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When should an antibiotic be used?

Health Tips brought to you by U.S. HealthWorks Medical Group. Our experienced medical experts provide information here that we hope will broaden your health care knowledge.

Today we talk with Dr. A.K. Misra, medical director for U.S. HealthWorks in South San Francisco, about the use of antibiotics. Dr. Misra is double-board certified in Sports Medicine and Internal Medicine.

Q: At what point should a patient use an antibiotic?

A: The answer is complex. While one may require antibiotics (also known as antimicrobials) for a particular condition, the answer depends on the totality of the medical facts, which includes all of the clinical information available, inclusive of past medical history. According to information from the Choosing Wisely Foundation, which is organized by the ABIM Foundation, too many variables must be factored in to answer this question as a simple yes or no.

Q: How does one resolve this quandary regarding antibiotics?

A: It’s important to understand that all antibiotics are not designed for the same type of bacteria. I often use the phrase “which drugs for which bugs” when the bugs are bacterial. For example, the antibiotics recommended for a typical urinary tract infection in a female, versus a nursing home patient who has aspiration pneumonia, are not the same. The statistical reality is that most of the ailments physicians see in primary care, urgent care and emergency room encounters are driven much more by viruses than bacteria, in which antibiotics have no effect or role.

Q: What are some of the problems a patient can encounter if they take antibiotics when they are not indicated or appropriate?

A: This is often the hardest thing to explain to a patient who is sincerely ill and believes that antibiotics need to be administered. According to Choosing Wisely, antibiotic overuse has directly resulted in considerable bacterial resistance, not just in specific individuals, but in the communities where they live. Further, antibiotics also kill “good” bacteria in the gastrointestinal tract that serve multiple purposes, ranging from digestive to hormonal. Good bacteria also produce Vitamin K, essential for blood clotting. For women, even in the best indicated cases for antibiotics, it’s not uncommon for a vaginal yeast infection to occur as the normal flora bacteria in the vagina are significantly reduced by antibiotics, allowing yeast/fungus to take their place and cause an infection.

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  • American College of Physicians
  • Andrews Research & Education Foundation
  • American Board of Internal Medicine
  • JJM Medical College
  • Acuity Benefit consulting