After anti-reflux medications, antibiotics are probably the most overprescribed medications in the singer’s bathroom cabinet. Antibiotics are given daily for viral infections, for allergies, and for too many cases of “we’re not sure what’s wrong with you, but try this.” All of us, both patients and physicians, turn to antibiotics almost reflexively when a patient presents with signs of inflammation. I joked once with a drug rep that whoever invented the name “Z-Pak” should be given the Nobel Prize: it is short, easy for doctors to write, easy for patients to take, and makes a lot of money for the company!
Actually Azythromycin, a.k.a. Z-Pak, is a good drug. Antibiotics, as a class, are potentially life-saving medications, and the outcome of many illnesses is dramatically changed by their judicious use. So, antibiotics are great drugs—for the right indication. But what is the right indication?
Consider for a moment the root meaning of the word “antibiotic” (anti=against + bio=life). It suggests something that is “against living things” (in this case, bacteria). And implicit in the name is the concept that bacteria are bad, and we are engaged in chemical warfare against bacteria—a war to the end, winner takes all.
This is a simplistic way of looking at our bodies and, of course, the reality is much more nuanced. Carl Zimmer’s “Tending the Body’s Microbial Garden,” published in the New York Times last June1 offers an exciting and new perspective. It turns out that there is a world of bacteria (about 100 trillion) that cover our bodies, inside and out. The majority of this mass of bacteria (collectively called the microbiome) is useful—they make important substances, help us digest our food, and fend off harmful invaders.
This peaceful coexistence, which benefits both host and guest, reaches incredible degrees of sophistication. For example, there is a bacterium that infants need in their guts to help them to digest milk. This bacterium (lactobacillus species) develops for no apparent reason at a certain time in the vagina of the pregnant mother. The reason becomes clear during delivery. As the baby is born, some of the bacteria get into the baby’s mouth and set up shop in the baby’s gut. This allows the breast-fed infant to break down the milk he eats. If you do not find this awe-inspiring, you may have lost your capacity for wonder.
In addition to all of these good guys keeping the bad guys off the surface of the body, the body’s own immune defenses are a vast and sophisticated defense system that springs into action when one of the bad bacteria actually breaks through the surface. The immune system, in turn, is supported by good nutrition and good circulation.
In this light, the indiscriminate use of antibiotics seems like taking a chain saw to a forest. They should be used carefully and specifically. Although the body (and the microbiome) is for the most part forgiving, excessive antibiotic use will eventually be harmful: it weakens the body’s immune defenses and may kill off populations of beneficial bacteria, making you more sick and vulnerable.
When should you take antibiotics, then? Ideally these drugs should be taken when there are clear signs of bacterial infection: congestion, cough, and pain, accompanied by colored mucus, either from the nose or the chest. A red throat or tonsils also suggest bacterial infection, although not invariably. Fever and malaise are less specific indicators, since this may be caused by a virus. Chronic illnesses of the respiratory tract often have a bacterial component, even in the absence of pus in the sputum.
There are a couple of footnotes to this, however. First, some bacterial infections are minor, and your body is able to deal with them without outside help. For example, many colds (viral) progress to a secondary, bacterial infection (when your mucus turns yellow or green), and these usually clear up without antibiotics.
The other footnote pertains to the preventive use of antibiotics. I will at times give a singer a prescription to take even when the infection is viral, especially when she is stressed or otherwise vulnerable to a bacterial infection. Singers who tour are especially prone to this problem. I usually give such patients a prescription for antibiotics, with instructions to be taken if necessary. In general, I am more proactive with antibiotics if the singer’s travel and performance schedule are tight.
Finally, remember the other ways of dealing with infections. Good personal hygiene makes you less prone to illness and also makes you less infective to others. Always support your body’s immunity with good nutrition, rest, and hydration. Vitamins and foods with antibacterial effect (like garlic) may also be helpful. The best offense is a good defense. And when it comes to harmful bacteria, prevention by shoring up your defenses beats taking antibiotics for every sniffle.
1. www.nytimes.com/2012/06/19/science/studies-of-human-microbiome-yield-new-insights.html?_r=1&pagewanted=all
