The Crisis Hiding in Plain Sight
Antibiotics are among the most important discoveries in the history of medicine. Since the introduction of penicillin in the 1940s, they have saved hundreds of millions of lives by treating bacterial infections that were once routinely fatal. But decades of overuse and misuse have created a growing crisis: antibiotic resistance, where bacteria evolve to survive the drugs designed to kill them.
The Centers for Disease Control and Prevention (CDC) has declared antibiotic resistance one of the most urgent public health threats facing the world today. In the United States alone, antibiotic-resistant bacteria cause more than 2.8 million infections and 35,000 deaths each year. Globally, the World Health Organization (WHO) estimates that antimicrobial resistance contributes to nearly five million deaths annually.
At Zimmer Medical Group, we take antibiotic stewardship seriously. When we decline to prescribe antibiotics for a viral infection, it is not because we doubt your symptoms. It is because we are trying to protect you and everyone around you from a future where antibiotics no longer work.
How Antibiotic Resistance Develops
To understand resistance, it helps to understand how antibiotics work. Antibiotics kill bacteria or stop them from reproducing by targeting specific structures or processes in bacterial cells, such as cell walls, protein synthesis, or DNA replication.
However, bacteria reproduce rapidly, sometimes doubling their population every 20 minutes. With each generation, random genetic mutations occur. Most mutations are harmless or harmful to the bacterium, but occasionally a mutation gives a bacterium the ability to survive exposure to an antibiotic. This might happen through:
- Producing enzymes that break down the antibiotic before it can work
- Altering the target site so the antibiotic can no longer bind to it
- Developing pumps that actively push the antibiotic out of the bacterial cell
- Changing their outer membrane to prevent the antibiotic from entering
When an antibiotic kills the susceptible bacteria but leaves these resistant survivors behind, the resistant bacteria multiply and fill the niche left by their dead competitors. Even worse, bacteria can share resistance genes with each other through a process called horizontal gene transfer, spreading resistance to entirely different bacterial species.
Every time antibiotics are used, this selection process occurs. The more antibiotics are used, especially when they are used unnecessarily or incorrectly, the faster resistance develops.
When Antibiotics Are Appropriate and When They Are Not
One of the most important distinctions in medicine is between viral and bacterial infections, because antibiotics only work against bacteria. They have absolutely no effect on viruses.
Conditions That Do NOT Need Antibiotics (Usually Viral)
- Common cold. Caused by rhinoviruses and other viral agents. No antibiotic will shorten the duration or reduce symptoms.
- Most sore throats. The vast majority of sore throats in adults are viral. Only strep throat, confirmed by a rapid strep test or throat culture, requires antibiotics.
- Influenza (flu). The flu is caused by influenza viruses. Antiviral medications like oseltamivir (Tamiflu) can help, but antibiotics cannot.
- Most coughs and bronchitis. Acute bronchitis is almost always viral, even when it produces green or yellow mucus. The color of your mucus does not indicate whether an infection is bacterial.
- Most sinus infections. The majority of sinus infections are viral and resolve on their own. Antibiotics are only warranted when symptoms are severe, worsen after initial improvement, or persist beyond 10 days.
- Many ear infections in adults. Many resolve without antibiotics, especially in otherwise healthy adults.
Conditions That DO Require Antibiotics
- Confirmed strep throat
- Urinary tract infections
- Bacterial pneumonia
- Skin infections such as cellulitis
- Certain sexually transmitted infections
- Bacterial meningitis
- Serious wound infections
When your doctor performs a physical examination and determines that your illness is most likely viral, withholding antibiotics is not dismissing your symptoms. It is providing you with the best evidence-based care.
The Real-World Consequences of Resistance
Antibiotic resistance is not a theoretical future problem. It is happening now:
Superbugs
Multidrug-resistant organisms (MDROs), commonly called superbugs, are bacteria resistant to multiple classes of antibiotics. Some of the most dangerous include:
- MRSA (methicillin-resistant Staphylococcus aureus): Once confined to hospitals, MRSA now causes serious skin and bloodstream infections in the community.
- C. difficile (Clostridioides difficile): This bacterium causes severe, sometimes life-threatening diarrhea and colitis, most often following antibiotic use that disrupts the normal gut bacteria. The CDC classifies C. diff as an urgent threat, responsible for nearly 500,000 infections and 29,000 deaths annually in the US.
- CRE (carbapenem-resistant Enterobacterales): Resistant to carbapenems, which are often the last line of defense against serious infections. The mortality rate for CRE bloodstream infections can exceed 50 percent.
- Drug-resistant tuberculosis: A growing global concern, with treatment regimens lasting up to two years with toxic medications.
The C. diff Connection
Every course of antibiotics disrupts your gut microbiome, the trillions of beneficial bacteria that inhabit your intestines and play critical roles in digestion, immune function, and overall health. When antibiotics eliminate protective gut bacteria, C. difficile, which is naturally resistant to many antibiotics, can proliferate unchecked, releasing toxins that damage the colon.
C. diff infections range from mild diarrhea to fulminant colitis requiring emergency surgery. The risk increases with each course of antibiotics, particularly broad-spectrum antibiotics. This is another reason your doctor may be cautious about prescribing antibiotics for mild or likely viral illnesses.
What You Can Do to Help
Antibiotic resistance is a collective problem that requires collective action. Here is what every patient can do:
1. Do Not Pressure Your Doctor for Antibiotics
If your doctor determines that your illness is viral, trust their judgment. Requesting or expecting antibiotics for a cold or flu puts both of you in a difficult position and contributes to the overuse that drives resistance.
2. Complete Your Full Course When Prescribed
When antibiotics are prescribed, take every dose as directed, even if you start feeling better. Stopping early leaves behind the most resistant bacteria, giving them a chance to multiply.
3. Never Share or Save Antibiotics
Taking someone else's antibiotics or saving leftover pills for future use is dangerous. The wrong antibiotic, the wrong dose, or the wrong duration can promote resistance and may not treat your infection.
4. Practice Prevention
The best way to reduce antibiotic use is to prevent infections in the first place:
- Wash your hands frequently and thoroughly
- Stay up to date on vaccinations, which prevent bacterial infections like pneumococcal disease and pertussis
- Practice food safety to prevent foodborne bacterial infections
- Manage chronic conditions to reduce infection susceptibility
5. Ask Questions
When your doctor prescribes an antibiotic, it is reasonable to ask:
- Is this infection definitely bacterial?
- Is there a narrower-spectrum antibiotic that could work? (Narrow-spectrum antibiotics target specific bacteria and cause less collateral damage to your gut microbiome.)
- How long do I need to take it?
- What side effects should I watch for?
The Pipeline Problem
Developing new antibiotics is a slow, expensive, and financially unattractive process. Unlike medications for chronic conditions that patients take for years, antibiotics are used for short courses. This means pharmaceutical companies see limited financial return on their investment, leading many to abandon antibiotic research in favor of more profitable drug classes.
The result is a shrinking pipeline of new antibiotics at precisely the time we need them most. Several organizations, including the CDC and WHO, are working to incentivize antibiotic development, but progress has been slow.
This is why preserving the effectiveness of the antibiotics we already have is so critical. Every unnecessary prescription erodes these finite resources.
A Shared Responsibility
Antibiotic resistance is not something that happens to other people. It affects patients in every hospital, every clinic, and every community. When antibiotics stop working, routine surgeries become dangerous, cancer chemotherapy becomes riskier, and simple infections become potentially deadly.
Your doctor's decision to withhold antibiotics when they are not needed is not dismissive. It is protective, both of your individual health and of our collective ability to fight serious infections.
Have questions about your treatment or concerned about an infection? Contact Zimmer Medical Group to schedule an appointment. We are committed to providing thoughtful, evidence-based care that protects both your health today and the effectiveness of our treatments for the future.
