Antibiotics: Types, Uses, and Side-Effects
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What are antibiotics?
Antibiotics are a category of medications specifically designed to combat bacterial infections. Also referred to as antibacterials or antimicrobials, these drugs can be administered in various forms:
Liquid.
Tablets.
Capsules.
They may also be applied via:
Cream or ointment.
Injection.
Antibiotics by injection
Individuals requiring antibiotic injections typically begin treatment in a hospital setting due to severe infections. The medical team may continue administering antibiotics post-discharge, especially if a lengthy treatment is necessary.
Do antibiotics work on viruses?
It's crucial to understand that antibiotics are exclusively effective against bacterial infections and not against viruses or fungi. Conditions like the common cold or flu, as well as fungal infections, will not benefit from antibiotic therapy. Patients often mistakenly believe antibiotics have benefitted their viral infections simply due to the body's natural healing process.
In rare instances, a viral infection may lead to a secondary bacterial infection requiring antibiotic intervention.
Types of antibiotics
The antibiotic landscape encompasses numerous variations, each bearing different brand names depending on the manufacturer. They are categorized based on their mechanisms of action. Different antibiotics target specific bacteria or parasites, which is why tailoring therapy to the type of infection is essential. Key classes of antibiotics include:
Penicillins - including phenoxymethylpenicillin, flucloxacillin, and amoxicillin.
Cephalosporins - such as cefaclor, cefadroxil, and cefalexin.
Tetracyclines - examples include tetracycline, doxycycline, and lymecycline.
Aminoglycosides - including gentamicin and tobramycin.
Macrolides - such as erythromycin, azithromycin, and clarithromycin.
Clindamycin.
Sulfonamides and trimethoprim - an example is co-trimoxazole.
Metronidazole and tinidazole.
Quinolones - including ciprofloxacin, levofloxacin, and norfloxacin.
Nitrofurantoin - particularly for urinary tract infections.
In addition to these primary classes, there are antibiotics that specialists may prescribe for rare infections like tuberculosis.
How do antibiotics work?
Antibiotics function either by killing bacteria or inhibiting their growth. This can occur through various mechanisms, such as disrupting the integrity of the bacterial cell wall or preventing replication.
When are antibiotics usually prescribed?
When do I need antibiotics for a sore throat?
Dr Sarah Jarvis MBE, FRCGPTypically, antibiotics are reserved for serious bacterial infections.
Most common ailments stem from viral infections. In fact, mild bacterial infections can often be resolved by the immune system without antibiotics. For instance, antibiotics usually have little to no effect on the recovery from most ear, nose, throat, and sinus infections, even when bacterial pathogens are involved.
Nevertheless, antibiotics are critical for treating certain severe infections like meningitis or pneumonia, where timely intervention can be life-saving. Physicians are adept at evaluating patients to identify serious conditions and determine the necessity for antibiotics. Urinary infections are also frequently treated with antibiotics to prevent complications.
Furthermore, antibiotics can be utilized for treating acne, either orally or through topical application.
Which antibiotic is usually prescribed?
The selection of antibiotics primarily relies on the infection site and the bacteria involved. Each antibiotic works against specific pathogens, influencing the choice of prescription.
For example, with pneumonia, physicians are aware of the bacteria that are prevalent in causing the condition and will select an antibiotic that effectively targets them.
Other considerations include:
Severity of the infection.
Functionality of renal and hepatic systems.
Dosing regimen.
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Concurrent medications.
Common side effects.
History of antibiotic allergies.
Pregnancy or breastfeeding status.
Local infection patterns.
Antibiotic resistance trends in the community.
Some antibiotics are deemed safe for use during pregnancy and breastfeeding.
How to take antibiotics
Proper administration of antibiotics is vital for maximizing their efficacy. For instance, certain antibiotics must be ingested with food, while others should be taken on an empty stomach.
Improper use can hinder the absorption of the medication, reducing its effectiveness. Always heed the guidance provided by healthcare professionals and the instructions accompanying the prescribed antibiotic.
Completing the entire course of antibiotics as directed is equally essential. Although individuals may feel better before finishing the medication, it's critical to finish the regimen. Stopping early can leave bacteria partially treated, increasing the risk of developing resistance.
Overuse of antibiotics has led to bacterial mutations and resistance. For example, methicillin-resistant Staphylococcus aureus (MRSA) has emerged as a challenging pathogen due to antibiotic resistance. Other bacteria produce enzymes, like extended-spectrum beta-lactamases (ESBLs), enabling them to resist certain antibiotics.
The rise in antibiotic resistance poses a significant global health challenge, as these medications are crucial for treating severe infections. If a healthcare professional advises against antibiotic use, it's important to trust their judgment and not pursue them unnecessarily.
Should a secondary infection occur, antibiotics may become essential. Healthcare professionals adhere to guidelines aimed at curbing unnecessary antibiotic prescriptions.
Side-effects of antibiotics
This document cannot cover every potential side effect associated with antibiotics, but several common ones have been reported.
While most side effects are not life-threatening, they can be bothersome. Common adverse reactions include:
Soft stools.
Diarrhoea.
Nausea or vomiting.
Occasionally, patients may experience allergic reactions, such as itchy rashes. Although severe allergic responses can occur, they are relatively uncommon. Allergies to penicillin account for a significant portion of anaphylaxis-related fatalities in the USA, causing around 2 deaths per 100,000 individuals prescribed penicillin annually.
Antibiotics may also disrupt the balance of beneficial bacteria in the bowel and vagina, allowing conditions like thrush to flourish and potentially altering the gut microbiome for months following a single treatment course.
Some notable side effects include:
Severe, watery diarrhoea and abdominal cramps—indicative of Clostridium difficile infection, a serious gut infection resulting from antibiotic use.
Shortness of breath, hives, rash, and swelling of the tongue, face, or lips—possible signs of an allergic reaction. Seek immediate medical assistance for severe symptoms.
White patches on the tongue—potential signs of oral thrush.
Interactions
Certain antibiotics may interact with other medications, leading to adverse reactions or diminishing the effectiveness of one or both treatments.
Oral contraceptive pill
Previously, it was advised to use supplementary contraception when taking antibiotics alongside the combined oral contraceptive pill. This guidance has changed based on recent evidence.
Overall, antibiotics (excluding rifampicin, which is rarely prescribed) do not affect the efficacy of the birth control pill. It should be taken as usual.
How to get antibiotics
In the UK, antibiotics are typically available from pharmacies with a doctor's prescription. In some regions, they can be obtained over the counter. However, to mitigate antibiotic resistance stemming from misuse, seeking medical advice before acquiring antibiotics is advised. Countries with over-the-counter antibiotic availability often face higher resistance rates.
Can a pharmacist prescribe antibiotics?
Pharmacists may offer a limited selection of antibiotics directly to patients, such as those for urinary tract infections in specific age groups.
How long do you take antibiotics for?
The duration of antibiotic treatment varies significantly based on infection type, severity, and symptom resolution speed. Treatment lengths may include:
Three days for urinary tract infections.
One to two weeks for pneumonia.
A few months for bone infections.
Many months for acne.
Who cannot take antibiotics?
It's rare for individuals to be entirely unable to take some form of antibiotic. The primary (but uncommon) reason for avoidance is a prior allergic reaction. Following an allergic episode to one antibiotic, healthcare providers can often recommend a different one if necessary.
Some antibiotics are contraindicated during pregnancy, but healthcare professionals can suggest suitable alternatives when needed. Certain antibiotics may also need to be restricted if patients are on other medications.
Frequently asked questions
How long does it take for antibiotics to work?
In general, antibiotics start showing effects within 2 to 5 days, depending on the specific infection. Symptoms related to urinary and skin infections can improve even sooner.
How long do antibiotics stay in the system?
Most antibiotics are excreted through urine or stool within 24 hours. However, the long-lasting impact on gut microbiota may persist for weeks or months.
Can you feel better after one dose of antibiotics?
While antibiotics typically do not produce immediate effects, they may prompt quick symptom relief for urinary or skin infections. Feeling better after the initial dose might indicate that antibiotics were unnecessary.
Can you take paracetamol with antibiotics?
Yes, combining paracetamol with antibiotics is typically advised if patients experience pain or fever.
Do antibiotics make you tired?
Fatigue can result from serious bacterial illnesses requiring antibiotics, as these conditions frequently induce tiredness. Some antibiotic side effects, like diarrhoea or nausea, can also contribute to fatigue. Occasionally, antibiotics may directly induce tiredness.
Can you take antibiotics and drink alcohol?
Some antibiotics (like metronidazole) interact significantly with alcohol, potentially causing severe nausea. Other antibiotics, such as trimethoprim and erythromycin, can also be affected. Most antibiotics do not typically interact negatively with alcohol, but it is advisable to avoid drinking while unwell, especially with severe bacterial infections.
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