When are antibiotics necessary?

Antibiotics save lives.

We use antibiotics to treat infections, and there is no doubt that in many instances, antibiotics are truly lifesaving.

However, the Centers for Disease Control and Prevention (CDC) estimate that at least 30 percent of antibiotics in U.S. outpatient settings are prescribed unnecessarily.

There are four main kinds of germs out there in the world: bacteria, viruses, yeast and parasites. As health care providers, we worry specifically about the overuse of medications that are meant to treat bacteria.

Antibiotics promote growth of “resistant” bacteria.

Learn more about when antibiotics are and aren’t needed to treat some common infections.

Antibiotics kill bacteria by targeting molecules and processes that are essential to the survival of bacteria.

However, it only takes a few days and doses of antibiotics to force bacteria to make genetic changes to themselves. In addition, some bacteria may be naturally able to ward off certain antibiotics.

Antibiotic use will promote the growth of bacteria that will be able to withstand future antibiotics. These surviving bacteria are “resistant” to antibiotics.

Antibiotic use in one person has implications for the whole family.

If we overuse antibiotics – by prescribing or taking them for a common cold, for example – we run the risk of having bacteria become resistant to common antibiotics. This means that the antibiotics wouldn’t work as well in the future for that individual.

We share and exchange bacteria among our families and friends through our daily interactions (e.g., shaking hands, hugging, standing close while talking). The shared bacteria include those made resistant by use of antibiotics. Antibiotics are the only medication that, if taken by one person, has effects on the future health of another person.

Antibiotics are more difficult to design now than in the past.

Earlier in the 20th century, bacteria were just starting to be studied, and it was easy to find targets to then design antibiotics. Nowadays, it is harder to find new targets because most of the targets have already been discovered.

If a new target is found, it also takes approximately 10 years to eventually design and manufacture a new antibiotic. Thus, the number of new antibiotics being developing keeps dropping each year.

Antibiotics have side effects.

Like any medication, antibiotics have risks and side effects. It’s not uncommon for people taking antibiotics to experience diarrhea, develop yeast infections or suffer fevers and allergic reactions.

Some patients experience side effects that are so worrisome, they go to their doctor or come to the hospital for evaluation and treatment.  

Antibiotics should be used appropriately.

Antibiotics should be used for clear reasons: the treatment or prevention of bacterial infection. Antibiotics designed to kill bacteria should not be given to someone who has just a cold or a runny nose.

If antibiotics continue to be used indiscriminately, we may enter a “post-antibiotic” world in which infections by resistant bacteria will outrun the ability to make new antibiotics.

We need to find ways to minimize antibiotic use. This will prevent the forced survival of resistant bacteria, which can spread within our families.

Antibiotic use is closely assessed at OHSU.

As a healthcare institution that cares for a wide variety of children and medical conditions, OHSU may prescribe antibiotics as part of a patient’s treatment. Providers and pharmacists well-versed in antibiotics work to determine the necessity of the antibiotic in individual pediatric patients and make recommendations regarding dosing and duration. Physicians and front-line staff receive educational seminars about antibiotics throughout the year.

How can parents and caregivers make informed decisions about antibiotics usage?

If you’re concerned your child has an infection and are visiting a health care provider, have a frank conversation about benefits and risks of antibiotics. If the provider states that they’d like to give your child an antibiotic, ask if it is necessary. In some instances, you can watch and wait and monitor the situation (many infections, like ear infections or sore throats, can go away on their own without antibiotics).

Preventing infections is key

If you don’t have an infection, you don’t need an antibiotic. A few common-sense (but effective) ways to prevent infections in the first place

  • Wash your hands
  • Get vaccinated
  • Self-care. This includes ensuring that your family members get enough sleep, eat healthy foods, drink enough water, reduce stress and get regular exercise. A healthy body is more resistant to infection, and hence should not need antibiotics

It’s also good to be aware that with the upcoming viral season, antibiotics may not be needed. Influenza is a virus, and antibiotics don’t work for viruses. Instead, an antiviral medication might be used to treat the flu. Learn more about the difference between antibiotics and antiviral drugs.


Dawn Nolt, M.D., M.P.H.
Associate Professor of Pediatrics
Division of Infectious Diseases
OHSU Doernbecher Children’s Hospital