Why Antibiotics Aren’t Always Appropriate and Should Always be Taken as Prescribed

This week marks Antibiotics Awareness Week, an annual observance instituted by the U.S. Centers for Disease Control & Prevention (CDC) to raise awareness of the threat of antibiotic resistance and the importance of appropriate antibiotic use.

Resource editors spoke with Timothy Gauthier, PharmD, antimicrobial stewardship clinical manager for Baptist Health South Florida, about how the over-prescribing of antibiotics – and their misuse by many people – is creating serious challenges for healthcare professionals around the world.

Dr. Gauthier, a pharmacist trained in infectious diseases and antimicrobial stewardship, also says the country’s current amoxicillin shortage is an important reminder that we cannot take antibiotics for granted.

Antibiotics are unlike other drugs, explains Dr. Gauthier, in that rather than working on people, they target the microbes that actually make people sick. “Unfortunately, the more we expose these microbes to antibiotics, the more we pressure them to become resistant to those antibiotics,” he says.

Antibiotic resistance: rise of the “super bugs”

The widespread use of antibiotics, both appropriate and inappropriate, pressures bacteria to become more resistant to our antibiotic drugs, according to Dr. Gauthier. “We’ve known about the threat of antibiotic resistance since penicillin was introduced in the 1940s,” he says. “It has now progressed to the point that antibiotic resistance has become a major public health threat worldwide.”

Dr. Gauthier says he has seen bacteria resistant to all existing antibiotics available for use here in the United States. “It’s very scary and it’s the reason why I’m so passionate about this topic,” he says. “I’m really worried about what antibiotics my children will have available 20 or 30 years from now – especially if they develop complex medical conditions. And just imagine, if our antibiotics become less effective, how that would impact our ability to perform even routine surgeries.”

The problem of drug-resistant microbes – sometimes called “super bugs” in the media – has been exacerbated by the lack of new antibiotics coming to the market, Dr. Gauthier explains. “There have been no great antibiotic innovations in recent decades. The last new class of antibiotics targeting Gram negative bacteria such as E. coli, which is the leading cause of urinary tract infections, was discovered more than 60 years ago,” he says.

No new antibiotics on the horizon

The outlook for new, more effective antibiotics is not very encouraging, says Dr. Gauthier. “Unfortunately, the antibiotic pipeline is broken,” he says. He cites the profit motive of “Big Pharma” as the primary reason why we now find ourselves at this point

Because antibiotics can actually cure diseases – unlike many other types of medicines – there is less opportunity for pharmaceutical companies to recoup their huge investments in research and development and marketing, Dr. Gauthier explains. “With antibiotics, there simply isn’t a healthy enough return on their investment, so we see very few new ones being developed. Even for the antibiotics that come to market, the first thing we often do is shelve it until a special circumstance, which further reduces economic incentives for Big Pharma.”

With the world running out of effective options to fight infections, Dr. Gauthier says that if we want antibiotics to be there for us when we really need them, “we need to use them wisely.” He calls antibiotic resistance “a societal issue – it is everyone’s problem” and says we all need to be part of the solution.

Still, Dr. Gauthier says, there is some reason for hope. “There are some noteworthy efforts to push antibiotic development forward, such as CARB-X, which is an alliance that aims to accelerate global antibacterial innovation by supporting the development of new antibiotics and other life-saving products to combat the most dangerous drug-resistant bacteria.” Those efforts have been slow-moving, however, he adds.

Minimizing antibiotic resistance starts at home

How can you help ensure that antibiotics will work when you or a loved one needs them? “First of all, don’t demand antibiotics from your doctor – let them make a diagnosis and determine if they’re needed,” Dr. Gauthier advises. “Sometimes, antibiotics are indicated; other times, we simply need to manage symptoms and employ supportive care.” If your infection is caused by a viral pathogen, he says, an antibiotic wouldn’t help anyway, since they only work against bacteria, not viruses.

Dr. Gauthier stresses that people should never take antibiotics unless they’re doing so under the guidance of a licensed medical professional. “Take them exactly as prescribed and don’t stop taking them unless your doctor has told you it’s okay to stop.” He also says that people should never use an antibiotic prescribed for someone else. “Only your doctor can determine if an antibiotic is indicated for your illness, and which one is appropriate to fight your specific pathogen.”

Also, Dr. Gauthier says people shouldn’t use a “leftover” antibiotic that’s been sitting in their medicine cabinet for years. “Not only can antibiotics degrade and become less effective over time, but it may also be the wrong tool for the job and do more harm than good.”

Finally, Dr. Gauthier reminds people of the importance of practicing good hand hygiene as well as other simple infection control measures, including masking when appropriate and cleaning and disinfecting high-touch surfaces around your home or workplace daily. “We learned the importance of these prevention measures with COVID, which is a viral pathogen, but they can also be effective in preventing the spread of bacterial pathogens.”

For more information about antibiotic resistance, watch this recent Baptist Health Resource Live conversation between Dr. Gauthier and host Jonathan Fialkow, M.D., chief of cardiology at Miami Cardiac & Vascular Institute and chief population health officer for Baptist Health.