Do I need this antibiotic?

Q: I was prescribed a course of antibiotics for a year to prevent recurring urinary tract infections. Should I be concerned about antimicrobial resistance?

Anytime you take antibiotics, regardless of the dose or duration, there’s a risk of developing resistance, said Dr. Sarah Kabbani, a public health physician at the Centers for Disease Control and Prevention.

Antibiotics work by killing bacteria in your body. But some bacteria will survive and thrive, which can make future infections more difficult to treat. This result, called antimicrobial resistance, is responsible for more than 35,000 deaths in the United States each year.

Although antibiotics are necessary for serious and life-threatening infections, they are sometimes prescribed for less urgent situations. Here’s how to know if an antibiotic is right for you.

What to consider

The most important question to discuss with your doctor before taking an antibiotic is: Do I really need it?

Quite possibly not, said Dr. Bradley Langford, a pharmacist who specializes in antimicrobial resistance at Public Health Ontario in Toronto. According to the CDC, at least 28 percent of antibiotics prescribed in outpatient settings, such as doctors’ offices and emergency departments, are unnecessary.

In recent years, US health experts have recommended being more conservative in prescribing antibiotics for common situations, such as treating acne or preventing infections from dental procedures.

If a provider recommends an antibiotic, research suggests that the shorter the course, the lower the risk of resistance, and in many cases shorter courses are as effective as longer ones.

Still, some providers continue to prescribe longer courses than necessary, said Dr. Kabbani, so whatever your situation, ask if you are doing the shortest possible course.

Also consider the type of antibiotic. Broad-spectrum antibiotics, which target many types of bacteria, are more likely to cause resistance than those that target fewer types.

And lower doses don’t automatically mean less chance of resistance, Dr. Langford said. The most important thing is whether you are taking antibiotics and for how long.

Common situations of antibiotic use

Most of us know that we should not take antibiotics for viral infections such as colds, coughs and flu. But the guidelines for other situations may be less straightforward.

Surgical and dental procedures

Prophylactic antibiotics are often prescribed before surgeries to reduce the risk of infection. In such cases, antibiotics are worth taking, Dr. Kabbani said.

But taking antibiotics before a dental procedure often isn’t necessary, he said; the drugs should be reserved for those at higher risk of complications, according to the American Dental Association.

Recurrent urinary tract infections

If you have chronic UTIs, defined as more than two in six months or more than three in one year, short courses of prophylactic antibiotics that usually last three months to a year can reduce their recurrence in adults. But the drugs still carry risks of resistance and unwanted side effects (such as rashes, diarrhea, or yeast infections).

Doctors are increasingly recommending that if you have recurrent UTIs, it’s best to start with alternative prevention methods, such as drinking more fluids, Dr. Langford said. Cranberry products, such as juices or supplements, may also help. Or, if you regularly get UTIs after intercourse, you can take a single dose of the antibiotic right after intercourse.

There is very limited evidence for taking prophylactic antibiotics for recurrent UTIs indefinitely, said Dr. Kabbani. But if you are prescribed them for an extended course, make sure you know how long it should last; it’s usually no more than a year, Dr. Langford said.

If your doctor detects bacteria in your urine but you don’t have symptoms, avoid antibiotics, research suggests, because they can increase your risk of developing symptomatic UTIs in the future.

Skin conditions

People with skin conditions such as rosacea or acne are commonly prescribed antibiotics. In fact, dermatologists prescribe more antibiotics than providers in any other medical specialty, said Dr. John Barbieri, a dermatologist at Brigham and Womens Hospital in Boston.

For severe rosacea, antibiotics are usually the best treatment, Dr. Barbieri said. Although medicated creams or gels or gentle skin care routines can help with milder cases.

For acne, effective alternative treatments are available, including benzoyl peroxide washes, topical retinoids, and salicylic acid products.

Topical antibiotics such as clindamycin can help mild cases of acne, with fewer side effects than oral antibiotics, but can still cause antimicrobial resistance. So take them in combination with other topical treatments, such as retinoids, experts say, to reduce your exposure.

If your acne is severe, oral antibiotics such as doxycycline or minocycline won’t cure it, but they can improve a flare-up quickly, Dr. Barbieri said, so they can be helpful in temporarily managing your acne while you follow other treatments to long term.

If you can’t use an alternative treatment because of its side effects or another health condition, it’s reasonable to use oral antibiotics for longer periods, Dr. Barbieri said.

Ultimately, that decision will depend on your unique situation, said Dr. Langford, so it is important to discuss all possible options with your provider. For some, the benefit of antibiotics will outweigh the risk, he added. But many people won’t need them at all.