Getting the most out of taking antibiotics

When my daughter Maureen was a toddler, we would visit my mother-in-law’s house. Having over a dozen grandchildren under the age of 8, she kept a giant toy box in the corner of her living room. It contained building blocks, crayons and coloring books, and empty prescription bottles with child-resistant lids.
As a pharmacist, I was very uncomfortable having my daughter “play” with child-resistant tops of medicine vials. Each time we'd visit her, I would make sure I found and removed all the medicine vials from Grandma’s toy box before letting Maureen near it.
This irritated my mother-in-law because she could not understand my objection to providing something that would engage her grandchildren.
I tried explaining that the purpose of putting a child-resistant top on medicine vials was to prevent them from being easily opened by a child. By treating pill bottles with child-resistant tops like toys, eventually, her grandchildren would discover how to open any medicine bottle quickly and easily.
What does this have to do with antibiotics, and how to get the best out of them?
Antibiotics work by interfering with how a particular type of bacteria survives and multiplies.
To be effective, an antibiotic attacks a bacteria's weakest points. One common target is the membrane surrounding and protecting each bacteria, called the cell wall. Penicillins and similar antibiotics physically attach themselves to specific proteins essential to building and maintaining the cell wall. Once this happens, the protein molecules can't support the cell wall anymore, causing it to rupture. The bacteria dies.    
The more an antibiotic comes in contact with a bacteria, the more likely it is that bacteria will eventually find a workaround and survive to multiply despite you taking the antibiotic.
Bacteria multiply themselves constantly. Eventually, a slight error occurs, and they mutate into a similar but not identical organism. If a bacterial cell mutates in a way that keeps an antibiotic from successfully attacking them, it can multiply unhindered. This creates a strain of bacteria that the antibiotic can no longer target. We call this developing resistance.
It’s like giving my daughter more opportunities to learn how to open a child-resistant top. Given enough time, eventually, she'll figure out how to open it. When attacked by an antibiotic, if bacteria are not killed fast enough, some of them can manage to change themselves just enough to allow them to survive the attack. If they are no longer affected by that antibiotic, it becomes useless against them. This is called "resistance."
Suppose you don't take a large enough dose of antibiotic or don't take it long enough. In that case, the targeted bacteria can find a "workaround" by accidentally mutating into something the antibiotic can’t fight against.
The biggest challenge of using antibiotics is to ensure they "cure" the infection without helping create a new strain of bacteria resistant to its attack.
Many of our older antibiotics used to be more effective. Over time, with repeated courses of treating infections, bacteria have changed just enough to keep them from being targeted.
Resistance to antibiotics is one of the most severe threats to medical care today. What if you got pneumonia which could NOT be cured because there were no antibiotics left that worked?
Viruses work differently than bacteria. Like pirates, they target specific cells and enter them. Once inside, the virus replaces the building blocks of your own DNA and RNA with its own. It hijacks your own cells to produce more viruses, instead.
Smaller than most bacteria, viruses move into and work inside our cells, protected from attack by antibiotics. Their outer covering has a very different cell membrane or cell wall than bacteria. Antibiotics can’t attack viruses effectively, so don’t work for viral infections.
Here are 4 Keys to Taking Antibiotics Effectively While Discouraging Resistance:
1. Speak Up.
If an antibiotic causes vomiting within an hour of taking it, eat some food before trying it again. If you can’t keep an antibiotic down for at least an hour, call your doctor for something else.
2. Get to the Finish Line.
You may feel wholly recovered when only partway through taking an antibiotic. Don’t quit early.
3. Don’t Hoard Leftovers for Future Infections.
Using only one or two doses of an old antibiotic to “catch” an infection before it gets going encourages resistance.  
4. Not All Infections Are Bacterial.
Many infections are actually caused by viruses, NOT bacteria. Taking antibiotics for these infections won't help you. In fact, antibiotics can interfere with our immune systems' response to viral infection.

Dr. Louise Achey, Doctor of Pharmacy, is a 43-year veteran of pharmacology and author of Why Dogs Can’t Eat Chocolate: How Medicines Work and How YOU Can Take Them Safely. Get clear answers to your medication questions at her website and blog ©2022 Louise Achey

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