You feel sick enough to drag yourself to a doctor…and leave clutching a prescription for an antibiotic. Hold on! There’s a one-in-three chance that this drug won’t help you—and a decent chance that it will hurt you.

Studies done in 2016 and 2018 by The Pew Charitable Trusts in partnership with the CDC found that’s the case. Although the studies did not investigate the root causes for this antibiotic Rx explosion, the researchers believe that there are many factors at work. Some are “social,” meaning that patients expect and demand antibiotics when they feel sick, influencing doctors’ decisions to prescribe them. Example: You mention to your doctor that the last time you had these same symptoms, you took a particular antibiotic (you even mention it by name) and it did the trick. Whether or not it was the intention behind your comment, the doctor may infer that you expect to be prescribed the same antibiotic this time.

This is not to say that medical doctors don’t know when an antibiotic is truly indicated—they know that antibiotics kill only bacterial infections. But sometimes it’s hard to diagnose whether an infection is caused by bacteria or a virus. Some doctors may decide to prescribe an antibiotic just to be on the safe side.

But “the safe side” has a downside. Treating with unnecessary antibiotics accelerates the emergence of antibiotic resistance—the development of bacteria that are no longer sensitive to the antibiotics currently available. This is an extremely dangerous situation: It’s estimated that, every year 2 million Americans get an antibiotic-resistant infection and 23,000 people die from one.

It’s also possible to have adverse reactions to antibiotics, ranging from minor symptoms such as rashes and gastrointestinal discomfort to severe complications including Clostridium difficile, a bacterial infection that can result when the drug kills off healthful bacteria in your body, and the potentially deadly epidermal necrolysis, a disorder that starts with a severe skin reaction.

ILLNESSES THAT DO & DON’T NEED TO BE TREATED WITH ANTIBIOTICS

Some bacterial illnesses are very unlikely to go away without antibiotics. Two common ones are bacterial pneumonia and urinary tract infections.

Conditions that are often inappropriately treated with antibiotics include…

  • Viral upper respiratory tract infections including the flu
  • Viral pneumonia and bronchitis
  • Asthma
  • Allergies
  • Sinus infections
  • Sore throat
  • Middle ear infections

However, complicating things is the fact that sometimes sinus infections, sore throats and middle ear infections are caused by bacteria and do require antibiotics. But there is no good way to collect samples from the sinuses or the ears in a typical doctor’s office to culture to find out whether bacteria are present. These are situations when prescribing antibiotics to be safe might make sense.

On the flip side, some scientists are reevaluating the common procedure of treating acute uncomplicated diverticulitis (inflammation of small bulging pouches that can form in the lining of the digestive system, especially the colon) with antibiotics. Two studies published in the British Journal of Surgery concluded that antibiotics didn’t speed up recovery time or prevent complications or recurrence of the infection. With the growing concern over antibiotic resistance, some European guidelines have started to recommend managing acute uncomplicated diverticulitis without antibiotics.

Doctors in the US have not yet reached this conclusion. A review published in 2018 in The American Journal of Gastroenterology found that not treating diverticulitis with antibiotics appears to increase the need for elective surgery, and surgery carries its own set of risks. More study is needed before doctors should stop prescribing antibiotics for this infection.

HOW TO AVOID TAKING UNNECESSARY ANTIBIOTICS

It helps to recognize that your expectations and approach to your medical visit play a significant role in whether a health-care provider prescribes an antibiotic.

When an illness lands you in your doctor’s office or at an urgent care center, go without the preconceived idea of needing an antibiotic. Ask questions about your diagnosis so that you can help make an informed decision about your treatment. If the doctor thinks that an antibiotic is necessary, ask why so that you’re confident it’s the right course of action.

If you have a condition for which it’s not possible to confirm a bacterial cause, such as a sinus infection, you might work out a treatment-and-follow-up plan with your doctor that puts off taking an antibiotic while you wait to see if other remedies help.

To keep your need for antibiotics to a minimum, double up on efforts to stay well. Antibiotic use increases in the winter and throughout flu season because the flu can look like a bacterial infection or can lead to one. Take all the preventive steps you can, including getting vaccinations that are appropriate for you and frequent hand washing.