Antibiotics: when do I need them?

If you’ve recently been to the GP and been prescribed antibiotics for a bacterial infection, you’re not alone.

Around one third of Australians take antibiotics at least once a year, with rates being much higher for older people.¹

Antibiotics are an incredibly effective and powerful method to fight bacterial infection, but there are serious downsides when they’re overused or taken incorrectly.

“Antibiotics are a type of medication that work by either killing, fighting off, or preventing the replication of bacteria that cause infections,” says Bupa GP Dr Janice Tan. “They are very effective when used to treat bacterial infections such as UTIs, skin infections and respiratory infections such as ear infections, strep throat or bronchitis.”

Antibiotics have been widely available since the 1940s. Before their use, even minor infections could cause serious illness and death.²

Antibiotics are used to treat serious bacterial infections that can cause health complications, like pneumonia and cellulitis (a skin infection), and for UTIs like cystitis that can often recur. Other uses include treating infected wounds and preventing infection after operations.

Antibiotics are not effective for viral infections such as influenza, or fungal infections which can be treated with topical creams or oral medications.

It’s important to note, says Dr Tan, that even if you do contract a bacterial infection, you may not always need antibiotics.

“Depending on the individual and the severity of the infection, some doctors or clinicians may recommend a ‘watch and wait’ approach, partly to see if the infection is bacterial and not viral, or to see if the body can fight off the infection by itself.”

However, this isn’t always practical.

“I’m not going to tell a patient with a UTI to wait a few days before prescribing antibiotics. We need to be practical about what the patient needs and can cope with.”

If antibiotics are used when they aren’t needed, or are not used in the right way, it increases the chance of the bacteria adapting, changing and mutating to defend itself against the medication. This is called antibiotic resistance.

“The main cause of antibiotic resistance is widespread antibiotic use,” says Dr Tan. “So, when you're using antibiotics when they're not needed, or when you're not taking them properly, like missing doses or not finishing the course. These things can cause these bacteria to evolve more rapidly. There are even some cases now where we come across bacteria and there's only one antibiotic in the world that it’s still sensitive to. This is a scary reality because it means we can’t kill the infection.”

There are ways to help reduce the risk of antibiotic resistance.

“The first step is really distinguishing between a viral, fungal and bacterial infection,” says Dr Tan. “Antibiotics won’t work on viral, fungal or parasitic infections. A GP can help determine if you need antibiotics.”

Even with a doctors’ help, it may not always be obvious what kind of infection you have.

“There is no 100% way to know on the spot whether an infection is viral or bacterial,” says Dr Tan. “We determine likelihood based on the history, the examination, the vital signs and how the patient is feeling. If you’re fairly well it’s more likely to be viral. If you’re super sickly, it’s most likely bacterial. If there is a question mark we may take a delayed approach. With a viral infection you are going to see an improvement within 3 or 4 days. If it’s bacterial you’ll see a deterioration in that time.”

If you are unwell, it’s important to try other remedies and self-care to look after yourself and not just rely on medications.

“Even when treating a bacterial infection, antibiotics are just one of the ingredients needed as part of your treatment plan. Things like making sure you’re well hydrated, well rested, and that you're eating, drinking and sleeping. These are all very important parts of a recovery for any infection, bacterial, viral or fungal.”