Antibiotics: When You Need Them, And When You Don’t

By Diane Kane, MD

pill bottleIn 1928, Alexander Fleming accidentally discovered penicillin, the first antibiotic for curing and preventing bacterial infections. Unfortunately, because of the overuse of this wonder drug, we now have bacteria that resist antibiotics, causing infections that are harder to cure and more costly to treat.

Each year, antibiotic-resistant bacteria infect at least 2 million people in the United States, and at least 23,000 people die as a direct result of these infections. Many more people die from other conditions complicated by an antibiotic-resistant infection.

When are antibiotics OK?

Antibiotics kill bacteria, not viruses, so they are not an appropriate treatment for most viral infections:

• Colds and flu
• Sore throat
• Bronchitis
• Sinus or ear infection
• Conjunctivitis (pink eye)

However, you may have a bacterial infection if you have the above ailments along with a fever of 102°F or a fever accompanied by green or yellow mucus and lasting three or more days. Additional symptoms may indicate the presence of bacterial pneumonia or strep throat. In these cases, treatment with antibiotics is appropriate after a doctor confirms the diagnosis.

If you have an artificial heart valve, a heart valve repair or a previous history of an infected heart valve, you can prevent a bacterial infection by taking antibiotics before having dental work.

Take only when necessary

Misdiagnosis can also result in the unnecessary use of antibiotics. Seniors typically have bacteria in their urine; it does not necessarily indicate a urinary tract infection (UTI). Your doctor should test for a UTI only if you have symptoms such as burning when urinating or severe urgency and frequency of urination.

Similarly, leg swelling due to varicose veins is often misdiagnosed as cellulitis or a skin infection.

Beware of side effects

Antibiotics can unleash other health problems such as allergic reactions (skin irritations, swelling of the face and throat and breathing problems), intestinal problems leading to dehydration and kidney issues, and drug interactions, especially with blood thinners.

Moreover, antibiotics kill good bacteria, giving life-threatening C. difficile (“C. diff”) bacterium a chance to infect the colon. At least 250,000 illnesses and 14,000 deaths result from C. diff annually in the U.S.

Be proactive

Reduce your risk of illness by getting an annual flu shot; a pneumonia shot; a Tdap shot to protect against tetanus, diphtheria and whooping cough; and a shingles vaccination.

If you get sick and an antibiotic is appropriate, follow your doctor’s instructions and get plenty of rest. Be sure to finish your prescription, even if you start to feel better.

While antibiotics are good for many things, they are not right for everything. They should be prescribed with care to avoid the potential (and serious) consequences of misuse and overuse.

Physician Diane Kane is chief medical officer at St. Ann’s Community. She is board-certified in internal medicine, geriatrics, and hospice and palliative Medicine and has been involved in senior care for 30 years. Contact her at or visit