Dear Dr. D.,

I have recently been experiencing symptoms such as a cough, sore throat and sneezing. How come my doctor back home normally prescribes me antibiotics to get rid of the symptoms, but my doctor here at school said I didn't need them?

No Antibiotics

Dear No Anti,

Whether you know it or not, your question goes directly to the heart of a topic that now is thought of as one of the world's most pressing public health concerns — the overuse of antibiotics leading to the development of antibiotic-resistant infections. And you thought it was just going to be simple as me saying that one doctor was right and one was wrong… uh-uh!

You see, there are really two ways to address your question. I can provide you with knowledge about illness and antibiotics, or I can talk about what you should expect to get out of medicine as a consumer and how this affects your treatment. Well, since it is a rare, slow day in the office, let's do both.

The simple answer to your question is that you probably did not need antibiotics the second time, and in fact, you might not have needed them the first time. It all depends on the origin of your illness. To understand this, we need to first start with a little knowledge about what causes most illnesses.

It doesn't take a medical degree to know that most times when you are physically sick, your illness is either caused by bacteria or a virus. The simple but understated truth is that illnesses caused by a virus will not respond to antibiotics. Colds, flu, most coughs, bronchitis, sore throats (not caused by strep) and most runny noses are caused by viruses. Antibiotics will have no effect on viruses. Antibiotics kill bacteria, not viruses. Let me say that again — antibiotics kill bacteria, not viruses. Taking antibiotics when not indicated or not needed could do more harm than good. Some bacteria can resist and defend against antibiotics, and taking them when not needed could increase the risk of antibiotic-resistant infections.

Eighty-five percent of MSU students reported getting a cold or the flu last year according to the National College Health Assessment, and I surmise that many of them either asked, demanded or were erroneously prescribed antibiotics, or maybe even took some they had left over. Or even worse, took someone else's antibiotics for their illness. This is not good. Antibiotics for viral infections will not cure, or help others from catching the illness, or for that matter, help you feel any better physically.

Antibiotics have become neutral in our mind and in our vocabulary because they have been around a long time, and they are thought of as "good medicine." What we are forgetting is that antibiotics are extremely powerful medications and should only be used when prescribed for a known bacterial infection. You should not take those that have been prescribed for someone else. The best advice I can give you about how to use prescribed antibiotics: Take it all, do not skip doses and don't save any for next time.

Even though you have taken antibiotics in the past and have not gotten a resistant infection does not mean it will happen that same way now. The threat of resistant bacteria is fairly new, and the threat to your health is severe. Not only are the infections harder to treat, but you increase the chances of spreading the infection to friends and family when the infections are resistant to antibiotics. It is important that we not let antibiotics fail at what they do best, and overusing them, especially when not indicated, is making this happen.

On the other hand, it also is important to understand how our expectations might have a bearing on the outcome of an appointment and also how the doctor responds to you. The question I would pose is, "What is it that you expect to get when you go in for a medical appointment?" Is it diagnostic expertise, is it caring treatment or do you expect a "cure?" My experience is that most people expect to get more than just answers. Many of them also expect to get a prescription (antibiotics or medication) to deal with their illness, and if they do not, many will rate their visit as unsatisfactory. This is problematic both for the consumer and the physician. Frankly, the best course of action in many instances might be that no prescription is warranted. So the best advice I can offer you is to limit your expectations to what is most important when it comes to medicine — knowledge. Expect that you will educate yourself, and then talk to your doctor or pharmacist about the right medicines at the right times for the right illnesses.

I hope your illness has run its course and you are well again! Happy trails!

Dr. D.