When you’re feeling really ill, it’s tempting to ask your healthcare professional to prescribe an antibiotic to help you fight off whatever ails you. After all, antibiotics can help you feel better, right?

Antibiotics can knock out bacterial infections only. These days, they might not even be able to do that. This is due to the rise of drug-resistant bacteria.

“Antibiotic resistance is threatening human health in ways that we’ve never seen,” says Robin Patel, MD, director of the Infectious Diseases Research Laboratory at the Mayo Clinic. “And we know that the situation is getting worse over time.”

Antibiotics are medications designed to stop infections caused by bacteria. They work either by killing off the bacteria or preventing the bacteria from reproducing and spreading. Both oral and topical antibiotics exist, as well as antibiotics that you must inhale or ones that must be administered intravenously or via injection.

For many years, antibiotics have been effective — even life saving — medications. In recent years, the rise of antibiotic-resistant bacteria has threatened the effectiveness of these medications.

Bacteria that were once vulnerable have changed in response to the use of antibiotics. They have become able to withstand, or resist, the medication and survive.

The result is antibiotic resistance. Some people even refer to bacteria with antibiotic resistance as superbugs.

Sometimes, bacteria are naturally resistant to antibiotics, perhaps due to a thicker-than-usual cell membrane or the ability to produce neutralizing enzymes, according to the Milken Institute School of Public Health.

In general, though, many bacteria develop a resistance to antibiotics in one of the following ways:

  • Mutations to the bacteria’s DNA can occur during replication (when the bacteria multiply). This makes them more resistant to antibiotics and better able to survive.
  • Horizontal gene transfer can occur. This involves genetic material moving from antibiotic-resistant bacteria to other bacteria and making them resistant, too.

The resistant bacteria can keep multiplying, even if they’re exposed to antibiotics.

The misuse and overuse of antibiotics over time have led to this point, according to the World Health Organization (WHO).

For example, a 2018 study noticed peaks in healthcare professionals prescribing antibiotics during the cold and flu season, even though those illnesses are caused by viruses and not bacteria. This suggests ongoing and widespread inappropriate prescribing of antibiotics during the winter.

To some degree, the growing crisis has occurred because antibiotics were so effective, says Patel. “They also became very easy to use, take, prescribe and because they were so helpful and easy to use, they became frequently used.”

But there was a cost. “The more antibiotics you use, the more pressure you put on bacteria to evolve resistance to those antibiotics,” Patel adds.

The biggest risk of antibiotic resistance is that we will no longer be able to defeat infections that were once treatable with antibiotics. Treatment options for many infections will become more limited. The remaining options may be expensive, which could put them out of reach for some people.

Additionally, many medical advances and treatments depend on the availability of antibiotics to make them possible. This includes joint replacement surgeries, organ transplants, cancer treatment, and the treatment of a number of chronic health conditions.

Researchers are continually looking at better ways to use the antibiotics we have. A 2019 randomized controlled trial found that a shorter course of antibiotics was as effective as a longer course in people hospitalized with gram-negative bacteremia (when a certain type of bacteria gets into the bloodstream), which can lead to sepsis or septic shock if untreated.

It’s also important to consider your own body’s microbiome. Your body is home to billions and billions of microorganisms — in your gastrointestinal tract, your oral mucosa, and even your skin.

When you take antibiotics, you kill off the bacteria causing the infection but you’re also destroying other microorganisms that can protect your body from threats. The result is an unbalanced microbiome.

Ultimately, researchers hope that a better understanding of microbial ecology may help create strategies for preventing infection and disease.

What individuals can do

You can help, too. Experts recommend that people follow instructions carefully when a doctor prescribes an antibiotic for them. They also urge people to follow these guidelines:

  • Do not demand antibiotics from your doctor or healthcare professional if they don’t prescribe one for you, since antibiotics are only appropriate for bacterial infections.
  • Do not take an antibiotic unless prescribed by a healthcare professional. (If you’re unsure about any antibiotics prescribed to you, follow up with your primary care doctor, if you have one.)
  • Don’t share antibiotics with anyone else.
  • Never use leftover antibiotics.
  • Take antibiotics as prescribed and follow all instructions on the packaging.

And if you have any questions, be sure to ask your healthcare professional.

“We are all learning how to do better,” says Patel.

It may seem that antibiotic-resistant bacteria have won the battle. According to WHO, “Antibiotic resistance is rising to dangerously high levels in all parts of the world.”

It’s not just antibiotic-resistant bacteria that’s a concern. Bacteria are just one of several types of organisms that can become antimicrobial resistant. Viruses, fungi, and parasites can also respond to treatments by changing and becoming resistant.

According to WHO, they are all a growing global threat because this resistance leaves society with “infections that become increasingly difficult or impossible to treat.”

In fact, a 2022 systematic analysis of antimicrobial resistance (AMR) estimated that 4.95 million deaths in 204 countries and territories were associated with bacterial antimicrobial resistance, and 1.27 million deaths were attributable to bacterial AMR.

The WHO cautions that urgent action is necessary to avoid creating a post-antibiotic era. The WHO notes that there must be ongoing research into new treatments and better surveillance of antibiotic-resistant infections.

In the United States, a number of entities, including several centers that are part of the Food and Drug Administration (FDA), are working on strategies to fight antimicrobial resistance.

Scientists are investigating other types of potential treatments, too.

Scientists are striving to learn more about the relationships and interactions between the microorganisms within the body, including how human behavior influences them.

They’re also exploring the potential of predatory bacteria. A 2021 review describes these bacteria as living antibiotics. Predatory bacteria are essentially bacteria that devour other bacteria, like Bdellovibrio bacteriovorus, which prey upon gram-negative bacteria.

The cost-benefit ratio of using predatory bacteria must be considered, though, researchers noted. This includes more research into the long-term effects on a person and their microbiome.

According to Patel, building upon phage therapy to combat multi-drug-resistant bacteria is another possibility. Phage therapy entails using viruses, or phages, to invade bacteria, according to research from 2017.

Are antibiotic-resistant bacteria resistant to every antibiotic?

No. But the Centers for Disease Control and Prevention (CDC) cautions that bacterial and fungal resistance to even one antibiotic can become a serious problem.

Can antibiotics be used to treat COVID-19?

Because COVID-19 is caused by a virus — a type of coronavirus known as the SARS-CoV-2 virus — it’s not vulnerable to antibiotics. Antibiotics could be used to treat a secondary bacterial infection that might develop, however.

How many prescriptions for antibiotics are written each year?

In 2020, U.S. healthcare professionals gave out 202 million prescriptions for antibiotics in the outpatient setting alone, according to the CDC. The region of the country with the highest rate of outpatient antibiotic prescriptions is the South.

What are the different kinds of antibiotics?

Some of the most commonly prescribed classes of antibiotics include:

  • penicillins
  • cephalosporins
  • tetracyclines
  • macrolides
  • fluoroquinolones
  • sulfonamides
  • glycopeptides

Antibiotic resistance is a very serious and ongoing problem. Scientists are searching for solutions and working on developing new medications that can replace antibiotics that no longer work to fight infection. Individuals like you can help, too, by following your doctor’s recommendations for antibiotic use.