One of the great discoveries of modern medicine was the invention of antibiotics. These kill bacteria and can cure life-threatening infectious diseases such as pneumonia, for which no effective treatment was previously available. But the misuse of antibiotics means that increasing numbers of bacteria are becoming immune to this type of medication. So it is particularly important that they are used correctly.

Antibiotics can save lives but they also alleviate bacterial infection symptoms and allow us to recover faster. But antibiotic treatment has side effects, as well. Of example, nausea or diarrhea are normal.

Antibiotics are also used far too often and there is systematic abuse of them. This caused several different types of bacteria to become antibiotic resistant (unresponsive).
Since tolerance has become more common, many illnesses in the past can not be treated as well as they could.

It is important to know the following things when using antibiotics to prevent resistance and side effects:

  • Antibiotics only work against bacteria. Many infections are caused by viruses and can’t be treated using antibiotics – examples include respiratory illnesses such as a cough, stuffy nose, bronchitis or the flu.
  • Excessive and improper use of antibiotics is causing side effects and reducing their efficacy in the long term.

What is antibiotic resistance?

Bacteria and other germs are said to be immune in medicine if they can especially tolerate exposure to external influences. For example, stomach (gastric) acid destroys most of the germs that reach the stomach with food. But some bacteria have a mucous coating which protects them from the acid. We are gastric acid resistant.

Antibiotic resistance operates on a similar principle: The bacteria have acquired a new property that protects them against the antibiotics. For example, certain types of bacteria may create a substance that makes certain antibiotics ineffective. The word “multiresistant” refers to bacteria which can defend themselves from several different antibiotics.

What causes resistance?

Many of the now resistant bacteria used to be susceptible to antibiotics. There are a few innovations in that that have played a role. To put it briefly, originally one type of antibiotic could neutralize a certain type of bacteria and then effectively stop the infection. But the bacteria’s genetic material may change by chance, producing often new properties. If the bacteria are safe against an antibiotic then the bacteria have become immune. Such types of properties can also move from one bacteria group to another.

If antibiotics are used more often, resistant bacteria are better able to reproduce because the other non-resistant bacterial strains are prevented. Antibiotics then no longer help against resistant bacteria-infections.

Which bacteria are antibiotic resistant, and why they are dangerous?

Streptococcus strains and bacteria Staphylococcus also resist antibiotics. Another example is named “the Staphylococcus aureus resistant to methicillin” (MRSA).Staphylococci can be found on skin and mucous membranes, and can cause infection, for example when they get into open wounds.

Many types of bacteria have now established resistant strains, such as Escherichia coli, Klebsiella and pseudomonads.

What is being done about antibiotic resistance?

Antibiotics are prescription-only in Germany. This means that the primary responsibility for diligent and accurate use rests with the physicians. They must first see if somebody has a bacterial infection actually. If they do, then it is important that the antibiotic is administered at the right dose and for long enough, and that the right antibiotic is chosen which will combat the bacteria most effectively.

Hygiene laws are also in place to keep resistant bacteria from further spreading and preventable infections from occurring. Inside a hospital these steps are especially important. Antibiotics are used relatively frequently there, which means that resistant germs can grow very quickly. When you come into contact with someone who has a resistant bacteria infection, it can help you wear disposable gloves, mask and hat, and use a hand disinfectant to avoid the germ spreading.

Antibiotics are also used in both veterinary and herbal medicine. Veterinarians also need to stick strictly to the antibiotic handling guidelines.

What can I do to prevent antibiotic resistance?

Being cautious when taking antibiotics can help both prevent antibiotic resistance as well as side effects.

The most important thing is not to overestimate what antibiotics can do: patients often expect to receive antibiotic prescriptions for treating medical conditions for which they are not qualified.

Antibiotics are needed to treat serious bacterial infections such as lung infections or meningitis (inflammation of the brain and spinal cord lining membranes). This is not the case when, for example, people who are otherwise healthy have virus-caused respiratory infections, such as cold or influenza (“flu”). Antibiotics are typically of no use, as they only kill bacteria. Antibiotics also have side effects that include allergic reactions, issues with the stomach and intestines, diarrhea and fungal infections. Because of these associated risks, careful consideration of the benefits and disadvantages of taking antibiotics is important.

What’s important to consider when taking antibiotics?

Antibiotics should be used, as long as they are approved by the doctor. Just because the disease’s symptoms subside, it doesn’t mean that all of the germs were destroyed. Remaining bacteria may cause the disease to begin again.

If some tablets are left over, they should not be retained or given to others for later use. The residual prescription may be disposed of in the ordinary garbage or dropped off at some pharmacies. Nevertheless, pharmacies are not obliged to accept open medicine. It is critical that the drug is not disposed of by pouring it down the drain or flushing it down the toilet. That’s bad for the environment and it also leads to resistance to bacteria.

Medicines can only function correctly if they are used correctly. The following things are important to learn when taking antibiotics:

Can the tablets be broken into smaller pieces to allow them to swallow more easily? Doing so can stop those drugs from working properly.

What food do you take with antibiotics? Antibiotics are usually taken with water, because it can influence how the body absorbs certain medications together with fruit juices, dairy products or alcohol. Dairy products include butter, milk, yogurt, and cheese. You may need to wait for up to three hours after taking an antibiotic before eating or drinking any dairy products. Grapefruit juice and dietary supplements which contain minerals such as calcium may also function to dampen the antibiotic effect.

When should you take antibiotics?

Many antibiotics should always be administered at the same time of the day; others should be taken before, during or after a meal. Of example, if you are supposed to take the medication three times a day, it typically needs to be taken at fixed times to distribute the effect equally over the course of the day. You will remember the 6 a.m., 2 p.m. regular times And 10:00 p.m. For example, for an antibiotic which needs to be taken every 8 hours.

Could you mix antibiotics with other medications?

Because antibiotics can interfere with other medicines, it is important to tell your doctor if you are taking other medicines, too. For example, antibiotics may interfere with certain thinners in the blood and with antacids. Some antibiotics may be less effective in making birth control pills.
Detailed information regarding the use of a specific antibiotic can be found in the package insert. If you’re not sure what to consider when taking the antibiotic, ask your doctor or pharmacist.

Sources

Federal Ministry of Health (BMG), Federal Ministry of Food and Agriculture (BMEL), Federal Ministry of Education and Science (BMBF). DART 2020. Zwischenbericht anlässlich der WHA 2016. May 2016.
Centers for Disease Control and Prevention (CDC). Antibiotic / Antimicrobial Resistance. June 12, 2017.
Deutsche Gesellschaft für Infektiologie e.V. (DGI). S3-Leitlinie: Strategien zur Sicherung rationaler Antibiotika-Anwendung im Krankenhaus. AWMF-Register-Nr.: 092-001. December 15, 2013.
Kayser FH, Böttger EC, Haller O, Roers A, Deplazes P. Taschenlehrbuch Medizinische Mikrobiologie. Stuttgart: Thieme; 2014.
Weltgesundheitsorganisation (WHO). Antimicrobial resistance. October 2016.
IQWiG health information is written to help people understand the benefits and drawbacks of key treatment options and health care services.

Because IQWiG is a German institute, some of the information provided here is unique to the health care system in Germany. In an individual case the suitability of any of the options described may be determined by talking to a doctor.

Our information is based upon the results of studies of good quality. It is written and reviewed by qualified experts by a team of healthcare professionals, scientists, and editors. You will find in our methods a detailed description of how our health information is produced and modified.

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