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We don’t always need antibiotics. How long do “common infections” even last?

25. 2. 2022

We don't always need antibiotics. How long do "common infections" even last?

Winter is often characterized by an outbreak of sickness. Most respiratory infections, however, are caused by viruses, which is why antibiotics won’t help. Even more surprisingly, they are not entirely necessary even for some bacterial infections. When should we pursue patience instead of antibiotic medications? We asked Milan Trojánek, M.D., PhD. from the Department of Infectious Diseases at the 2nd Faculty of Medicine of Charles University in Prague and Bulovka Hospital.

Does every bacterial infection have to be treated with antibiotics (ATBs)?

It is indisputable that ATBs are primarily intended for the treatment of infections caused by bacteria. However, at the same time, many bacterial infections that are treated on an outpatient basis are usually not very serious. They often resolve themselves spontaneously even without ATBs. Therefore, it is always necessary to evaluate the benefits and risks of antibiotic therapy.

Can we say that ATBs always speed up the treatment of an infection or is this also a myth?

This is a fairly widespread myth. It is true that in the case of bacterial infections there is usually a reduction in the duration of infection but unfortunately we often expect them to help us reduce the duration of common and frequent respiratory infections. These common infections, however, are mostly of viral origin and therefore no duration reduction can occur, as we have shown in large high-quality studies. We should give our bodies enough time to deal with the illness and must be patient – in the case of sinusitis, for example, it can take more than 2 weeks to fully recover.

What about those popular so-called three-day antibiotics?

The short-term so-called “three-day” antibiotic (azithromycin) is quite popular. Unfortunately its use has many risks.  Among other things, it quite significantly affects the microflora of the mucous membranes and their long-term effect greatly contributes to the selection of resistant bacterial strains – the sensitive ones are killed while the resistant ones survive and ATBs no longer work on them. Therefore, penicillin antibiotics are much more preferable.

Would you also choose any natural remedies for the treatment of respiratory infections?

I believe that the adjunctive treatment of respiratory illnesses is often much more useful than ATBs – this is mainly because most of the illnesses are caused by viruses on which ATBs will not have an effect. Furthermore, ATBs can do more harm by their side effects and by affecting the microflora.

ATBs are obtained by prescription. Should doctors be more educated not to prescribe ATBs unnecessarily?

Yes, ATBs should always be prescribed by a doctor. Nowadays, physicians already have various tools at their disposal to reduce the consumption of antibiotics, including deferred prescribing. We use it in situations when it is not entirely clear whether the patient has a bacterial infection and the administration of ATBs is necessary. For example, if it is Friday and we as doctors are not sure whether the patient will need antibiotics, we can negotiate with the patient that we will prescribe ATBs only if their condition does not improve by a certain time, for example Monday. It turns out that most patients do not end up picking up the prescription. In many cases, this is better than starting with ATBs straight away. Nevertheless, we have to give it up to general practitioners especially as many of them are taking their time and educating themselves on the appropriate times to prescribe ATBs to their patients.

Common duration of infections:

– Sore throat – 7 days

– Common cold – 10 days

– Sinusitis – 18 days

– Cough or bronchitis – 21 – days

Antibiotics are not necessary in many cases.