Antibiotics are powerful medicines that have transformed modern healthcare by helping treat many bacterial infections. They can be lifesaving when used appropriately, but their effectiveness is threatened by antibiotic resistance. Resistance occurs when bacteria develop the ability to survive medicines that were previously effective against them. Antibiotic resistance is a growing public health concern in the United States and worldwide.

Understanding how resistance develops and learning how to use antibiotics responsibly can help protect both individual health and the effectiveness of these important medicines.

What is antibiotic resistance?

Antibiotic resistance occurs when bacteria change in ways that allow them to survive an antibiotic that would normally kill them or stop their growth. It is important to understand that people do not become resistant to antibiotics; bacteria become resistant to antibiotics.

Bacteria can develop resistance naturally as they evolve. However, unnecessary or inappropriate antibiotic use can accelerate this process. When antibiotics eliminate susceptible bacteria, resistant bacteria may survive and multiply. Resistant bacteria can also share resistance traits with other bacteria, allowing resistance to spread. A person infected with resistant bacteria may have fewer effective treatment options. Treatment may require a different antibiotic, additional testing, longer medical care, or hospitalization in serious cases.

Why is antibiotic resistance a public health concern?

Antibiotic resistance affects more than just the person taking an antibiotic. Resistant bacteria can spread from one person to another and through healthcare settings, communities, animals, food, and the environment.

According to the CDC’s Antibiotic Resistance Threats in the United States, 2019 report, more than 2.8 million antibiotic-resistant infections occur in the United States each year, resulting in more than 35,000 deaths. Resistance can lead to longer illnesses, increased healthcare costs, longer hospital stays, and a greater risk of complications. It can also make some routine medical care more challenging. Effective antibiotics are important for patients undergoing certain surgeries, organ transplantation, cancer treatments, and other procedures where bacterial infections can create serious complications.

The World Health Organization (WHO) considers antimicrobial resistance a major global health threat. Misuse and overuse of antimicrobial medicines are among the factors that contribute to resistance.

How does antibiotic resistance develop?

Resistance can develop whenever bacteria are exposed to antibiotics, but inappropriate use can increase the pressure that favors the emergence of resistant strains. Several factors can contribute to antibiotic resistance, including:

• Taking antibiotics when they are not medically necessary
• Using an antibiotic that is not appropriate for the infection
• Taking antibiotics incorrectly
• Using leftover or someone else’s antibiotics
• Poor infection prevention and hygiene
• The spread of resistant bacteria in healthcare and community settings
• Inappropriate antimicrobial use in animals and agriculture

Antibiotic resistance is therefore not caused by a single person or behavior. It is a complex problem that involves human and animal health, healthcare, agriculture, and the environment.

Antibiotics do not treat viral infections

One of the easiest ways to reduce unnecessary antibiotic use is to understand that antibiotics work against bacteria, not viruses. Many common illnesses, including colds and influenza (the flu), are caused by viruses. Antibiotics do not kill viruses and will not make a viral infection go away faster.

Symptoms such as coughing, fever, sore throat, congestion, and tiredness do not necessarily indicate a bacterial infection. Some bacterial and viral infections can cause similar symptoms, so a healthcare professional may need to evaluate the illness and, when appropriate, perform diagnostic testing. Taking an antibiotic “just in case” can expose you to side effects without providing a benefit and may contribute to antibiotic resistance.

Are antibiotic-resistant infections treatable?

Yes. Antibiotic resistance does not mean that an infection is always untreatable.

Healthcare professionals can use laboratory testing, including bacterial cultures and susceptibility testing when appropriate, to determine which antibiotics may be effective. Depending on the infection, a doctor may prescribe a different antibiotic or use another treatment approach. However, treatment can become more complicated when bacteria are resistant to several antibiotics. Some resistant infections require more intensive medical care, which is why preventing resistance is so important.

Researchers are also working to develop new antibiotics, diagnostic tools, vaccines, and other treatments. However, new medicines alone cannot solve antibiotic resistance. Protecting the effectiveness of existing antibiotics is equally important.

Who can be affected by resistant infections?

Anyone can develop an infection caused by antibiotic-resistant bacteria. However, some people have a greater risk of serious complications from infections, including certain hospitalized patients, older adults, people with weakened immune systems, and people with particular underlying medical conditions. People undergoing major surgery or immune-suppressing treatments may also be more vulnerable to serious infections.

Healthy people are not completely protected. Resistant bacteria can spread through communities and healthcare facilities, potentially infecting anyone.

How to prevent antibiotic resistance?

Everyone has a role to play in reducing antibiotic resistance. Simple, responsible actions can help preserve the effectiveness of these medicines.

1. Use antibiotics only when needed

Do not take antibiotics simply because you have a cold, cough, fever, or other symptoms. Ask your healthcare professional whether your illness is bacterial and whether an antibiotic is appropriate. If your doctor says you do not need an antibiotic, do not pressure them to prescribe one. Avoiding unnecessary antibiotics is an important way to prevent resistance.

2. Take antibiotics exactly as prescribed

When an antibiotic is prescribed, follow your healthcare professional’s directions carefully. Take the recommended dose and follow the prescribed schedule. Do not change the dose, extend treatment, or stop treatment on your own. If you experience side effects or have concerns about the medicine, contact your doctor or pharmacist for advice.

3. Never share antibiotics

Do not give your antibiotics to another person, even if they have symptoms similar to yours. The correct antibiotic depends on the type of infection, the bacteria involved, allergies, medical history, and other factors. A medicine that worked for you previously may not be appropriate for someone else.

4. Do not save leftover antibiotics

Never save leftover antibiotics for a future illness. A future infection may have a different cause and may require a different treatment. Using an old prescription without medical advice can delay appropriate treatment and expose you to unnecessary side effects.

5. Prevent infections

Preventing infections reduces the need for antibiotics in the first place. Helpful measures include:

• Washing your hands regularly
• Keeping cuts and wounds clean and covered
• Practicing good respiratory hygiene
• Following appropriate food-safety practices
• Staying home when medically advised while sick
• Keeping up with recommended vaccinations

Vaccination can help prevent certain infections and reduce the need for antibiotic treatment.

What is antibiotic stewardship?

Antibiotic stewardship means using antibiotics responsibly and appropriately. Healthcare professionals consider whether an antibiotic is necessary, which antibiotic is most suitable, and the appropriate dose and duration. The goal is not to prevent patients from receiving antibiotics when they genuinely need them. Instead, stewardship aims to ensure that antibiotics are used effectively while minimizing unnecessary exposure. Patients contribute to antibiotic stewardship by taking medicines only as prescribed, asking questions about their treatment, and avoiding self-medication.

Why should you avoid self-medicating with antibiotics?

Using antibiotics without appropriate medical guidance can be risky. The illness may be viral rather than bacterial, or the bacteria may not respond to the selected antibiotic. Antibiotics can also cause side effects, including nausea, diarrhoea, allergic reactions, and other medication-specific side effects. They may interact with other medicines or supplements.

For these reasons, antibiotics should not be treated as general remedies for infections. A healthcare professional should determine whether they are appropriate.

The future of antibiotic treatment

Antibiotics remain essential, but their effectiveness cannot be taken for granted. As bacteria evolve and resistance increases, some medicines may become less effective against particular infections. The development of new antibiotics and other treatments is important, but preserving the medicines we already have is equally necessary. WHO highlights the need for responsible antimicrobial use, infection prevention, improved diagnosis, and continued research.

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Final thoughts

Antibiotic resistance is a serious global health challenge, but responsible antibiotic use can help slow its spread. Antibiotics should be used only when medically appropriate and in accordance with professional guidance. They should not be used for viral infections, shared with others, or saved for future illnesses. When prescribed, patients should follow their healthcare professional’s instructions and ask for advice if they experience side effects or have questions about treatment. Preventing infections through good hygiene, vaccination, food safety, and appropriate infection-control practices is also essential.

Antibiotics can save lives when used correctly. By using these medicines responsibly today, patients and healthcare professionals can help preserve effective treatments for bacterial infections in the future.