing a major global health crisis due to antibiotic resistance — the antibiotics we rely on for serious and life-threatening diseases no longer work because we’ve used them so much that the bugs we are treating have outsmarted us and can withstand exposure to them. We now have antibiotic resistant super bugs and increasingly, no effective treatments for many of them! At least 2 million people get infected with antibiotic-resistant bacteria each year, resulting in at least 23,000 deaths, according to the Centers for Disease Control and Prevention (CDC).
There are also immediate risks to taking antibiotics. They can cause allergic reactions, additional antibiotic resistant infections on top of whatever you are being treated for, and can cause a deadly diarrhea caused by the bacteria Clostridium difficile. Many antibiotics can cause additional serious consequences ranging from rupture of the tendons with common medications like ciprofloxacin used to treat urinary tract infections, to fatal cardiac arrhythmias. We take them like they are no big deal – but they really are!
Further, pharmaceutical companies are no longer developing new antibiotics because they “can’t break even.” The last new antibiotic class for gram-negative bacteria was the quinolones, developed 4 decades ago.
The Scary Myth of the Harmless Antibiotic & Why Doctors Over-prescribe Antibiotics
There are many common reasons that doctors over-prescribe antibiotics, the most common being feeling uncomfortable not treating a possible bacterial infection (in other words, the fear of being wrong if they didn’t treat and it turned out the patient did have one), fear of malpractice, the patient requesting an antibiotic, and additionally, the patient not being able to miss work.
Is Your Doctor an Antibiotic Over Prescriber?
Chances are that the answer is yes, your doctor is an antibiotic over prescriber, because most are. A study done looking at records from the Veteran Affairs (VA) system between 2005 and 2012 found that on more than 1 million visits to primary care, urgent care, and emergency room settings for upper respiratory infections, most of which are viral and never require antibiotic treatment, antibiotics were prescribed almost 70% of the time, and this number was trending upward. Perhaps the most concerning issue is that in studies of antibiotic use it has been found that over 10% of doctors surveyed believe that it doesn’t really matter if they over prescribed, because the antibiotic wouldn’t hurt even if it wasn’t needed.
Antibiotic Stewardship: 6 Ways to Avoid Unnecessary Antibiotics
Stewardship means the activity or job of protecting and being responsible for something. Since it’s pretty clear that most doctors feel comfortable giving out antibiotics like candy, and aren’t going to tell us when they really aren’t needed, we have to take personal responsibility for avoiding unnecessary antibiotics treatment. Taking personal responsibility can also have an impact on ecological health and global antibiotic resistance. Antibiotic stewardship specifically refers to coordinated efforts to improve the appropriate use of antibiotics. Reading this article is your first step!
Read on for the next steps in avoiding antibiotic overuse and misuse.
1. Express Your Preference to Avoid Antibiotics
If you don’t want to be prescribed an antibiotic, let your doctor know. She or he may be prescribing one under the false impression that it’s what you want or expect. She or he may also feel so busy and harried that it’s just easier and faster to write an antibiotic prescription than to have a conversation with you about why an antibiotic isn’t necessary. So make your preferences known loud and clear. If the medical condition requires an antibiotic, then your doctor should respectfully let you know that this is the case and explain why. Then you can discuss what is safest and most appropriate for you. If it is unclear whether an antibiotic is truly needed, but there is a high suspicion that you have a bacterial infection, ask your doctor to check your procalcitonin level, a biomarker for infection. This test has been shown to be successful in nearly every well-controlled trial.
2. Ask Questions
If an antibiotic has been prescribed and yet it’s not your preference to take one, ask your doctor how important it is for you to start taking it immediately, or whether a “watch and wait” observation period is appropriate, ask how long you can watch and wait for, and what you should look out for as signs of improvement or of things getting worse, and how long it should take for you to get better. Also, ask if there are any alternatives – for example, there may be nutritional or herbal supplements that you can try instead of the antibiotics. If an antibiotic is deemed to be necessary, ask your doctor about doing a short course, for example, 3-5 days instead of 10-14 days. Short courses of antibiotics are virtually always effective in well-controlled trials.
3. Get Smart!
Get educated about the common health conditions that would bring you to the doctor for yourself or one of your kids and for which antibiotics are commonly misused, including ear infections, bronchitis, and even strep throat, so you can make wise and optimally healthful decisions. A great resource is called Get Smart, created by the Centers for Disease Control and Prevention (CDC) exactly for the purpose of helping you – and your doctors – avoid unnecessary antibiotics. You can refer to this site before you visit the doctor’s office and even bring information with you to help you avoid unnecessary antibiotics, you can visit the site with your doctor who might not even know about it, and visiting the site may even help you avoid a premature or unnecessary doctor’s visit.
4. Trust Your Body and Make the Time to Heal
My great-grandmother always said rest was the most important thing we could do when we’re sick – including time for convalescence after an illness. Unfortunately, most of us were never taught the simple types of wisdom our grandmothers knew, and most of us don’t (or feel we can’t) take the time to get well – whether getting a few days help with the kids or taking a few days off of work. So we ask for antibiotics in hopes that our symptoms will clear up faster – and sometimes antibiotics can make this happen. But the problem is that if we take antibiotics to hasten healing now, we might pay the price with chronic problems later. When we get sick what we really need to do is eat simply and well, take some time for R&R, and get some extra rest. In short: Pay now in time or pay later in health.
5. Learn About Alternatives to Antibiotics
Simply by changing your diet (clue: drop the dairy, sugar, and flour products for a few days) and adding in a few natural supplements including vitamins, minerals, and herbs, you can reduce the symptoms, severity, and duration of most common viral and many bacterial infections without having to use antibiotics. Sometimes, even more complex acute and chronic infections respond well to natural remedies without having to use antibiotics – but this might require you to see an integrative MD, a licensed naturopathic doctor, or a skilled herbalist for suggestions. On my website you will find an ever-growing body of resources on the natural treatment of common infections and many other of your health concerns.
6. Eat Antibiotic-Free
80% of the antibiotic use in the United States is for growth promotion and disease prevention in farm animals – and these antibiotics make their way to us in what is know as the “farm to fork” phenomenon. Not only do antibiotics make their way to us, but so do resistant bacteria and bacterial resistance genes, which can be traced directly from chickens to the chicken meat in grocery stores to blood cultures in people. The practice of antibiotic use on farms was discontinued in some European countries many years ago, without economic or animal health consequences – and this is beginning to happen in our country as well. We can protect our health and the environment, and demand farming changes like this by voting with our dollars and purchasing only antibiotic-free meat.
If you really do need to use an antibiotic, it is not the end of the world, and it is important to be practical and open to the wonderful array of options both nature and science have to offer us for our health and well being. A healthy gut will usually repair itself perfectly if antibiotic use is rare or infrequent. The addition of fermented foods like sauerkraut, kimchee, and homemade yogurt (if you tolerate dairy, or if not, try coconut yogurt with live active cultures), as well as a probiotic and gentle gut healing herbs can also help restore your gut’s natural health and flora.
Bartlett JG, Gilbert D Spellberg B. Seven ways to preserve the miracle of antibiotics. Clin Infect Dis. 2013;56:1445-1450
Jones, BE et al. Variation in outpatient antibiotic prescribing for acute respiratory infections in the veteran population: A cross-sectional study. Ann Int Med. 2015. Jul 21; 163-73.
Schuetz P, Briel M, Christ-Crain M, et al. Procalcitonin to guide initiation and duration of antibiotic treatment in acute respiratory infections: an individual patient analysis. Clin Infect Dis. 2012;55:651-662.