One of the most significant medical advances ever seen. Life-changing and lifesaving. Close to miraculous. A truly historic development that has changed history. Antibiotics can be said to be all of these things, and more. And yet antibiotics are not perfect and their use is also not perfect. There are confusions, mistakes, abuses, complexities, controversies, uncertainties, and more. So let’s take a look at this very important group of medications.

  • Antibiotics are medications that suppress or fight or kill microorganisms. The overwhelming majority of antibiotics are effective and only effective against bacteria (not other microorganisms such as viruses or fungi or parasites) and so the term “antibiotic” is really interchangeable with “antibacterial” for practical purposes.
  • People have used “antibiotics” since ancient times where, for example, the use of mould (we now know that mould contains penicillin) in wound care is often seen. Penicillin was really the first antibiotic used in a modern way (as a known medication used to fight bacterial infection) – discovered by Alexander Fleming in 1928, penicillin was a game-changer, initially most notably in the care of wounds during World War 2. The development of more and more classes of antibiotic has continued since and there are now several major classes and hundreds of specific types of effective antibiotics (not just penicillin).
  • During the latter part of the past century, we began to see antibiotic resistance emerging as a problem. It turns out that when bacteria are repeatedly exposed to antibiotics, they sometimes develop resistance to those antibiotics, rendering them ineffective. This is a complex field, but it seems that the excessive use of antibiotics has created or worsened this problem. It is now widely felt that antibiotic resistance has become a major issue such that over 1m people die annually as a result of antibiotic resistance – treatments (antibiotics) that worked in the past no longer do, and so some patients succumb to overwhelming infection that is, in effect, untreatable. This s a very real concern today and we all need to be certain to only use antibiotics when necessary – in this regard it is likely that the use of antibiotics for minor and or viral illnesses (like colds and flu, noting that antibiotics are NOT effective against the cold and flu or any viruses) is the major error being made by patients and by doctors. Certainly, the solution (more discerning use of antibiotics) requires education of patient and doctor alike (this gets tricky and complicated but please think it through yourself and please discuss this with your own doctor).
  • Antibiotics can cause a range of side effects with the most notable being disruption of the body’s normal “bug-balance” that in turn can cause diarrhoea and fungal overgrowth such as oral or vaginal thrush. Antibiotics can also render the contraceptive pill ineffective, which is clearly a big issue for some. Some of the more powerful antibiotics can cause an array of other adverse effects but in general, most antibiotics in common use have a fairly good safety record.
  • Some antibiotics interact with alcohol. This may cause very distressing and dangerous symptoms (hospital care is sometimes needed). But contrary to common belief, this issue only applies to SOME types of antibiotics, not ALL antibiotics.
  • Antibiotics can be used orally (tablets and syrups) or systemically (by injection or intravenous drip), depending mainly on the severity of the infection faced (systemic antibiotics are almost always stronger).
  • In more recent time and in some circles/cultures, antibiotics have become associated with being bad for human health, the environment, and more. As such, we start to see people who refuse to use antibiotics at all. This is certainly an understandable approach but is, on balance, probably an excessive over-reaction and even dangerous (lives may be lost).

Antibiotics can be lifesaving. They are mainly safe and well tolerated. Most are not overly expensive. These are close-to-miracle drugs that have saved millions of lives. BUT they should be used in a careful mindful deliberate manner. Use. But use with intelligence and care.

Written by Dr Colin Burns