Antibiotics as Weapons of Mass Destruction

Antibiotics are not benign.
Adverse effects from antibiotics occurred 20% of the time in hospitalized patients in this retrospective chart review of almost 1500 patients.  Most were GI, renal, or hematologic.  Each 10-day course of additional antibiotics was associated adverse drug events in 3%.  Adverse events were adjudicated by two infectious disease specialists as to whether the antibiotic was the likely cause, and the study may have overestimated the adverse effects of antibiotics.  For example, GI adverse effects were "diarrhea" mentioned in chart review or "nausea or vomiting" not known to be from another cause.  However, serious complications within 90 days included C. difficile colitis in 4% and development of confirmed multi-drug resistant bacterial infection in 6%.  Authors deemed 20% of the antibiotic courses to be unnecessary (such as treatment of asymptomatic bacteriuria).  The prospect of adverse effects from antibiotics must factor into the equation every time we order them.  Yes, they save lives in some cases, but the complication rate is not trivial.

Spoon Feed
Adverse effects from antibiotics are very common, up to 20% of the time in hospitalized patients.  Only use them when needed.

Source
Association of Adverse Events With Antibiotic Use in Hospitalized Patients.  JAMA Intern Med. 2017 Jun 12. doi: 10.1001/jamainternmed.2017.1938. [Epub ahead of print]

Peer reviewed by Thomas Davis.