unwell It is winter in the southern hemisphere and with this comes the usual winter illnesses. The vast majority of these are caused by viruses and do not need antibiotics. Yet it seems that many people still want antibiotics for cold and flu like illnesses and many doctors continue to prescribe them.

Research in the USA has shown that one third of antibiotics prescribed are not needed. This equated to a staggering 47 million unnecessary prescriptions in the US each year. The study looked at data from Centre for Disease Control (CDC) surveys. Around 13% of all outpatient visits in the US resulted in a prescription for an antibiotic.

The survey found that 44% of prescriptions were for upper respiratory tract infections such as colds, sore throats, and sinus infections. Lead author Katherine Fleming-Dutra an epidemiologist at the CDC told the Washington Post that doctors often prescribe due to pressure from patients or parents. “Clinicians are concerned about patient satisfaction and the patient demand for antibiotics” she said.

An editorial in the Journal of the American Medical Association noted that the numbers might understate the situation, as it did not include prescriptions from phone consultations, nurse practitioners or physical assistants.

In Australia, a survey by NPS MedicineWise found 38% of people expected an antibiotic prescription when they have a flu or cold. Their reasons included hating being sick, not being able to afford time off work and belief that an antibiotic would help them get better.

The latter is a bit disappointing given the amount of knowledge out there about how antibiotics will not get you better from a virus. The first two are legitimate reasons for wanting to get better but again the implied assumption is that taking an antibiotic makes a difference.

To be fair, if there is a strong enough belief in taking an antibiotic, people will feel better because of the placebo effect. Unfortunately the improvement will be ascribed to the tablet and reinforce the belief for next time.

Why should we even care? Many believe that a course of antibiotics has no downside and some parents believe they are “better safe than sorry”.

At both an individual and societal level it matters. For the person there is the interference with the guts normal flora. This can lead to a variety of gastro symptoms. Repeated disruption is associated with the development of autoimmune conditions and even some metabolic conditions. For children there is an increased risk of asthma and other allergy problems and even childhood obesity.

At a society level we are facing increased bacterial resistance to antibiotics due to their overuse. Some of the blame lies with agriculture, but doctors and patients are not blameless. A UK review concluded, “Our arsenal to defeat superbugs is running out”.

Bacteria have been around longer than humans. They adapt. Those not killed by antibiotics multiply and flourish. Their resistance gives them a survival advantage and this is passed on. This has but should not have come as a surprise.

Bacterial infections still exist. They are a particular threat to those with immune impairment and those with pre-existing medical conditions like kidney, heart or lung disease to name but a few.

And one day you or a loved one may actually need an antibiotic! If they no longer work when needed because they have been used when not needed then this is being sorry rather than safe.

The bottom line is viruses cause cold and flu like illnesses. They do not respond to antibiotics. This is not influenced by the age of the person. If you have a virus do not expect to get an antibiotic.