Antibiotics haven’t had the best press lately. The misuse and overuse of antibiotics have been implicated in the rise of life-threatening superbugs, which have proliferated in recent years. Repeated use of antibiotics is hard on our guts as well — the drugs destroy both bad bugs and good bugs which, over time, can lower immunity.
Yet, in certain circumstances, antibiotics are life-saving medications. Although we’re increasingly aware of the dark side of antibiotics, we wouldn’t want to live in a world without them.
So, what’s the best way to approach antibiotics? Here are some tips:
Make sure they’re necessary. Antibiotics are only effective against bacterial infections, not viral infections, but they’re often prescribed for both — many times because patients demand them.
It can be tough to quickly tell the difference — bronchitis has both a viral and bacterial form, for example, and many doctors are moving fast thanks to packed patient schedules. But a blood or urine test (or in some cases, a tissue biopsy) can be used to determine the root cause of your cough and fever. If you’ve got a virus, skip the antibiotics.
“When an antibiotic is not needed, there’s a potential to cause harm without providing any benefit — C. difficile diarrhea is an example,” says medical epidemiologist Lauri Hicks, DO, who serves as the medical director for the CDC’s Get Smart: Know When Antibiotics Work campaign. “Potential patient-safety issues should be part of the decision-making process when thinking about antibiotics.”
Match the antibiotic to the ailment. If you need antibiotics, talk to your provider about which makes more sense — broad-spectrum or narrow-spectrum antibiotics. “You don’t want to use a hammer for a pushpin,” says functional-medicine practitioner Kara Fitzgerald, ND. “Broad-spectrum antibiotics will damage the healthy bacteria that we want to keep around.”
The practice of prescribing an aggressive antibiotic for a less aggressive infection isn’t uncommon, says Hicks. “We see a lot of outpatient providers prescribing antibiotics that are much more broad spectrum than necessary.”
One popular broad-spectrum drug, Z-Pak, is often prescribed when antibiotics aren’t needed at all, such as in a case of viral bronchitis, says Hicks.
In some cases, however, broad-spectrum antibiotics are necessary. “You want to use the appropriate agent for the job,” notes Fitzgerald. “If you’ve got something that is extremely resistant or aggressive, you may need the stronger medication.”
Build up your immune system. A robust immune system helps you fight off an infection and can possibly shorten your time on antibiotics. “If you’re low on zinc, vitamin A, or vitamin D, immunity is not as robust and you won’t be able to fight infection as effectively,” says functional-medicine family physician P. Michael Stone, MD.
Vitamin D may play a particularly outsized role in boosting immunity. Research shows that vitamin D “induces antimicrobial peptide gene expression,” which is a fancy way to say that it has its own antibiotic effect.
The GI tract is home to a huge number of the body’s immune cells, so keeping the gut in good shape is also crucial for immune function. Bone broth is a powerful gut healer — and vegans and vegetarians can get some of the same benefits from veggie-only versions, like Rebecca Katz’s Magic Mineral Broth.)
Take probiotics after you finish the antibiotics. Speaking of the gut, probiotics are a great way to help repopulate the good bugs in your system. Take probiotics when you finish a course of antibiotics. You can also take them during your course of antibiotics, says Fitzgerald, as long as you space the doses several hours apart.
Your repopulation efforts will be even more successful if you feed all that good bacteria with prebiotics. Prebiotic foods include garlic, onions, leeks, jicama, artichokes, chicory, and potatoes and are sometimes referred to as resistant starches.
You can also cut off the food supply to the bad bugs. Their No. 1 love? Sugar. So go easy on baked goods, desserts, processed foods, and sweetened beverages in general, but especially after finishing a course of antibiotics.
Talk to your provider about duration. If you’ve taken antibiotics, you’ve probably gotten this advice: “Make sure you take every single pill!” But some experts are beginning to question conventional wisdom.
When it comes to duration “you’ll get a lot of different answers because there isn’t a lot of good research out there to support doctors’ decisions,” says Hicks. There are two schools of thought: Take the full course no matter what and stop the drugs when you feel better.
The challenge with the first option is that you might end up taking more antibiotics than you need. The challenge with the second approach is that you might feel better even if the problem hasn’t resolved. “That’s the case with ear infections in kids,” adds Hicks. “When kids take a shorter course, they tend to have more relapses.”
Stone agrees: “You can’t only go by [the disappearance of] symptoms. Older people, for example, don’t tend to get as high of a fever response, so they may think they’re fully better when they aren’t and need to finish the antibiotic course.”
Stopping a course too soon can also complicate more pernicious infections. “I see shorter durations fail when infections are more resistant,” says Fitzgerald. “With Lyme disease, if we cut off treatment too soon, the organism can hide and flourish.”
So, what should savvy antibiotic users do as the duration debate rages on? Hicks, Fitzgerald, and Stone all agree that you should always make the decision to stop taking the drugs (or not) with your provider. Have a conversation when you get the prescription or when you start to feel better.