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  • Writer's pictureThe San Juan Daily Star

Do I need that antibiotic?

Emplty medication blister packs in New York, May 3, 2024. If it’s not medically necessary, you may want to consider the risk of antimicrobial resistance. (Eric Helgas/The New York Times)

By Anna Gibbs

Q: I was prescribed a yearlong course of antibiotics to prevent recurrent urinary tract infections. Should I be worried about antimicrobial resistance?

A: Whenever you take antibiotics, no matter the dose or duration, there is a risk of developing resistance, said Dr. Sarah Kabbani, a public health physician at the Centers for Disease Control and Prevention.

Antibiotics work by killing bacteria in your body. But some bacteria will survive and thrive, which can make future infections more difficult to treat. This result, called antimicrobial resistance, is responsible for more than 35,000 deaths in the United States each year.

While antibiotics are necessary for serious, life-threatening infections, they’re sometimes prescribed for less urgent situations. Here’s how to tell if an antibiotic is right for you.

What to consider

The most important question to discuss with your doctor before taking an antibiotic is: Do I really need it?

It’s very possible that you don’t, said Dr. Bradley Langford, a pharmacist specializing in antimicrobial resistance at Public Health Ontario in Toronto. According to the CDC, at least 28% of antibiotics prescribed in outpatient settings like doctors’ offices and emergency departments are unnecessary.

In recent years, U.S. health experts have recommended being more conservative in prescribing antibiotics for common situations, like for treating acne or preventing infections from dental procedures.

If a provider does recommend an antibiotic, research suggests that the shorter the course, the lower the resistance risk, and in many cases, shorter courses are just as effective as longer ones.

Still, some providers continue to prescribe longer courses than are necessary, Kabbani said, so whatever your situation, ask if you’re on the shortest course possible.

Also consider the type of antibiotic. Broad-spectrum antibiotics, which target many types of bacteria, are more likely to cause resistance than those that target fewer types.

And lower dosages don’t automatically mean less chance of resistance, Langford said. What’s more important is whether you’re taking antibiotics at all, and for how long.

Common situations for antibiotic use

Most of us know that we shouldn’t take antibiotics for viral infections, like colds, coughs and flus. But guidelines for other situations may be less straightforward.

— Surgical and Dental Procedures

Prophylactic antibiotics are often prescribed before surgeries to reduce the risk of infection. In those cases, antibiotics are worth taking, Kabbani said.

But taking antibiotics before a dental procedure is often not necessary, she said; the drugs should be reserved for those at higher risk of complications, according to the American Dental Association.

— Recurrent Urinary Tract Infections

If you have chronic UTIs, defined as more than two in six months or more than three in a year, short courses of prophylactic antibiotics — typically lasting from three months to a year — can reduce their recurrence in adults. But the drugs still carry risks for resistance and unwanted side effects (like rashes, diarrhea or yeast infections).

Doctors are increasingly recommending that if you have recurrent UTIs, it’s best to start with alternative prevention methods, such as drinking more fluids, Langford said. Cranberry products, like juices or supplements, may help, too. Or, if you regularly get UTIs after sexual intercourse, you might take a single dose of an antibiotic just after intercourse.

There’s “very limited evidence” for taking prophylactic antibiotics for recurrent UTIs indefinitely, Kabbani said. But if you are prescribed them for an extended course, make sure you know how long it should last; usually, it’s no more than a year, Langford said.

If your doctor detects bacteria in your urine but you don’t have symptoms, avoid antibiotics, research suggests, as they may increase your risk for developing symptomatic UTIs in the future.

— Skin Conditions

People with skin conditions like rosacea or acne are commonly prescribed antibiotics. In fact, dermatologists prescribe more antibiotics than providers in any other medical specialty, said Dr. John Barbieri, a dermatologist at Brigham and Women’s Hospital in Boston.

For severe rosacea, antibiotics are often the best treatment, Barbieri said. Though medicated creams or gels or gentle skin care routines can help with milder cases.

For acne, alternative and effective treatments are available, like benzoyl peroxide washes, topical retinoids and products with salicylic acid.

Topical antibiotics like clindamycin may help mild cases of acne, with fewer side effects than oral antibiotics, but they can still cause antimicrobial resistance. So take them in combination with other topical treatments, like benzoyl peroxide, experts say, to reduce your exposure.

If your acne is severe, oral antibiotics like doxycycline or sarecycline won’t “cure” it, but they can improve an outbreak quickly, Barbieri said, so they may be helpful for temporarily managing your acne while pursuing other, longer-term treatments.

If you can’t use an alternative treatment because of its side effects or because of another health condition, it’s “reasonable” to use oral antibiotics for longer periods, Barbieri said.

That decision will ultimately depend on your unique situation, Langford said, so it’s important to discuss every possible option with your provider. For some, “the benefit of antibiotics will outweigh the risk,” he added. But many people won’t need them at all.

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