Immediate Harm

We’re beginning to understand the harm caused by our antibiotic 'bombs'.

According to a leading medical journal, viral infection is the cause of up to 98% of sinusitis and, in the USA, the disorder affects about 14% of the adult population every year, i.e. some 30 million Americans. Despite the likely viral cause, antibiotics are prescribed “more often than not;” indeed, sinusitis is the fifth leading reason for prescription of antibiotics by US primary care physicians.

What drives this massive over-prescription problem is a mindset among physicians that “antibiotics won’t do any harm and may help,” says highly-regarded infectious disease specialist Brad Spellberg, MD. He frames the issue this way:

“Perhaps if providers had a better grasp of the risk for immediate harm caused to the patient by the antibiotic prescription — as opposed to the vague and intangible notion of a small harm to society at large that may occur over time — they might be better armed to make a more appropriate risk/benefit decision about whether to prescribe the antibiotic … Resistance is not merely for the public at large. Resistance will occur in the individual patient as a consequence of their new prescription.” (My emphasis.)

The concern is not simply that antibiotics cause unwanted side effects like diarrhea, rashes, nausea, and stomach pain, and even life-threatening allergic reactions, kidney toxicity, and severe skin reactions, as the US Centers for Disease Control warns us. The story runs deeper than that. We think antibiotics are like laser-guided missiles that attack only the bugs that make us sick. But they’re not. They’re actually too powerful – like nuclear weapons that destroy everything, good bacteria included, said Margaret Riley, PhD, in her address to the Institute of Medicine this year.

We need our good bacteria – which is most of our bacteria – to keep us healthy. They help us digest food, build nutrients, and crucially, they’re part of our immune response. So if you knock them out with an antibiotic you are left more vulnerable to infection, immediately and in the long run.

The leading edge of antibiotic research is telling us things we couldn’t have imagined even a few years ago: for example, that the antibiotic-driven destruction of our microbiome – our internal collection of microbes, bacteria especially – is contributing to the rise of our “modern plagues:” obesity (antibiotics are The Fat Drug), asthma, allergies, diabetes, and certain forms of cancer.

But here’s the thing. These negative consequences happen even when you should use an antibiotic. Understandably, you have to risk it when dealing with a serious bacterial-driven infection which can be limb and life-threatening. But to prescribe antibiotics “more often than not,” when only 2% of sinusitis cases are bacterial is something our best clinician-researchers are telling us we need to stop – now.




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