Get Smart:: Know When Antibiotics Work Get Smart:: Know When Antibiotics Work
Centers for Disease Control and Prevention
Questions About Antibiotic Resistance
What are bacteria and viruses?
Bacteria are single-celled organisms usually found all over the inside and outside of our bodies, except in the blood and spinal fluid. Many bacteria are not harmful. In fact, some are actually beneficial. However, disease-causing bacteria trigger illnesses, such as strep throat and some ear infections. Viruses are even smaller than bacteria. A virus cannot survive outside the body’s cells. It causes illnesses by invading healthy cells and reproducing.
What kinds of infections are caused by viruses and should not be treated with antibiotics?
Most coughs and bronchitis
Sore throats (except for those resulting from strep throat)
How do I know when an illness is caused by a viral or bacterial infection?
Sometimes it is very hard to tell. Consult with your doctor to be sure.
When do I need to take antibiotics?
Antibiotics are very powerful medications. They should only be used when prescribed by a doctor to treat bacterial infections.
Do I need an antibiotic when mucus from the nose changes to yellow or green?
Yellow or green mucus does not indicate a bacterial infection. It is normal for the mucus to get thick and change color during a viral cold.
Should I ask my doctor to prescribe antibiotics?
Talk to your doctor about the best treatment. You should not expect to get a prescription for antibiotics. If you have a viral infection, antibiotics will not cure it, help you feel better, or prevent someone else from getting your virus.
What is antibiotic resistance and why should I be concerned?
Antibiotic resistance occurs when bacteria change in a way that reduces or eliminates the effectiveness of antibiotics. These resistant bacteria survive and multiply – causing more harm, such as a longer illness, more doctor visits, and a need for more expensive and toxic antibiotics. Resistant bacteria may even cause death.
What can I do to avoid antibiotic-resistant infections?
Start by talking with your healthcare provider about antibiotic resistance.
Ask whether an antibiotic is likely to be effective in treating your illness.
Do not demand an antibiotic when your healthcare provider determines one is not appropriate.
Ask what else you can do to help relieve your symptoms.
What can I do to protect my child from antibiotic-resistant bacteria?
Use antibiotics only when your doctor has determined that they are likely to be effective. Antibiotics will not cure most colds, coughs, sore throats, or runny noses. Children fight off colds on their own.
If mucus from the nose changes from clear to yellow or green, does this mean that my child needs an antibiotic?
Yellow or green mucus does not mean that your child has a bacterial infection. It is normal for the mucus to get thick and change color during a viral cold.
Does this mean that I should never give my child antibiotics?
Antibiotics are very powerful medicines and should only be used to treat bacterial infections. If an antibiotic is prescribed, make sure you take the entire course and never save the medication for later use.
How do I know if my child has a viral or bacterial infection?
Ask your doctor. If you think that your child might need treatment, you should contact your doctor. But remember, colds are caused by viruses and should not be treated with antibiotics.
Facts About Antibiotic Resistance
Antibiotic resistance has been called one of the world’s most pressing public health problems.
The number of bacteria resistant to antibiotics has increased in the last decade. Nearly all significant bacterial infections in the world are becoming resistant to the most commonly prescribed antibiotic treatments.
Every time a person takes antibiotics, sensitive bacteria are killed, but resistant germs may be left to grow and multiply. Repeated and improper uses of antibiotics are primary causes of the increase in drug-resistant bacteria.
Misuse of antibiotics jeopardizes the usefulness of essential drugs. Decreasing inappropriate antibiotic use is the best way to control resistance.
Children are of particular concern because they have the highest rates of antibiotic use. They also have the highest rate of infections caused by antibiotic-resistant pathogens.
Parent pressure makes a difference. For pediatric care, a recent study showed that doctors prescribe antibiotics 65% of the time if they perceive parents expect them; and 12% of the time if they feel parents do not expect them.
Antibiotic resistance can cause significant danger and suffering for people who have common infections that once were easily treatable with antibiotics. When antibiotics fail to work, the consequences are longer-lasting illnesses; more doctor visits or extended hospital stays; and the need for more expensive and toxic medications. Some resistant infections can cause death.
How You Can Help Prevent Antibiotic Resistance
Do not take an antibiotic for a viral infection like a cold, a cough or the flu.
Take an antibiotic exactly as the doctor tells you. Do not skip doses. Complete the prescribed course of treatment, even if you are feeling better.
Do not save any antibiotics for the next time you get sick. Discard any leftover medication once you have completed your prescribed course of treatment.
Do not take antibiotics prescribed for someone else. The antibiotic may not be appropriate for your illness. Taking the wrong medicine may delay correct treatment and allow bacteria to multiply.
Antibiotic prescriptions in outpatient settings can be reduced dramatically – without adversely affecting patient health – by not prescribing antibiotics for viral illnesses, such as colds, most sore throats, coughs, bronchitis, and the flu.
Parents should not demand antibiotics when a healthcare provider has determined they are not needed.
Parents should talk with their healthcare provider about antibiotic resistance.
Parents should not give their children antibiotics for a viral infection like a cold, a cough, or the flu. Antibiotics should be used only to treat bacterial infections.
Parents should ensure that their children take all medication as prescribed, even if symptoms disappear. If treatment stops too soon, some bacteria may survive and re-infect.
A Prescription for Parents: Five Hints to Understanding Antibiotic Usage
When are antibiotics necessary? Your doctor can best answer this complicated question and the answer depends on the diagnosis. Here are a few examples:
Ear infections : There are several types; many need antibiotics, but some do not.
Sinus infections : Most children with thick or green mucus do not have sinus infections. Antibiotics are needed for some long-lasting or severe cases.
Cough or bronchitis : Children rarely need antibiotics for bronchitis.
Sore throat : Viruses cause most cases. Only one major kind, “strep throat,” requires antibiotics. This condition must be diagnosed by a laboratory test.
Colds : Colds are caused by viruses and may last for two weeks or longer. Antibiotics have no effect on colds, but your doctor may have suggestions for obtaining comfort while the illness runs its course.
It is worth noting that viral infections sometimes lead to bacterial infections. But treating viral infections with antibiotics will not prevent bacterial infections and may trigger infections with resistant bacteria. Keep your doctor informed if the illness gets worse, or lasts a long time, so that the proper treatment can be given as needed.
Fluid in the Middle Ear: Tips for Parents
A doctor said your child has fluid in the middle ear, also called otitis (oh-TIE-Tus) media with effusion (uh-FEW-zhun) (OME). Fluid usually does not bother children and it almost always goes away on its own. This does not have to be treated with antibiotics, unless it lasts for a few months. Here are some facts about OME and ear infections.
What are the main kinds of ear infections?
Swimmer’s ear (otitis externa) is an infection of the ear canal that can be painful and is treated with eardrops.
A middle ear infection, which a doctor might call “acute otitis media” (AOM), may cause ear pain, fever, or an inflamed eardrum, and is often treated with oral antibiotics.
What causes OME?
Fluid may build up in the middle ear for two reasons. When a child has a cold, the middle ear makes fluid just as the nose does – it just doesn’t run out as easily from the middle ear. After a middle ear infection, fluid may take a month or longer to go away.
Are antibiotics ever needed for OME?
Sometimes antibiotics may be needed if the fluid is still present after a few months and is causing decreased hearing in both ears. For this reason, your child will need an ear check in a few months. If there is still fluid in the middle ear, your child may need a hearing test.
What should I do?
The best treatment is to wait and watch your child. Since fluid in the middle ear rarely bothers children, it is best to let it go away on its own. Right now, your child might not need antibiotics.
You may need to schedule a visit to see the doctor again in a few months to be sure the fluid is gone.
Why not try antibiotics now?
Taking antibiotics when they are not needed can be harmful. Each time people take antibiotics, they are more likely to carry resistant germs in their noses and throats. Common antibiotics cannot kill these resistant germs. Your child may need antibiotics that are more costly, given by a needle, and/or administered in the hospital. Since OME will almost always get better on its own, it is better to wait and take antibiotics only when they are needed.
A Child’s Runny Nose: Tips for Parents
Your child has a runny nose. This is a normal part of what happens during the common cold and as it gets better. Here are some facts about colds and runny noses.
What causes a runny nose during a cold?
When germs that cause colds first infect the nose and sinuses, the nose makes clear mucus. This helps wash the germs from the nose and sinuses. After two or three days, the body’s immune cells fight back, changing the mucus to a white or yellow color. As the bacteria that live in the nose grow back, they may also be found in the mucus, which changes the mucus to a greenish color. This is normal and does not mean your child needs antibiotics.
What should I do?
The best treatment is to wait and watch your child. Runny nose, cough, and symptoms like fever, headache, and muscle aches may be bothersome, but antibiotics will not make them go away any faster.
Some people find that using a cool mist vaporizer or saltwater nose drops makes their child feel better.
Are antibiotics ever needed for a runny nose?
Antibiotics are needed only if your doctor tells you that your child has sinusitis. Your child’s doctor may prescribe other medicine or give you tips to help with a cold’s other symptoms like fever and cough, but antibiotics are not needed to treat the runny nose.
Why not try antibiotics now?
Taking antibiotics when they are not needed can be harmful. Each time people take antibiotics, they are more likely to carry resistant germs. Your child may need antibiotics that are more costly, given by a needle, and/or administered in the hospital. Since a runny nose almost always gets better on its own, it is better to wait and take antibiotics only when they are needed.
Cold and Flu Season: No Reason for Antibiotics
Colds, flu, and most sore throats and bronchitis are caused by viruses. Antibiotics do not help fight viruses. And they may do more harm than good: taking antibiotics when they are not needed – and cannot treat the illness – increases the risk of a resistant infection later.
Antibiotics Are Not for Colds and Flu
Most infections are caused by two main types of germs – bacteria and viruses.
Bacteria are organisms found almost anywhere, except normally sterile sites, such as the blood stream and spinal fluid. A few bacteria, known as pathogens, can cause diseases in humans, animals, and plants.
Viruses are organisms that cause disease by invading healthy host cells. As virus particles multiply, the host cells burst, allowing the viruses to infect other cells.
Antibiotics kill bacteria, not viruses
Antibiotics will not cure upper respiratory viral illnesses, such as:
Colds or flu
Most coughs and bronchitis
Sore throats not caused by strep
Tens of millions of antibiotics prescribed in doctors’ offices each year are for viral infections, which cannot effectively be treated with antibiotics. Doctors cite diagnostic uncertainty, time pressure on physicians, and patient demand as the primary reasons why antibiotics are over-prescribed.
Taking antibiotics for viral infections – such as a cold, cough, the flu and most bronchitis – will not:
Cure the infections
Keep other individuals from catching the illness
Help a person feel better
Taking antibiotics for viral infections will increase the risk of antibiotic resistance.
The spread of viral infections can be reduced through frequent hand washing and by avoiding close contact with others.
What To Do For Colds and Flu
Children and adults with viral infections recover when the illness has run its course. Colds caused by viruses last for two weeks or longer.
Measures that can help a person with a cold or flu feel better:
Increase fluid intake
Use a cool mist vaporizer or saline nasal spray to relieve congestion
Soothe throat with ice chips, sore throat spray, or lozenges (do not give lozenges to young children)
Viral infections sometimes lead to bacterial infections. Patients should keep their doctor informed if their illness gets worse or lasts a long time.
What can parents do if their children are too young or the healthcare provider advises against using cough and cold medicines?
Parents might consider clearing nasal congestion in infants with a rubber suction bulb. Also, secretions can be softened with saline nose drops or a cool-mist humidifier.
Are cough and cold medicines safe for children under 2 years of age?
There are no Food and Drug Administration (FDA)-approved dosing recommendations for children under 2 years of age. These drugs can, in rare cases, be harmful or even fatal. Parents and healthcare providers should use caution when giving cough and cold medicines to children under 2 years of age.
Do cough and cold medicines work in children under 2 years of age?
There is little evidence that cough and cold medicines work in children under 2 years of age.
Should parents give cough and cold medicines to children under 2 years of age?
Parents should consult a healthcare provider before giving cough and cold medicines to their children and should always tell providers about all prescription and over-the-counter medicines they are giving their child.
Should healthcare providers prescribe cough and cold medicines to children under 2 years of age?
Healthcare providers should exercise caution when recommending or prescribing cough and cold medicines to children under 2 years of age and should always ask caregivers about any other cough and cold medicines the child might be receiving. No FDA-approved dosing recommendations exist for over-the-counter cough and cold medicines in children under 2 years of age.
What should parents and doctors be careful of if they want to give cough and cold medicines to children under 2 years of age?
Be especially careful if giving more than one cough and cold medicine at a time to children under 2 years of age. Two medicines may have different brand names but may contain the same ingredient. Some cough and cold medicines contain more than one active ingredient.
Questions about antibacterial cleaning agents, acne medication, and probioticss
Q. Are antibacterial-containing products (soaps, household cleaners, etc.) better for preventing the spread of infection? Does their use add to the problem of resistance?
A. An essential part of preventing the spread of infection in the community and at home is proper hygiene. This includes hand-washing and cleaning shared items and surfaces. Antibacterial-containing products have not been proven to prevent the spread of infection better than products that do not contain antibacterial chemicals. Although a link between antibacterial chemicals used in personal cleaning products and bacterial resistance has been shown in in vitro studies, no human health consequence has been demonstrated. More studies examining resistance issues related to these products are needed.
The Food and Drug Administration (FDA) Nonprescription Drugs Advisory Committee voted unanimously on October 20, 2005 that there was a lack of evidence supporting the benefit of consumer products including handwashes, bodywashes, etc. containing antibacterial additives over similar products not containing antibacterial additives.
Weber JT, Hughes JM. Beyond Semmelweis: Moving Infection Control into the Community. Ann Intern Med. 2004;140:397-398.
Larson EL, Lin SX, Gomez-Pichardo C, Della-Latta P. Effect of antibacterial home cleaning and handwashing products on infectious disease symptoms: a randomized, double-blind trial. Ann Intern Med. 2004 Mar 2;140(5):321-9.
Q. Can antibiotic resistance develop from acne medication?
A. Antibiotic use, appropriate or otherwise, contributes to the development of antibiotic resistance. This is true for acne medications that contain antibiotics. Short and long-term use of antibiotics for treatment or prevention of bacterial infections should be under the direction of a physician to ensure appropriate use and detection of resistance.
Q. Do probiotics have a role in preventing or treating drug resistance or drug-resistant infections?
A. Probiotics are defined as microorganisms that when administered in sufficient quantities may improve health. There are a variety of probiotics that have been studied for various health benefits. Their role in preventing drug resistant infections in humans has not been established. CDC is currently monitoring research on probiotic use, but cannot make any recommendations at this time.