Let me tell you a little cautionary tale. Once upon a time (roughly twenty years ago) a strong new antibiotic came forth uniformed in a handy little green 6 pill, 5 day pack. Emblazoned across his uniform was the catchy swashbuckling name, Z-pak. For doctors, easy to write; for patients easy to take – dosed just once a day for five days. And man could he fight! All the common thugs feared him: bacterial sinusitis and bronchitis, skin infections, middle ear infections, strep throat, and even some of the more common community-acquired pneumonias – all of them seemed to melt back into the shadows at his presence.

And so the popularity of Z-pak grew. After a couple of years patients would often ask, not just for any old antibiotic, but for Z-pak by name: “Hey I’ve had a cough and congestion for a couple days. I really can’t afford to be sick. Could you prescribe Z-pak? It always clears me right up.”

But alas as the years went by something else started happening – Z-pak started to fail in his mission. I’d get a call back that the sinus infection was weakened but not gone – could they have another round of Z-pak? Over the course of the next 5 to 10 years those failures went from rare to somewhat common to rather predictable. Increasingly, Z-pak was losing the battle with the bad guys. After repeated battles with Z-pak, the “weak” bacteria were being killed off, but the strong, resistant ones were surviving and multiplying. Soon much of the community of bacteria was resistant to the once-mighty Z-pak. In short, he had become a victim of his own popularity. And we haven’t even mentioned the whole pack of viruses over whom Z-pak never held any power.

What can we learn from this little tale? First of all Z-pak is not alone. Any antibiotic that is frequently used tends to select out more and more resistant bacteria. And so, when an effective antibiotic is really needed, sometimes it’s hard to find one that still works. Indeed there are now some super-bugs out there showing resistance to nearly every available antibiotic.

So who needs antibiotics? Legions of sufferers of serious bacterial infections do. How can we maintain the effectiveness of antibiotics so that when we need them, they still work? There are several vital steps needed:

  • Avoid treating viruses like the common cold with antibiotics. They are simply of no use at all in fighting viruses and they only add expense, side effects and resistance problems.
  • Don’t be too quick to throw an antibiotic at every ear infection, sinusitis or bronchitis. Many of these are either viral (where the antibiotic is useless) or a mild enough bacterial infection where the body can fight it off without the antibiotic.
  • When you really need an antibiotic, take all of it at full strength. Otherwise you may kill off only the weak susceptible bacteria while leaving the partially resistant ones to multiply and re-infect yourself and others.
  • Get appropriate immunizations against common infections so that your own immune system can kill infections before they really take hold, thus reducing the need for antibiotic treatments.

Who needs antibiotics? We often do, and if we can get better at calling them out to fight

for us only at the right times, they’ll be there to help us when we really need them.

Andrew Smith, MD is board-certified in Family Medicine and practices at 1503 East Lamar Alexander Parkway, Maryville. Contact him at 982-0835