When taken properly, antibiotics are wonder drugs that save countless lives and cure numerous infections. But after decades of unparalleled success, casual use is breeding a biotic backlash.

Is it a cold or is it the flu?

Colds and the flu have similar symptoms. Understanding the differences will help you know when to call your health care provider. A cold usually comes on over a period of several days and includes a runny nose with clear mucus that may darken after two or three days, sore throat, sneezing and coughing. Colds can last for up to two weeks and over-the-counter (OTC) medications can often help relieve these discomforts. Check with your health care provider if your symptoms last longer. Symptoms of the common cold include:

  • Sneezing
  • Stuffy or runny nose
  • Sore throat
  • Coughing
  • Watery eyes
  • Mild headache
  • Mild body aches

Unlike colds, the flu usually comes on suddenly. Flu symptoms are more severe and can last from a few days to two weeks. A medical test is the only way to determine if what you have is, in fact, the flu. Most people recover from the flu without complications, but severe cases can lead to bronchitis and sinus and ear infections and pneumonia, which can be fatal. Flu can also make chronic health problems like asthma, diabetes or heart disease worse. Check with your health care provider if you are have any of these conditions or if your flu symptoms progress. Symptoms of the flu include:

  • Fever or chills (not everyone experiences this)
  • Coughing
  • Sore throat
  • Stuffy or runny nose
  • Muscle or body aches
  • Headaches
  • Fatigue (tiredness)
  • Vomiting and diarrhea (more common in children)

Cold and flu viruses can survive for hours on hard surfaces like doorknobs, bedside tables, sinks, toilets, counters, phones and toys. Touch a contaminated area and then touch yourself, and you run the risk of getting sick. Cleaning with common household staples like bleach, vinegar, soap and water will kill cold and flu viruses, and frequent hand washing will reduce your likelihood of picking up one of these nasty bugs. If you do get sick, coughing and sneezing into your elbow will help in not spreading the illness to others.

The right way to take antibiotics is to strictly follow your doctor’s directions as printed on the package.

  • Be sure to take the whole dose for as many days as directed, unless you have side effects that you did not expect (in which case, consult your health care provider before discontinuing).
  • Be aware of special instructions for taking the medicine. These should be printed on the label but also check with your health care provider and pharmacist. Keep antibiotics in a cool, dry place. Check labels and talk with your pharmacist to see if you should store medications in the refrigerator.
  • Never give an antibiotic prescribed for one person to someone else.
  • Do not save leftover antibiotics or take ones that were prescribed for another illness unless your doctor gives you the okay. Ask your pharmacist about safe disposal of leftover medicine.

Because antibiotics are powerful and can knock out a bacterial infection – such as bronchitis or pneumonia – in a few days, patients suffering with respiratory, nasal and achy symptoms often ask for a prescription. These symptoms, however, are most likely the result of a viral infection from a cold (see sidebar), and antibiotic medicines have no impact on viral infections at all. If you have a cold, only rest, fluids and over-the-counter drugs to control symptoms are helpful. In these cases, antibiotics are a waste of time and money.

Because the symptoms are so similar, only a medical test can determine if your illness is bacterial or viral. Tests usually involve a trip to a lab, payment of a fee and a wait of two days for the results. By the time the results are back, if it is bacterial, it might have worsened. Under these circumstances, it is hardly surprising that patients and doctors may think it best to “get started” on antibiotics to minimize the duration of the illness. For decades the thinking was, “If it’s viral, the antibiotics won’t do any good, but they won’t do any harm either.” It turns out, however, that the unnecessary use of antibiotics does do harm, though not always directly to the patient involved.

The reasons are complex and rooted in the way bacteria reproduce. Since bacteria is always present in our bodies (even if we’re not sick), the introduction of antibiotics creates conditions that give mutant strains a chance to evolve, strains that are “immune” to the antibiotics around them. Later, in this same individual or after transmission to others, the mutant strain can develop into a bacterial infection that cannot be treated by standard antibiotic medicine.

The process is aggravated when someone begins an antibiotic treatment but abandons it before the prescribed period of time runs out because the symptoms of the illness have abated. In such cases, bacteria strains that are present do not get the full treatment and fortify themselves against future antibiotic treatments.

Decades of misuse of antibiotics has helped breed strains of bacteria that no longer respond to antibiotics. As a result, the medical profession is scrambling to find effective treatments for gonorrhea, tuberculosis and urinary tract infections. Meanwhile, victims of these bacteria suffer longer and more serious illnesses, which cause additional doctor visits, and, sometimes, extended hospital stays. In some cases, multiple courses of expensive antibiotics are required, still with no guarantee of success.

In the most glaring example, antibiotic resistance has created a lethal super bug known as methicillin-resistant staphylococcus aureus (MRSA), which sickens and kills thousands and which does not succumb to common antibiotics like amoxicillin, oxacillin and penicillin. MRSA is particularly fond of wounds and surgical sites, but infections can occur anywhere on the body. The microbe also spreads easily to people who have none of the risks. Once primarily confined to hospital and other health care settings, MRSA now shows up in outbreaks at athletic facilities, day care centers, dormitories, and military barracks.

Worldwide, doctors are making efforts to limit the inappropriate use of antibiotics. The United Kingdom has had broad success, but progress in reversing this habit is generally slow. It will help that patients understand the reasons to exercise caution in using these drugs and discuss their needs fully with their doctors before seeking an antibiotic prescription.

Most importantly, even if your symptoms improve, always follow your doctor’s orders, finish your medications, do not cut your meds in half and do not take old, possibly weakened antibiotics. Be responsible about your antibiotic use and protect yourself, your family and the community.

[Janet Lubman Rathner]