Using antibiotics correctly and preventing resistance

Photo of antibiotics
PantherMedia / ALESSIO FURLAN

The development of was one of the greatest discoveries in modern medicine. They fight and can cure life-threatening infectious diseases such as , for which there was previously no effective treatment. But the widespread and improper use of means that more and more are becoming resistant to this kind of medication. So it is especially important to use them correctly.

Antibiotics can save lives, relieve the symptoms of bacterial infections and help us to recover faster. But treatment with also has side effects. Nausea or diarrhea are common, for example.

Antibiotics are also used far too often, and improper use is fairly widespread. This has caused many different types of bacteria to become resistant (unresponsive) to . Because has become more common, many diseases can no longer be treated as well as they could in the past.

When using , it's important to know the following things to prevent and side effects:

  • Antibiotics only fight . Many infections are caused by viruses and can't be treated using – examples include respiratory illnesses such as a cough, stuffy nose, bronchitis or the flu.
  • Excessive and improper use of causes side effects, and in the long term reduces their effectiveness.

What is antibiotic resistance?

In medicine, and other germs are said to be resistant if they aren't affected by things that would usually be expected to harm them. An example: Most germs that enter the stomach with food will be killed by stomach (gastric) acid. But some are covered with a mucous coating that protects them from the acid. They are resistant to gastric acid.

Resistance to works in a similar way: The have acquired a new property that protects them from the antibiotic. Some types of can produce a substance that makes certain ineffective, for example. Bacteria that can protect themselves from several different are referred to as "multidrug-resistant."

What causes resistance?

Many of the that are now resistant used to be killed by . The medications could originally "disarm" certain types of and then effectively stop the . But the genetic material of can change by chance over time, sometimes creating new properties. For instance, a certain type of may develop properties that protect it against . Those are then resistant to those . These kinds of properties can also be transferred from one type of to another.

If are used very often, resistant are better able to reproduce because the other non-resistant strains of are stopped. Then the no longer help to fight infections caused by the resistant .

Which bacteria are resistant and why are they dangerous?

Antibiotic-resistant are often a type known as Streptococcus and Staphylococcus . One example is called “methicillin-resistant Staphylococcus aureus” (MRSA). Staphylococcus can be found on skin and mucous membranes and may cause – for example if they get into open wounds.

Resistant strains have now developed in other types of , such as Escherichia coli, Klebsiella and Pseudomonas .

What is being done about antibiotic resistance?

In Germany, are prescription-only. This means that doctors are first and foremost responsible for careful and appropriate use. They should first see whether someone actually has a bacterial . If they do, then it's important that the antibiotic is prescribed at the right dose and for long enough, and that the right antibiotic is selected that will most effectively fight the .

There are also hygiene regulations to keep resistant from spreading further and to stop preventable infections from occurring. These measures are especially important in hospitals. Antibiotics are used there quite frequently, so resistant germs can quickly develop. To protect yourself from these germs and prevent them from spreading, you can wear disposable gloves, a medical mask that covers your nose and mouth, and a gown. Using hand sanitizers also helps. This is especially important if you come into contact with someone who is infected with resistant .

Vets and farmers use too. So vets also have to comply with the rules for handling sensibly.

What can I do to prevent antibiotic resistance?

Being cautious about taking can help prevent both antibiotic and side effects.

The most important thing is to not overestimate what can do: Patients often expect to be prescribed even though won't help to treat their medical problem.

Antibiotics are needed to treat serious bacterial infections like lung infections or meningitis ( of the membranes lining the brain and spinal cord). This is not the case when, for example, people who are otherwise healthy have respiratory infections caused by viruses, such as a cold or influenza (“the flu”). Antibiotics will usually be of no help here because they only fight . Antibiotics also have side effects such as allergic reactions, stomach and bowel problems, nausea and fungal infections. Because of these associated risks, it's important to carefully consider the advantages and disadvantages of taking .

What's important to consider when taking antibiotics?

Antibiotics should be taken for as long as the doctor has prescribed them. Just because the symptoms of the illness go away, it doesn't mean that all of the germs have been killed. Remaining may cause the illness to start up again.

If some tablets are left over, they shouldn't be kept for later use or given to other people. Leftover medication can be thrown away in the normal waste bin or dropped off at some pharmacies. Pharmacies don't have to accept opened medicine, though. It is important not to get rid of medication by pouring it down the drain or flushing it down the toilet. That's bad for the environment and also increases the likelihood that will become resistant.

Medications can only work properly if they are used correctly. It is important to know the following things when taking :

  • Can the tablets be broken into smaller pieces to make them easier to swallow? That depends on the specific medication. Doing this might stop some from working properly.
  • What food can you take with? Antibiotics are usually taken with water because taking them together with fruit juices, dairy products or alcohol can affect how the body absorbs some of them. Dairy products include milk, butter, yogurt, and cheese. After taking an antibiotic you may need to wait for up to three hours before eating or drinking any dairy products. Grapefruit juice and dietary supplements containing minerals like may also lessen the effect of .
  • When should you take ? Some are always meant to be taken at the same time of day, others are meant to be taken before, with or after a meal. If you're supposed to take the medicine three times a day, for example, it usually needs to be taken at set times so that the effect is spread out evenly over the course of the day. An antibiotic that needs to be taken every 8 hours could be taken at 6 a.m., 2 p.m. and 10 p.m.
  • Can you take together with other medications? Because can interact with other medications, it's important to tell your doctor if you take other medications too. Antibiotics might interact with some blood thinners and antacids (heartburn medicine), for example. Some can make birth control pills less effective.

You can find detailed information on how to use a specific antibiotic in the package insert. If you're not sure how to take it properly, you can ask your doctor or pharmacist.

Bundesministerium für Gesundheit (BMG), Bundesministerium für Ernährung und Landwirtschaft (BMEL), Bundesministerium für Bildung und Forschung (BMBF). DART 2020. Zwischenbericht anlässlich der WHA 2016. 2016.

Centers for Disease Control and Prevention (CDC). Antibiotic / Antimicrobial Resistance (AR / AMR). 2020.

Deutsche Gesellschaft für Infektiologie (DGI). S3-Leitlinie: Strategien zur Sicherung rationaler Antibiotika-Anwendung im Krankenhaus - Update 2018. AWMF-Register-Nr.: 092-001. 2019.

Kayser FH, Böttger EC, Deplazes P et al. Taschenlehrbuch Medizinische Mikrobiologie. Stuttgart: Thieme; 2014.

World Health Organization (WHO). Antimicrobial resistance. 2020.

IQWiG health information is written with the aim of helping people understand the advantages and disadvantages of the main treatment options and health care services.

Because IQWiG is a German institute, some of the information provided here is specific to the German health care system. The suitability of any of the described options in an individual case can be determined by talking to a doctor. informedhealth.org can provide support for talks with doctors and other medical professionals, but cannot replace them. We do not offer individual consultations.

Our information is based on the results of good-quality studies. It is written by a team of health care professionals, scientists and editors, and reviewed by external experts. You can find a detailed description of how our health information is produced and updated in our methods.

Comment on this page

What would you like to share with us?

We welcome any feedback and ideas. We will review, but not publish, your ratings and comments. Your information will of course be treated confidentially. Fields marked with an asterisk (*) are required fields.

Please note that we do not provide individual advice on matters of health. You can read about where to find help and support in Germany in our information “How can I find self-help groups and information centers?

Updated on August 24, 2021
Next planned update: 2024

Authors/Publishers:

Institute for Quality and Efficiency in Health Care (IQWiG, Germany)

How we keep you informed

Follow us on Twitter or subscribe to our newsletter or newsfeed. You can find all of our films online on YouTube.