Antibiotics differ from other medications in a less considered way. Most medications alter our physiologic responses; antibiotics act on populations of bacteria that live in or infect us. They can kill susceptible bacteria while leaving more resistant ones behind. That means antibiotic use can affect both the person taking the drug and the bacterial populations that future antibiotics will have to confront. The battle between bacteria and future antibiotic treatment raises concerns about fostering antimicrobial resistance (AMR).
The WHO estimates that AMR is directly responsible for over 1 million deaths annually and contributes to 5 million more. Closer to home, a 2019 CDC report attributed 2.8 million antibiotic-resistant infections and 35,000 deaths to AMR. With roughly 1 in 6 culture pathogens showing resistance to first-line antibiotics, we increasingly need more expensive and more toxic second-line antibiotics. In short, AMR and our use of antibiotics is a public health issue.
If antibiotic resistance makes unnecessary treatment consequential, the next question is why so many of us still reach for antibiotics when they may not help.
Where Antibiotic Myths Come From
To consider some common myths, we should turn to today’s Homeric teller of tales: social media. Studies have suggested several pillars.
False Information often begins with difficulty distinguishing viral from bacterial illness. Not every sore throat is strep, for example, and the color of mucus alone cannot reliably tell you whether an infection is bacterial. Antibiotics do not affect viral infections; antivirals do. The confusion has historical roots: when confirming a bacterial diagnosis could take days, physicians sometimes had good reason to prescribe empirically, before test results were available. Those habits can persist. While today we have essentially instant on-site strep testing, some physicians, faced with a demanding patient, still offer a swag-bag prescription to make up for the long wait to be seen and the not-so-certain diagnosis.
Do-it-yourself prescribing creates another problem. People sometimes save leftover antibiotics for a “rainy day,” take them when similar symptoms return, or give them to a family member or friend who seems to have the same illness. But similar symptoms can have very different causes, and the right antibiotic—if one is needed at all—depends on the infection. Saving, sharing, and reusing antibiotics therefore turn a prescription drug into an improvised diagnosis.
Misunderstood biology supplies a third source of confusion. Antibiotics can seem harmless enough to justify a “might as well try” approach. But each exposure can favor bacteria that can survive that drug (a process known as selective pressure). At the same time, social media gists about AMR have created a different misconception: that repeated antibiotic use makes our bodies resistant to antibiotics. It doesn't. The bacteria become resistant, making infections caused by them harder to treat.
A Fourth Myth
“If I miss doses or don't finish every pill, I will create a superbug.”
That familiar warning contains a more complicated truth than many of us were taught. Missing doses can compromise treatment, and patients should not simply decide on their own to stop an antibiotic when they feel better. But the old blanket rule, that failing to take every last pill necessarily breeds resistant “superbugs,” does not accurately describe how resistance develops.
A recent “brief report” from the Infectious Diseases Society of America sheds light on myths that begin life as science, but are no longer tenable in light of scientific progress. The scientific method is overtaking our ability to “get the word out.”
In a survey of roughly 1,500 US adults, people were asked about the role of antibiotics in treating a respiratory infection.
- 60% preferred a seven-day or longer course of treatment, finding it safer and more effective
- 88+% “always finished a prescribed course” even after symptoms had resolved, largely because they had previously received that exact instruction from a medical professional.
The instruction to finish every antibiotic course has deep historical roots. Early experience with penicillin showed that treatment that was too short could fail, allowing infections to relapse. From those observations emerged an understandable preference for longer courses and a durable message to patients: finish the prescription. What made sense as a precaution in an earlier era, however, gradually hardened into a general rule.
The problem was not that the original advice was foolish; it was that a sensible precaution became harder to change than the evidence behind it.
Subsequently, over 120 randomized controlled trials have shown that shorter durations (3–5 days) are as effective, safer, and no more likely to foster resistance for common bacterial infections. As the facts change, so does the science. However, getting the word out to physicians and then to patients is a completely different task, and it creates a lag. Some of today’s myths about antibiotics, retold on social media, originated in physicians' offices.
When Good Advice Outlives the Evidence
The lesson is that antibiotic misinformation cannot simply be divided into science and nonsense. Some of it is nonsense, some reflects an intuitive but mistaken understanding of biology, and some is yesterday’s medical wisdom lingering beyond its expiration date. That last category may be the hardest to dislodge: “finish every pill” became a powerful public-health message precisely because physicians taught it successfully for decades, even as newer evidence showed that shorter courses are often equally effective and safer. Science can change its mind when the evidence changes; getting physicians, patients, and social media to change theirs takes considerably longer.
Source: US Adults’ Perspectives on Antibiotic Durations and Adherence to Therapy for Common Bacterial Respiratory Infections: A National Survey IDSA DOI: 10.1093/ofid/ofag407
Chuck Dinerstein, MD, MBA
Director of Medicine
Dr. Charles Dinerstein, M.D., MBA, FACS is Director of Medicine at the American Council on Science and Health. He has over 25 years of experience as a vascular surgeon.
