Key messages for the general public: Self-medication with antibiotics

1. Antibiotics can only be prescribed by a medical doctor who has examined you

Many winter illnesses can cause the same symptoms, but they might not require the same treatment. If you have been prescribed an antibiotic for a previous illness and have recovered well, it is tempting to want to use the same antibiotic if you have similar symptoms. However, only a medical doctor who has examined you can ascertain if a winter illness requires treatment with antibiotics.

• Never try to buy antibiotics without a prescription.
• Never save antibiotics for later use.
• Never use leftover antibiotics from previous treatments.
• Never share leftover antibiotics with other people.

Do not keep leftover antibiotic treatments [8]. If you received more antibiotic doses (e.g. tablets, gel caps) than you were prescribed, ask your pharmacist about how to dispose of the remaining doses.

2. Antibiotics are not painkillers and cannot cure every illness

Antibiotics do not work like painkillers and cannot relieve headaches, aches, pains or fevers.

• Antibiotics are only effective against bacterial infections and cannot help you recover from infections caused by viruses such as the common cold or the flu [9–12, 14].
• Up to 80% of winter illnesses affecting your nose, ears, throat and lungs are of viral origin, so taking antibiotics will not make you feel better [11, 12].  

3. Taking antibiotics for wrong reasons, such as against colds and flu, will not help you feel better faster, and may cause side-effects

Taking antibiotics against a cold or the flu has no benefit for you: antibiotics simply do not work against viral infections [9-12]. In addition, antibiotics may cause several unpleasant side effects such as diarrhoea, nausea or skin rashes [9, 10, 13-15].

Taking antibiotics to fight mild bacterial infections, such as rhinosinusitis, sore throats, bronchitis or earaches, is often unnecessary [15-19] since, in most cases, your own immune system is able to deal with such mild infections.

Most symptoms can be alleviated with over-the-counter medicines. Taking antibiotics will not reduce the severity of your symptoms and will not help you feel better faster [10, 12, 15, 17].

If your symptoms persist or if you have any concern, it is important that you see your doctor. If you really have a severe infection such as bacterial pneumonia, your doctor will prescribe antibiotics. Seek help more quickly than other people :

• if you are over 65 years old;
• if you have asthma or diabetes;
• if you have lung disease (e.g. chronic bronchitis, emphysema, chronic obstructive pulmonary disease);
• if you have heart problems (e.g. previous heart attack, angina, chronic heart failure);
• if you have a medical problem where your immune system is suppressed; or
• if you are taking drugs that suppress the immune system (e.g. steroids, chemotherapy for cancer, some drugs used to suppress thyroid gland functions). 

List adapted from ‘Genomics to combat resistance against antibiotics in community-acquired LRTI in Europe’, a project funded by the European Commission’s Directorate-General for Research and Innovation.   

4. Take the time to get better

Meeting life’s demands while being ill can be a source of stress, especially if you are experiencing certain symptoms for the first time. Finding an appropriate time to visit the doctor can be difficult, expensive and time-consuming. Knowing how to manage your symptoms can help you cope better with your illness. Learn how you can take care of yourself without antibiotics.

For most winter illnesses, your condition will improve after two weeks.

Table adapted from ‘Get better without antibiotics’, Health Service Executive Ireland, and ‘Patients antibiotic information leaflet’, Royal College of General Practitioners.If your symptoms persist or if you have any concern, it is important that you consult your doctor.

5. Ask your pharmacist for advice: other medicines can help relieve your symptoms

Your pharmacist may recommend over-the-counter medicines to help alleviate your symptoms.

Always ask for advice, especially if you are taking medicines for any other condition.

• Painkillers relieve aches, pains and fevers.
• Anti-inflammatory medicines, such as throat sprays or pastilles, help you swallow more easily.
• Oral expectorants clear secretions in your airways.
• Nasal sprays and decongestants help you breathe more comfortably.
• Antihistamines alleviate stuffy, sneezy and itchy noses.

Drinking plenty of fluids and getting some rest will help improve any winter illness.

References 

1. Bell BG, Schellevis F, Stobberingh E, Goossens H, Pringle M. A systematic review and meta-analysis of the effects of antibiotic consumption on antibiotic resistance. BMC Infect Dis 2014;14:13. [open access link]
2. Chung A, Perera R, Brueggemann AB, Elamin AE, Harnden A, Mayon-White R, et al. Effect of antibiotic prescribing on antibiotic resistance in individual children in primary care: prospective cohort study. BMJ 335(7617):429. [open access link]
3. Donnan PT, Wei L, Steinke DT, et al. Presence of bacteriuria caused by trimethoprim resistant bacteria in patients prescribed antibiotics: multilevel model with practice and individual patient data. BMJ 2004;328(7451):1297-301. [open access link]
4. London N, Nijsten R, Mertens P, van den Bogaard A, Stobberingh E. Effect of antibiotic therapy on the antibiotic resistance of faecal Escherichia coli in patients attending general practitioners. J Antimicrob Chemother 1994;34(2):239-46. [link]
5. Malhotra-Kumar S, Lammens C, Coenen S, Van Herck K, Goossens H. Effect of azithromycin and clarithromycin therapy on pharyngeal carriage of macrolide-resistant streptococci in healthy volunteers: a randomised, double-blind, placebo-controlled study. Lancet 2007;369(9560):482-90. [open access link]
6. Nasrin D, Collignon PJ, Roberts L, Wilson EJ, Pilotto LS, Douglas RM. Effect of β lactam antibiotic use in children on pneumococcal resistance to penicillin: prospective cohort study. BMJ 2002; 324(7328):28-30. [open access link].
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9. Arroll B, Kenealy T. Antibiotics for the common cold and acute purulent rhinitis. Cochrane Database Systematic Reviews 2013 Jun 4;6:CD000247. [open access link]
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11. Heikkinen T, Järvinen A. The common cold. Lancet 2003;361(9351):51-9. [open access link]
12. Mäkelä MJ, Puhakka T, Ruuskanen O, et al. Viruses and bacteria in the etiology of the common cold. J Clin Microbiol 1998;36(2):539-42. [open access link]
13. Keeney KM, Yurist-Doutch S, Arrieta MC, Finlay BB. Effects of antibiotics on human microbiota and subsequent disease. Annu Rev Microbiol 2014 Jun 2. [Epub ahead of print]
14. Shehab N, Patel PR, Srinivasan A, Budnitz DS. Emergency department visits for antibiotic-associated adverse events. Clin Infect Dis 2008;47(6):735-43. [open access link]
15. Smith SM, Fahey T, Smucny J, Becker LA. Antibiotics for acute bronchitis. Cochrane Database of Systematic Reviews 2014, Issue 3. Art. No.: CD000245. [link]
16. Coker TR, Chan LS, Newberry SJ, et al. Diagnosis, microbial epidemiology, and antibiotic treatment of acute otitis media in children: a Systematic review. JAMA 2010;304(19):2161-9. [open access link]
17. Spinks A, Glasziou P, Del Mar CB. Antibiotics for sore throat. Cochrane Database Systematic Reviews 2013 Nov 5;11:CD000023. [link]
18. Young J, De Sutter A, Merenstein D, et al. Antibiotics for adults with clinically diagnosed acute rhinosinusitis: a meta-analysis of individual patient data. Lancet 2008;371(9616):908-14. [open access link]
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