Popping Antibiotics Like Antacids

During the height of the Omicron wave, a friend developed cough and called for advice. While I was trying to find out if he had other symptoms/signs of Covid-19, he told me happily that he had already started Augmentin, on the advice of another non-doctor friend, who had memorized the prescription that a third doctor had given during the last Delta wave. His friend was confident that Augmentin would make him better. My friend’s cough disappeared in two days, which likely would have happened anyway, but he ascribed it to the use of Augmentin, which means the next time he has cough, he will again pop in a few Augmentin tablets and encourage others around him to do the same. Not only that, he took the Augmentin for just 3 days and stopped as soon as his cough subsided.

Augmentin is an antibiotic, the brand name of a combination of amoxicillin and potassium clavulanate. Though, it is a prescription drug, it is easily available over the counter in most pharmacies in India, without a prescription. So anyone who thinks that Augmentin is the drug to take for any cough, cold, fever, body ache, etc, can go to most chemist shops, buy a strip and start popping the drug on their own, without much trouble.

Earlier this week, the Lancet published an analysis of worldwide antimicrobial resistance [1] by the Antimicrobial Resistance Collaborators. They attribute 1.27 million (12.7 lakh) deaths worldwide in 2019 directly to antibiotic resistance, while in a total of 4.95 million (49.5 lakh) deaths, antibiotic resistance played a significant role.

The rampant use of antibiotics has led to many common bacteria developing antibiotic resistance. My Mom recently had a bad pneumonia and her sputum culture showed that the bug (Streptococcus) was resistant to at least 3 common antibiotics, including the one she had been taking till then. Luckily, the bacterium was sensitive to other common antibiotics such as penicillin and she recovered quickly after the antibiotic was changed.

Akshay Baheti and I wrote a piece last year titled the “The Matka of Doing Something Medicine”, when during the first and second waves of Covid-19, antibiotics such as azithromycin were being prescribed as frequently as paracetamol. Self medication with antibiotics as with my friend, adds another layer to the whole problem.

Most fevers of short duration are viral in etiology. Antibiotics have no role in viral fevers, except in some situations, such as in immunocompromised patients, where the treating doctor may believe it is necessary to give antibiotics prophylactically. To pop antibiotic pills as if they were antacids or painkillers, to be taken whenever you feel like one, without any logic or sense, just adds to the unfolding crisis of increasing resistance to antibiotics and consequent increasing morbidity and mortality.  Antibiotics also need to be taken for a specific duration of time, usually not less than 5 days, to ensure they get enough time to do their work of killing the bad bacteria, without leaving some half treated ones behind, which could then mutate and become resistant.

In South Asia alone, the Antimicrobial Resistance Collaborators estimate around 389,000 deaths in 2019 directly to antibiotic resistance and 1.39 (13.9 lakh) million deaths partly due to antibiotic resistance. These are big numbers and most likely an underestimate.

Antibiotics have their own side effects. Apart from nausea and diarrhea, they kill the normal bacteria and flora that make up our gut microbiome, which in turn is intimately associated with our mental well-being, our appetite, weight loss/gain and other health parameters. Like with everything in life, there is no free lunch. And you don’t really want to mess with your gut microbiome unnecessarily.

What does this mean for you and I? Antibiotics save lives and reduce the morbidity and mortality associated with bacterial infections. But they have to be used judiciously.  So, please, please don’t take antibiotics on your own, without a definite proven infection and without a doctor’s prescription. Question your doctor if you are prescribed antibiotics each time you have a viral fever or some cough or feel under the weather. Just as you do extensive online and offline research and think ten times before booking a vacation, so also with antibiotics…think ten times and then some before putting them in your body.  And you don’t want to be that person who lands up with a bacterial infection that no antibiotic works on because all the bacteria infecting you have developed antibiotic resistance, perhaps because you were the one popping antibiotics like antacids and painkillers.

Footnote

1. Antimicrobial Resistance Collaborators. Global burden of bacterial antimicrobial resistance in 2019: a systematic analysis. Lancet. 2022 Feb 12;399(10325):629-655.

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