Medicine that still works · 12 minutes
More than a million deaths a year are already caused by infections that no longer respond to the drugs that used to cure them — more than malaria or HIV. Not in some distant future: now, in ordinary hospitals, to ordinary people. And the thing driving it fastest is not exotic. It's antibiotics taken for illnesses they were never going to help.
The single most common misunderstanding: people believe their body becomes resistant to antibiotics, like a tolerance to caffeine. It doesn't. The bacteria become resistant — and bacteria travel. They move between people, through hospitals, on hands and food and doorknobs, across borders. The resistance your unnecessary course helped breed may never affect you at all. It may affect a child in a cancer ward two years from now.
The mechanism is plain evolution. Any large bacterial population contains a few individuals that happen to survive a given antibiotic. Kill the susceptible ones and you have not just cured an infection — you have cleared the field for the survivors, who now multiply without competition. Do that when there was no infection worth treating, and you paid the evolutionary price for nothing.
What makes this different from other environmental problems is what it takes down with it. Working antibiotics are the floor under all of modern medicine: surgery, childbirth, chemotherapy, transplants, intensive care, a scraped knee that gets infected. Very few genuinely new classes have reached patients in decades. We are spending an inheritance and barely earning any.
A simplified petri dish. Indigo colonies are killed by the standard antibiotic; lime colonies survive it. Give a course when it isn't needed and you clear space for the survivors. Let a viral illness run its course and susceptible bacteria drift back.
A teaching model, not a prediction — real resistance depends on the bug, the drug and the setting. The direction, though, is exactly this: pressure selects, and relief lets susceptibility recover.
"It's dragging on, so antibiotics will speed it up."
Not for a virus. Colds, flu, COVID and most coughs, sore throats and sinus infections are viral — antibiotics do literally nothing to them. A cough after a cold commonly lasts two to three weeks. The antibiotic doesn't shorten it; it just adds side effects and resistance.
"Green or yellow mucus means it's bacterial."
It doesn't. The colour comes from your own immune cells, and it appears in ordinary viral colds. It's one of the most persistent myths in medicine, and it has generated millions of pointless prescriptions.
"My body has become resistant to antibiotics."
Bacteria become resistant, not people. And they don't stay put: resistant bacteria spread between people and countries. This is why your prescribing habits are a public matter, not only a private one.
"The strong, broad-spectrum one is the better one."
Usually the opposite. A narrow antibiotic that matches the bug does the job with less collateral damage. Broad-spectrum drugs wipe out much of your gut flora — inviting C. difficile and worse — and breed resistance across many species at once. "Reserve" antibiotics exist to stay in reserve.
"I'll keep the leftovers for next time."
There should be no leftovers. A saved half-course is the wrong drug, at the wrong dose, for the wrong length, chosen without a diagnosis — a near-perfect recipe for resistance and for masking something serious. Take unused antibiotics back to the pharmacy.
"If it ever gets serious, they'll have something for me."
That promise is quietly expiring. Almost no new antibiotic classes have reached patients in decades — it's scientifically hard and commercially unattractive, since a good new antibiotic must be used as little as possible. There is no pipeline waiting to bail us out.
Fear of resistance must never delay treatment that's genuinely needed. Bacterial infections can kill in hours, and hesitation is as dangerous as overuse. Antibiotics are urgent and right for conditions like sepsis, meningitis, bacterial pneumonia, kidney infections and infected wounds — and in sepsis, every hour of delay measurably raises the risk of death.
Say the word "sepsis" out loud when you call or arrive. It changes how fast you are seen.
The goal is not fewer antibiotics at any cost. It's the right antibiotic, for the right infection, at the right moment, for no longer than needed — which requires exactly one thing from you: asking rather than assuming, in both directions.
Resistance is the collective cost, and collective costs rarely change anyone's Tuesday. So here is the private one: an antibiotic you didn't need is not a neutral event for your own body.
Antibiotics can't aim. A course clears out much of the bacterial population you depend on for digestion and immune signalling, and recovery can take weeks to months. In that window you're more vulnerable, not less — most visibly to Clostridioides difficile, an opportunist that moves into the cleared space and causes severe, sometimes dangerous diarrhoea. It is largely a disease of antibiotic use.
Roughly one course in five brings side effects, from nausea and diarrhoea to rashes, thrush and — with certain classes — tendon and nerve problems that regulators now warn about explicitly. Allergic reactions land people in emergency departments. None of that is a reason to refuse a needed antibiotic; all of it is a reason not to take an unneeded one.
One thing to watch for after any course: diarrhoea that is severe, watery, bloody, or comes with fever and cramping — during treatment or in the weeks after — deserves a call to your doctor rather than an anti-diarrhoeal from the shelf. Say that you have recently taken antibiotics; it changes what they look for.
Small children get a lot of infections — that's normal immune development, not a failure of care. They are also where unnecessary prescribing concentrates, because a feverish child, an exhausted parent and a waiting room at 6pm is the hardest place in medicine to say "let's wait".
A useful sentence to bring into the consultation: "I'm not here for antibiotics — I'm here to know whether he needs them, and what to watch for tonight." It removes the pressure the doctor was braced for, and it usually gets you a far more detailed answer.
Doctors prescribe unnecessary antibiotics for a very human reason: they read the patient as wanting them, and disappointing a worried parent at the end of a long clinic is hard. You can dissolve that pressure in one sentence — and get better care while you're at it.
Do you think this is bacterial or viral?— signals that you want an assessment, not a prescription.
What should improve, and by when? When should I come back?— the single most useful question in medicine. A named timeline turns anxious waiting into a plan.
If antibiotics can wait, could we use a delayed prescription?— you leave with a script to fill only if things worsen. It's an evidence-based standard practice and it cuts use sharply.
If I do need them: is this the narrowest choice, and the shortest effective course?— for many infections, short courses now work as well as long ones. Your prescriber decides the length; your asking makes the shorter option easy to offer.
What side effects should make me call you?— antibiotics are real drugs with real harms; knowing the warning signs is part of taking them properly.
Most antibiotics worldwide are given not to people but to farmed animals, often to healthy ones. Resistance bred there does not stay there. This is a policy problem — which means the useful individual response isn't guilt at the supermarket; it's supporting rules that restrict routine farm use, and the countries that have done it show it works without collapsing farming.
Every infection prevented is an antibiotic never needed. Vaccines (flu, pneumococcal, COVID, childhood schedule), hand-washing, clean wound care and staying home while contagious all cut antibiotic use measurably. Vaccination is antibiotic policy that happens to come in a syringe.
Europe shows how much room there is: prescribing per person differs several-fold between countries with equally good health outcomes. The Netherlands prescribes among the least in Europe and its patients do not fare worse — Dutch GPs are famous for "let's wait and see". Romania and several neighbours sit at the other end, with correspondingly high resistance. Nothing biological explains that gap. It's habit, expectation, and how easily a pill can be obtained — all of which are changeable, which is the good news buried in the bad.
Fourteen ordinary moments — a feverish child, a leftover blister pack, a pharmacy counter. Some call for holding back; some call for hurrying. Pick what you'd do; every answer explains why.
Print it and tape it inside the cabinet door, where the decisions actually get made.
Never: leftovers, someone else's pills, or antibiotics without a diagnosis. Return unused ones to the pharmacy.
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