Duration Health

Infection

Introduction

Minor infections will often go away on their own without antibiotics. When the body isn't able to clear an infection on its own, or if a serious bacterial infection is suspected, antibiotics are sometimes used to treat the infection. There are also some viral infections like influenza that are treated with antiviral agents.

The choice of whether to use an antibiotic, and which antibiotic to use, is complex, and you should always seek the advice of a physician before initiating an antibiotic. Antibiotics treat only bacterial infections, but many infections are caused by viruses, not bacteria.

Each antibiotic is effective against certain groups of bacteria, but often it is not known which bacteria are responsible for a given infection. Practitioners will therefore often choose an antibiotic based on the part of the body in which the infection occurs, since certain classes of bacteria are most often responsible for infections in a particular organ system.

Do not take multiple antibiotics at once. A better strategy is to choose one antibiotic, take a full course, and contact a physician to discuss next steps if symptoms have not resolved after the full course is completed. There are cases where a physician may recommend that certain antibiotics be taken together, as a pair, for specific types of infections.

Infections that occur with fever, a change in someone’s behavior, lethargy, weakness, decreased urination, or rapid or shallow breathing, may indicate sepsis and are always a medical emergency. Seek help immediately.

If most infections are viral, why do I get better when I take an antibiotic when I'm sick?

Antibiotics are drugs specifically design to kill bacteria. Each class of antibiotics kills bacteria by interfering with a particular component of the bacterial cell that the bacteria needs to survive. Viruses don't have these components, so they simply aren't affected by antibiotics.

It's not uncommon, however, for people to report that they feel better after taking an antibiotic during a viral infection. Why?

One explanation is the placebo effect, a well-known and extensively studied phenomenon whereby people feel better after taking a pill, no matter what the pill contains. This effect is so strong that when new drugs are developed, they are compared to a pill containing an inactive ingredient, because test subjects will report or experience an effect just by taking a pill, whether the new drug is working or not.

Another explanation is that during the time a patient is taking an antibiotic, the body is fighting the viral infection on its own. By the time the antibiotic is finished, the body has cleared the infection, and the person feels better. But this would have happened without the antibiotic.

Yet another explanation is that some antibiotics have anti-inflammatory effects on the body as a whole, as a side effect of the antibiotic. This reduction in inflammation makes a person feel better, but it's not because the antibiotic is treating the infection. A regular anti-inflammatory drug, such as ibuprofen, may have the same effect without the potential side effects of the antibiotic.

If an antibiotic might help, why not just try it?

The decision to give an antibiotic is a balancing act between the antibiotic's benefits (potentially treating a bacterial infection) and risks (side effects). These side effects can be serious. While you may have never personally experienced side effects from an antibiotic, experienced practitioners know that these side effects are in fact very common.

Side effects from antibiotics include diarrhea (the most common), allergic reaction (ranging from mild rash to life-threatening anaphylaxis), and, paradoxically, infection with a different microorganism. Because antibiotics are designed to kill bacteria, they also kill "good" bacteria in the body. (See: Human Microbiome) The loss of "good" bacteria gives "bad" bacteria (and fungi) an opportunity to grow and make you sick. A number of antibiotics also may have harmful drug interactions with commonly used medications that a person may already be taking for other conditions.

The bottom line is that the decision to start an antibiotic is synonymous with deciding that the benefits outweigh the risks. If the benefits are in doubt, it would be unwise to assume the risks.

Reference

Ciprofloxacin (generic for Cipro) is a fluoroquinolone antibiotic. It can be used to treat infections in the abdomen. Consider ciprofloxacin for diarrhea with blood or mucous. Ciprofloxacin can be taken with ondansetron, if nausea and/or vomiting accompany abdominal pain or diarrhea. Do not take ciprofloxacin with dairy products such as milk or yogurt, or with calcium-fortified juice. Ciprofloxacin is also used to treat other infections, for example, skin infections, sinus infections, urinary tract infections, and infections with some bioterrorism agents including anthrax.

InfectionMedication

Urine test strips are an amazing and inexpensive diagnostic tool. They can be used to detect urinary tract infections, dehydration, diabetes, and blood in the urine. A urine test showing positive leukocytes or nitrites may indicate a urinary tract infection. A high specific gravity or ketones in the urine may indicate dehyration. Glucose in the urine is a sign of uncontrolled diabetes.

GeneralDisposable

Ofloxacin is an antibiotic. Ofloxacin drops can be used to treat eye or ear infections.

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Praziquantel is used to treat flatworm infections like schistosomiasis. This medication should be taken with food.

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Emtricitabine is used in combination with other medications for HIV post-exposure prophylaxis. The decision to start post-exposure prophylaxis after a possible exposure to HIV is complex, and the standard of care is to initiate post-exposure prophylaxis medication only after laboratory testing. Seeking immediate medical attention is the best option. However, in an emergency or disaster situation in which medical care is unavailable, take this medication, along with tenofovir and raltegravir, as soon as possible (and within 72 hours) to prevent infection if you believe you have suffered a major exposure to HIV. Immediately seek qualified medical care.

InfectionMedication

Tenofovir is used for HIV post-exposure prophylaxis. The decision to start post-exposure prophylaxis after a possible exposure to HIV is complex, and the standard of care is to initiate post-exposure prophylaxis medication only after laboratory testing. Seeking immediate medical attention is the best option. However, in an emergency or disaster situation in which medical care is unavailable, take this medication, along with emtricitabine and raltegravir, as soon as possible (and within 72 hours) to prevent infection if you believe you have suffered a major exposure to HIV. Immediately seek qualified medical care.

InfectionMedication

Raltegravir (generic for Isentress) is used for HIV post-exposure prophylaxis. The decision to start post-exposure prophylaxis after a possible exposure to HIV is complex, and the standard of care is to initiate post-exposure prophylaxis medication only after laboratory testing. Seeking immediate medical attention is the best option. However, in an emergency or disaster situation in which medical care is unavailable, take this medication, along with emtricitabine/tenofovir, as soon as possible (and within 72 hours) to prevent infection if you believe you have suffered a major exposure to HIV. Immediately seek qualified medical care.

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Oseltamivir (generic for Tamiflu) treats influenza.

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Doxycycline is an antibiotic. Doxycycline can be used to treat Lyme disease, Yersinia (bubonic plague), Tularemia, and other infections. This medication should be taken with food.

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Atovaquone-proguanil (generic for Malarone) is used for malaria prophylaxis in areas with chloroquine-resistant Plasmodium falciparum, and can be used in most parts of the world where malaria occurs. Take it daily for 1-2 days before possible exposure to malaria, and continue daily for 7 days after leaving an exposed area. If you plan to travel to malaria-endemic areas, discuss with your Duration Health provider to determine which prophylaxis is appropriate for you.

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Trimethoprim-sulfamethoxazole (TMP-SMX, generic for Bactrim) is an antibiotic. It can be used to treat urinary tract infections and skin infections.

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Metronidazole (generic for Flagyl) is an antiprotozoal and antibiotic, which means it fights bacteria as well as other organisms that cause disease. Metronidazole can be used to treat infections in the abdomen.

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Ivermectin is used to treat parasite infections like head lice and scabies. This medication should be taken on an empty stomach.

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Azithromycin is an antibiotic. Azithromycin can be used to treat respiratory infections like pneumonia, abdominal infections, ear infections, throat infections, and other infections. It is often used in place of penicillin drugs in people with a penicillin allergy. It has a longer duration of action than other antibiotics, so it is usually given for a shorter course of therapy.

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Mupirocin (generic for Bactroban) is an antibiotic ointment. Mupirocin can be used to treat a localized skin infection, including infections caused by methicillin-resistant S. aureus bacteria (MRSA).

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Albendazole is used to treat tapeworm infections. This medication should be taken with food.

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Nitrofurantoin (generic for Macrobid) is an antibiotic used specifically to treat urinary tract infections.

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Amoxicillin-clavulanate (generic for Augmentin) is an antibiotic. It can be used to treat skin infections like bite wounds, ear infections, sinus infections, tooth infections, and other infections. This medication should be taken with food.

InfectionMedication

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