Antibiotic Resistance: Why Your Doctor Says No to Antibiotics
Being told that you do not need antibiotics often feels like being under-treated. It is usually the opposite: it is the more careful decision, and the reasons are worth understanding because the consequences land on the patient, not on an abstract public.
What antibiotics do and do not treat
Antibiotics kill bacteria. They have no effect whatsoever on viruses.
Viral, so antibiotics do nothing: the common cold, most sore throats, most coughs and bronchitis, influenza, COVID-19, most cases of acute diarrhoea and vomiting, dengue, chikungunya, measles, chickenpox, and most sinus congestion in the first week.
Bacterial, so antibiotics help: streptococcal throat infection, bacterial pneumonia, most urinary tract infections, typhoid, tuberculosis with specific drugs, cellulitis and other skin infections, bacterial meningitis, and infected wounds.
Roughly 80 percent of upper respiratory infections are viral. Green or yellow mucus is not evidence of bacterial infection; the colour comes from immune cells and appears in ordinary viral colds.
What resistance means for you personally
Every antibiotic course kills susceptible bacteria and leaves behind those that survive. These multiply and pass resistance to other bacteria, including species that cause serious disease.
The effect is not theoretical or distant:
- A simple urinary infection that once responded to a three-day oral course may require intravenous treatment and admission
- Routine surgery, chemotherapy, dialysis and childbirth depend on effective prophylactic antibiotics
- Resistant infections mean longer illness, more expensive drugs, more toxic drugs, and higher mortality
- India has among the highest rates of antimicrobial resistance globally, including carbapenem-resistant organisms for which few options remain
Resistance develops in your own bacterial flora. If you take unnecessary antibiotics, the resistant organisms you carry are the ones that may infect you later.
The harms of an unnecessary course
Beyond resistance, antibiotics are not harmless:
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- Diarrhoea in a significant proportion of users
- Clostridioides difficile colitis, which can be severe and recurs
- Disruption of the gut microbiome, with effects lasting months
- Fungal infections, including oral and vaginal thrush
- Allergic reactions, occasionally severe
- Specific toxicities: tendon rupture and nerve damage with fluoroquinolones, hearing and kidney damage with aminoglycosides, liver injury with several agents
- Interactions with other medicines, including oral contraceptives and blood thinners
Where resistance is being driven in India
- Over-the-counter sale without prescription
- Patient pressure for antibiotics at consultations
- Leftover antibiotics taken for a new illness
- Incomplete courses
- Antibiotics in poultry and livestock as growth promoters
- Pharmaceutical effluent in water bodies
- Poor sanitation, which spreads resistant organisms directly
- Fixed-dose combinations of doubtful rationale
What a responsible patient can do
- Do not ask for antibiotics. Ask instead what the likely cause is and what to watch for
- Never buy antibiotics without a prescription, including on a pharmacist’s suggestion
- Never take leftovers or someone else’s prescription
- Complete the prescribed course as directed. Current guidance increasingly favours shorter evidence-based courses, so follow the specific duration you were given rather than an assumed seven days
- Do not share antibiotics
- Dispose of leftovers at a pharmacy take-back point rather than flushing them
- Ask whether a test is appropriate, such as a urine culture or throat swab, before starting
- Get vaccinated. Preventing infection removes the question entirely
- Wash hands, handle food safely and drink safe water
When to return to the doctor
Not needing antibiotics today does not mean not needing them ever. Go back if:
- Fever persists beyond three to four days, or returns after settling
- You feel worse rather than better after the expected course of a viral illness
- Breathlessness, chest pain or coughing blood
- A sore throat with difficulty swallowing or drooling
- Severe one-sided facial pain after ten days of nasal symptoms
- Spreading redness or pus from a wound
- Burning urination with fever or back pain
- Confusion, drowsiness, stiff neck or a non-blanching rash
- Any infant under three months with fever
Delayed prescribing
Some doctors give a prescription with instructions to fill it only if symptoms have not improved in a specified number of days. This is a recognised strategy that reduces antibiotic use substantially without compromising safety. If you are offered it, use it as directed.
The honest summary
An antibiotic for a viral illness gives you all the side effects and none of the benefit, while making the drug less likely to work when you genuinely need it. A doctor who declines to prescribe one is usually doing the harder thing.
This is general information. If you have been prescribed an antibiotic, take it as directed and raise any concerns with the prescribing doctor rather than stopping on your own.