Antibiotics: What are they, Who do they help, Where do they not work?

Antibiotics:  What are they, Who do they help, Where do they not work?

Antibiotics are a group of medicines that kill germs.

There are three types of germs that can make us ill:
  1. Bacteria
  2. Viruses
  3. Parasites
There are plenty of medicines that kill bacteria and parasites, not so many that kill viruses.
Of course, it makes a big difference if a medicine works or not, so let's take a look at each of these types and whether antibiotics makes sense or not.

Bacteria are like us, living cells that eat food.  They are very small, always one-celled, and when the feed on us they make pus.  Antibiotics were invented to kill bacteria, and do a great job at it.
But, most of the infections we see in childhood, in fact the vast majority, are not caused by bacteria.
The most common infections bacteria cause are: ear infections (about 60% of them), pneumonia (about 20% of them in kids), strep throat, impetigo (a skin infection), and boils.  
Bacteria all have chemistries that are different from our cell's chemistries, so one could create a drug that blocks bacterial chemistry, but leaves our alone.  That's how the antibiotics are able to kill all the bacteria causing our infection, but leave our human cells alone.
If we know your child has an infection caused by bacteria, and the infection needs to go away, antibiotics are always available to kill essentially any bacteria.

Viruses are an odd thing.  They are essentially a packet of information.  Every virus is a small snippet of genetic material (DNA or RNA) wrapped in a coat of protein designed to deliver the genes into our cells. Once in place, the genes only job is to force our cell to make more viruses, usually popping the cell in the process.  We get sick from all the cells infected with a virus that get destroyed.
Viruses have very little chemistry inside of them, so there are very, very few ways a drug can be taken to kill a virus.  There are a few antibiotics that kill viruses, but each only kill one very specific type of virus.  Tamiflu kills the influenza virus, but not any other virus, for example.
Viruses cause most of the infections now seen in childhood, and every person alive will have dozens of these infections, every person.
Infections caused be viruses include colds, flus, and stomach flus.
The usual antibiotics have no impact at all on any viral infections, and we have seen many children on antibiotics for a bacterial infection actually develop a viral infection, while on the antibiotic.
For the common cold and all stomach flus, medical science has not yet developed any drug or medicine that could kill or control that virus.
For influenza infections, there is Tamiflu, but this drug is very limited in its ability to help.  It has no impact on the course of the illness if taken 48 hours or more after it starts.  Further, in children, the impact on the course of a case of influenza virus infection is rather small, even if started at the start of the infection.
When it comes to nearly all viruses, antibiotics are ineffective, really very useless.

Parasites and fungi
Parasites are worms and small cellular creatures that cause infections.  This category is an unusual source of serious infection.  The yeast that babies in diapers get is a fungus, as is ringworm, but aside from occassional growths on the skin, fungi and parasites are very unusual sources of infection in American children.
As with bacteria, parasites and fungi can have chemistries that are different than ours, so again there are usually varieties of antibiotics that can kill them and are very useful.

Hazards of antibiotic use
One of the glories of antibiotics is that they do not kill human cells, even though they can kill vast swarms of bacteria completely.

But three hazards of use still exist:

1.  Allergic reaction.  Anyone can develop an allergy to any antibiotic anytime.  Sometimes these reactions can be quite severe, even dangerous.  So no one should take an antibiotic unless it is clear it will help and clearly needed.

2.  Disruption of "good" bacteria.  It turns out that 99%+ of all bacteria are actually helpful, even necessary, for our health and well-being.   It even turns out that for every one of us, we walk around with 10 times as many bacterial cells in and on us as there are human cells.  Antibiotics make no distinction between good and bad bacteria.  Thankfully they kill the bad ones, but unfortunately, they wipe out the good ones, especially in our gut, too.  So no one should take an antibiotic unless it is clear it will help and clearly needed.

3.  Resistance.   All bacteria are smart, so if they see a drug a bunch of times, they will figure out a way to resist being killed by that drug.   Only one bacteria, so far, has failed to find a way from being killed by an antibiotic:  every strep germ we know of is killed by penicillin, even after 70 years of being exposed to penicillin.  But in all other instances, bacteria have evolved to find the once deadly antibiotic harmless to them.  This almost never happens during a 10 day course of one antibiotic in a person.  It usually takes millions of doses across millions of people for the emergence of one resistant bacteria that then survives and spreads.   But the point is that if every doctor prescribes antibiotics for illnesses, such as colds, for which they do not good, then we do have a situation in which hundreds of millions of dosages are given that do go on to breed resistant strains.  This matters because once a strain of bacteria evolves that is resistant to an antibiotic, that antibiotic is then rendered useless against that bacteria.  Over time, even proper use of antibiotic will lead to all bacteria being resistant to all antibiotics, but overuse makes that process go a lot faster.


1.  There is no magic to the word antibiotic, these are simply the category of all drugs that kill germs.
2.  For the most common infections of childhood, such as colds, no antibiotic has any effect.  For two reasons, then, antibiotics should not be used for colds:  they do not work at all, and use of them greatly accelerates the emergence of deadly resistant bacteria.
3.  For bacterial illnesses that require treatment, there are antibiotics that will work, that will cure the infection.  The main risk from use of these drugs are allergic reactions and disruption of the natural and beneficial bacteria in our bodies.  
4.  The disruption caused by use of antibiotics can have unexpected effects, many of which are not understood.  The use of probiotics has been proven to help reduce this disruption and keep our useful bacteria in good balance.

Dr. Arthur Lavin

*Disclaimer* The comments contained in this electronic source of information do not constitute and are not designed to imply that they constitute any form of individual medical advice. The information provided is purely for informational purposes only and not relevant to any person's particular medical condition or situation. If you have any medical concerns about yourself or your family please contact your physician immediately. In order to provide our patients the best uninfluenced information that science has to offer,we do not accept samples of drugs, advertising tchotchkes, money, food, or any item from outside vendors.

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