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Also consider the type of antibiotic. Broad-spectrum antibiotics, which target many types of bacteria, are more likely to cause resistance than those that target fewer types.
And lower dosages don’t automatically mean less chance of resistance, Langford says. What’s more important is whether you’re taking antibiotics at all, and for how long.
Common situations for antibiotic use
Most of us know that we shouldn’t take antibiotics for viral infections, like colds and flus. But guidelines for other situations may be less straightforward.
Surgical and dental procedures
Prophylactic antibiotics are often prescribed before surgeries to reduce the risk of infection. In those cases, antibiotics are worth taking, Kabbani says.
But taking antibiotics before a dental procedure is often not necessary, she says; the drugs should be reserved for those at higher risk of complications.
Recurrent urinary tract infections
If you have chronic UTIs, defined as more than two in six months or more than three in a year, short courses of prophylactic antibiotics – typically lasting from three months to a year – can reduce their recurrence in adults. But the drugs still carry risks for resistance and unwanted side effects (like rashes, diarrhoea or yeast infections).
Doctors are increasingly recommending that if you have recurrent UTIs, it’s best to start with alternative prevention methods, such as drinking more fluids, Langford says. Cranberry products, like juices or supplements, may help, too. Or, if you regularly get UTIs after sexual intercourse, you might take a single dose of an antibiotic just after intercourse.
There’s “very limited evidence” for taking prophylactic antibiotics for recurrent UTIs indefinitely, Kabbani says. But if you are prescribed them for an extended course, make sure you know how long it should last; usually, it’s no more than a year, Langford says.
If your doctor detects bacteria in your urine but you don’t have symptoms, avoid antibiotics, research suggests, as they may increase your risk for developing symptomatic UTIs in the future.
Skin conditions
People with skin conditions like rosacea or acne are commonly prescribed antibiotics. In fact, dermatologists prescribe more antibiotics than providers in any other medical specialty, says Dr John Barbieri, a dermatologist at Brigham and Women’s Hospital in Boston.
For severe rosacea, antibiotics are often the best treatment, Barbieri says. Though medicated creams or gels or gentle skin care routines can help with milder cases.
For acne, alternative and effective treatments are available, like benzoyl peroxide washes, topical retinoids and products with salicylic acid.
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Topical antibiotics may help mild cases of acne, but they can still cause antimicrobial resistance. So take them in combination with other topical treatments, like retinoids, experts say, to reduce your exposure.
If your acne is severe, oral antibiotics won’t “cure” it, but they can improve an outbreak quickly, Barbieri says, so they may be helpful for temporarily managing your acne while pursuing other, longer-term treatments.
If you can’t use an alternative treatment because of its side effects or because of another health condition, it’s “reasonable” to use oral antibiotics for longer periods, Barbieri says.
That decision will ultimately depend on your unique situation, Langford says, so it’s important to discuss every possible option with your provider. For some, “the benefit of antibiotics will outweigh the risk,” he adds. But many people won’t need them at all.
The New York Times
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