The convergence of viruses this fall and winter calls for antibiotic awareness


Winter is here and with it are the signs that we are heading into an intense respiratory season. As we wrap up US Antibiotic Awareness Week (November 18-24), this is a good time to share information on when antibiotics are useful and when they’re just doing harm.

Many hospitals across the US were packed to the brim this fall with children with RSV, a common virus that hits young children and the elderly especially hard. Recently, RSV cases have increased in Billings and western Montana. In addition, flu cases also began to rise earlier than usual and, like RSV, have seen a notable increase in Montana over the past week. The rise of these two seasonal viruses appears to be on a collision course with another wave of COVID-19.

When respiratory symptoms become severe, it’s not uncommon for people to visit their doctor expecting to get a prescription for an antibiotic, drugs we now think of as miracle cures for a quick cure. The right antibiotic can work wonders if it gets rid of a difficult bacterial infection quickly.

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But antibiotics don’t kill viruses that are the cause of cold, flu, RSV, and COVID. Taking antibiotics when they don’t work can harm you without bringing you any benefit. Common side effects can include rash, dizziness, nausea, diarrhea, and yeast infections. More serious side effects can sometimes include a severe, life-threatening form of diarrhea. Frequent rounds of unnecessary antibiotics have been linked to the development of inflammatory bowel disease.

At the Billings Clinic and other healthcare facilities across the country, we have teams to ensure that antibiotics are only used when needed and that we select the right drug at the most effective dose and duration for the condition. But 80% of antibiotics are used outside of hospitals and up to half are used improperly.

Infections become antibiotic resistant when the bacteria that cause them adapt and change over time, developing the ability to resist the drugs designed to kill them. The result is that many antibiotics are becoming less effective in treating disease. If you take these medicines even though they are not helpful, antibiotic-resistant bacteria can grow in your body, and these resistant bacteria can spread to others.

Every patient helps protect themselves from unnecessary side effects and ensure that the medicines we have now continue to work. The first step is to get a basic understanding of how antibiotics work: they kill bacteria that cause infections, but they don’t do anything to stop viruses.

The next step is to have an open discussion with your doctors about whether antibiotics are really needed. Talk to your doctor with an open mind about steps to help you feel better. Sometimes rest and time off from work, if possible, is the best approach to healing. Following your doctor’s advice to treat symptoms with things like cough suppressants or ibuprofen is more helpful than an antibiotic in many cases. In other cases, a plan for continuous monitoring and evaluation, sometimes called “watch and wait,” is better than getting an antibiotic “just in case.”

It’s also important to ask your doctor if you’re feeling better on your own and if any medications you’re already taking might interact negatively with antibiotics.

Avoiding viral infections in the first place is the ideal approach. Get flu and COVID vaccinations immediately if you haven’t already. Practice personal infection prevention and protect those around you by staying home if you are ill, wearing a mask if you or someone at home is ill and has to go out in public, and washing your hands frequently.

Antibiotics can be life-saving when used correctly and should be used to fight a bacterial infection when needed. But these medicines are a resource that we must use responsibly for our own health and ensure that these life-saving medicines continue to be available in the future.

T. Neil Ku, MD, FIDSA, is an infectious disease specialist and medical director of the Antimicrobial Stewardship Program at Billings Clinic.

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