Just because antibiotics may disrupt your microbiome or lead to the emergence of antibiotic-resistant “superbugs,” that doesn’t mean that using them is bad. Antibiotics are an important tool in medicine. It just means we could all stand to be a bit more selective in when and how we use them. Here are some guidelines that will help you use antibiotics wisely:
1. Avoid taking antibiotics unless it’s truly necessary. Your immune system is more than capable of clearing up common infections on its own. Save antibiotics for when you truly need them, for those more serious illnesses or infections that aren’t going away on their own.
2. Know the difference between broad-spectrum and narrow-spectrum antibiotics (see our Types of Antibiotics page), and make sure your doctor is prescribing the least-invasive treatment necessary.
How long should people take antibiotics?
Experts formerly advised patients take a full 2 week course of antibiotics, and continue taking them until the prescription was completely gone, even after they got better. The thinking was that if people took an antibiotic but didn’t completely wipe out the infection, it might come back with a resistance to the antibiotic. Sounds logical, but it turns out that this belief, like so many others in our society, was never based on science.
“Think of it as an urban legend with no substance,” says infectious disease specialist Brad Spellberg. It is good that doctors prescribe a long enough dose to get an infection under control, “but durations kept creeping longer with the misguided belief that ‘if I treat for longer, I’ll prevent relapse due to resistant pathogens’ – which is absolutely false.” (Wallis, 2021)
So the American College of Physicians changed their guidance in April 2021. (In fact, this forced me to completely rewrite much of this material almost immediately after I had completed it.) The new “best practices” guidelines recommend much shorter antibiotic treatments for 4 types of common infections:
1. Community-acquired pneumonia (as opposed to hospital acquired pneumonia)
2. “Uncomplicated” urinary tract infections (UTIs)
3. Skin infections (cellulitis), provided there is no pus
4. Acute bronchitis in people with chronic obstructive pulmonary disease.
Recent research has suggested short-course antibiotic treatments (3-5 days) work as well against many infectious diseases as a longer course treatment for common infections. Studies have found this to be true for children and adults alike. Yet a 2019 survey found doctors still write prescriptions for 9 or more days at a time around 35% of the time.
Some illnesses do require a longer treatment. For example, infections around prosthetic joints may require a 12-week treatment. And a longer-course of antibiotics is still recommended for certain ear infections, and has proved more effective at treating ear infections in children under 2. (ibid) So there may be cases when a longer course of antibiotic treatment is needed. Just be sure to engage in dialogue with your doctor to determine how much is needed to rid the infection without resorting to overkill and taking antibiotics unnecessarily.