YSK: Do You Really Need That Antibiotic? It’s antibiotic season. Brush up on how you should use them — and when to avoid them. (NYT, Dec 2023)
It's refreshing to see a major news outlet discussing collateral damage and not just resistance. Over the past decade, 99% of the time antibiotic overuse is covered and warned about it's always only in regards to resistance.
It's a good article that also doesn't spread the common misinformation of "just take some probiotics and fermented foods after antibiotics and you're good to go".
Swallowing an antibiotic is like carpet-bombing the trillions of microorganisms that live in the gut, killing not just the bad but the good too, said Dr. Martin Blaser, author of the book “Missing Microbes” and director of the Center for Advanced Biotechnology and Medicine at Rutgers University.
“I think the health profession in general has systematically overestimated the value of antibiotics and underestimated the cost,” Dr. Blaser said.
No shit. And it has spread like a virus to the general populace as well. The majority of people seem mentally addicted to antibiotics and think they're going to die if they don't get an antibiotic for every minor issue.
- Find out if you really need an antibiotic.
- Ask for the shortest course.
- Rethink probiotics.
I appreciate the NYT for finally helping spread this.
Just yesterday people on Lemmy were cheering about AI discovering new antibiotics. When I shared info about the concerns of collateral damage, the responses were more unintelligent and close-minded than on reddit. Extremely depressing.
For more info on this subject there's a wiki and forum at https://humanmicrobiome.info.
tl;dr - Asking your doctor for the shortest reasonable course is a good thing that will both protect you as a patient as well as minimize your risk of antimicrobial resistance. But the key phrase is ask your doctor, do not take it upon yourself to decide when to stop them. Take whatever course you're prescribed.
Pharmacist and 4th year medical student with a passion for antimicrobial stewardship and infectious disease.
Historical treatment duration for most infections was truly quite arbitrary. Evidence for most infections, when it is actually tested, have pretty consistently demonstrated shorter treatment durations than were classically taught (10-14 days for pneumonia now generally 5-7, 14 days for Gram Negative Bacteremia now 7, etc). There is a subset of infectious disease doctors that are bucking the trend of historical "you have to complete your course advice" for some infections. In general, what I have seen is recommendations to discontinue antibiotics with significant clinical improvement AND a non-life-threatening infection in a non-sterile body cavity. So nobody is shortening course durations for empyemas or endocarditis.
The issue becomes expecting patients to know what constitutes clinically meaningful recovery and whether or not their infection is one of the "safe" ones to stop antibiotics earlier.
At the end of the day, I totally disagree with your premise, as we should always strive for the minimum safe antimicrobial exposure. However I do agree that telling patients "shorter is better" is bad advice because I don't want laypeople making these decisions when usually no-ID physicians don't make them.