Here our antibiotics experts aim to answer your questions regarding COVID-19, antibiotics and antibiotic resistant infections. If you have a question you'd like answered, you can use the form to ask our patient support team and we will answer it within 48 hours depending on the question's complexity.
When I was admitted to hospital I was told I had to have a rectal (back passage) swab to test for resistant bacteria. What does this mean and why was I tested?
A rectal swab test is common practice in the UK and is nothing to worry about. Bacteria are naturally in your gut and help to digest food and form part of your immune system. However, these bacteria can also cause infections if they get into a different part of your body, such as urinary tract infections. Increased use of antibiotics causes these gut bacteria to become resistant to antibiotics. Normally, this causes no problem and is nothing to worry about – unless these resistant bacteria cause an infection.
The rectal swab test is a painless swab of your back passage to see if any of these resistant bacteria are living in your gut. If they are, you should be informed by your health professionals (nurses, doctors, etc.) and also given written information. Your healthcare team may also wear aprons and gloves and you may be moved to a single-occupancy room. This should not impact on the quality of care you receive. If you have any questions or concerns do not hesitate to speak to your healthcare team, or contact our Patient Support Service.
Antibiotics should never be put into your household waste, poured down the sink, or flushed down the toilet. This causes antibiotics to escape into the environment which can lead to antibiotic resistance developing in the soil, plants and animals.
If you do have any left over antibiotics, take these to your local community pharmacy where they can be disposed of safely free of charge.
Unfortunately yes, there is a connection between antibiotics and sun sensitivity. Some antibiotics (and other medicines) can make you more sensitive to the effects of the sun causing sun burn and rashes more easily than you normally might. The most common antibiotic associated with this is doxycycline, which is used for chest infections, skin infections (cellulitis) including MRSA and pelvic inflammatory disease. The fluoroquinolone antibiotics, which include ciprofloxacin and levofloxacin, have also been linked to this effect but less commonly so.
If you have been prescribed one of these antibiotics please try to stay out of the sun where possible to avoid any sunburn. Where this is not possible try to cover yourself with clothing and wear a high factor sun cream (at least SPF 30) and reapply regularly.
Other sources of UV light can also cause sun burn more easily whilst taking these antibiotics so also try to avoid using sun beds or UV lamps for other beauty purposes until the course has finished and the antibiotics are out of your system.
Rashes can develop due to many reasons and might not be due to the antibiotic. If you develop a rash whilst taking antibiotics please discuss with the person who prescribed you them.
Please take note of where the rash has developed. Did it cover the whole of the body or was it restricted to a small patch? Was the rash painful or itchy? How long after taking the antibiotics did it start? Did you have other symptoms or feel unwell whilst you had the rash? If possible it can be useful to take a picture to show your doctor.
Antibiotic allergies can restrict the arsenal of antibiotics which can be used to treat infections and can sometimes mean that first-line treatment cannot be used. Discussing side effects or possible allergies with a healthcare professional can help to determine how likely the antibiotic was to have caused the rash and ensure safe antibiotic use in the future.
Can taking low-dose antibiotics regularly (long term) prevent getting recurrent urinary tract infections (UTIs)?
Long term use of antibiotics is associated with antimicrobial resistance, therefore it is very important to discuss this with your doctor.
Starting regular antibiotics for prevention of a UTI will depend on a number of factors, such as number of infections over a period of time, any other underlying health conditions, sexual history and microbiology results of your urine sample.
Your doctor may suggest trying other preventative methods before starting regular antibiotics. Your doctor will weigh up the benefits of taking the antibiotics versus the risk of resistance to antibiotics depending on individual symptoms and recurrence of infection, therefore it is important to seek medical advise if you are unsure of any ongoing symptoms.
If you have symptoms of UTI with a negative urine test then this will need to be looked at in detail by your doctor, as it can still be a possible urine infection that hasn’t been picked up on the urine test. Your doctor may repeat the urine test or refer you for further tests to find out the cause for your symptoms. Always seek medical advice from your doctor if you are unsure of ongoing symptoms.
Male UTI treatments are often longer and more complicated than those for women. Because of how the male urinary tract system is naturally, when men get UTI they are classed as ‘complicated UTIs’. This means it is more difficult to treat UTIs in men and therefore requires a longer course of antibiotics compared to women. In most cases this is 7 days for men compared to a 3-day course for women.
It is always important to consultant your doctor about course length of antibiotics as this will also be based on your symptoms.
There are a few key risk factors that are common with recurrent UTI infections:
- Anatomy – Women are more likely to get UTI’s due to how their body is naturally making it easier for bacteria to get to the bladder and causing a UTI.
- Bathroom Habits – It is important to wipe from front to back after going to the toilet as this lessens the risk of bacteria moving from the bottom into the urethra (a tube which transports urine from the bladder to an opening).
- Sexual activity – Bacteria can spread more easily during sexual activity. Practicing good hygiene before and after sexual activity is also helpful.
- Other health issues – Having underlying health conditions or a suppressed immune system can make you more prone to bacterial infections. Certain conditions or disease groups can make you more prone to UTI’s such as:
- Autoimmune disease
- Neurological disease
- Kidney or bladder stones
- Surgery to any part of your urinary tract
Misuse of antibiotics happens when a person is prescribed:
- the wrong antibiotic
- the wrong dose of an antibiotic
- an antibiotic for the wrong length of time
Talk with your doctor about the best treatment for you when you are prescribed antibiotics.
You can find out more about what you can do to prevent the misuse of antibiotics here.
There has been a lot of research into how long antibiotic courses should be, to determine the shortest possible length of course needed to completely kill all bacteria. If you are being treated for an infection, the kind of antibiotics your doctor prescribes and the length of the course should be based on the best evidence. Feeling better, or an improvement in symptoms, does not always mean that the infection has completely gone. Your doctor has had years of training and has access to the latest evidence – so always follow their advice.
The World Health Organization states:
“Evidence is emerging that shorter courses of antibiotics may be just as effective as longer courses for some infections. Shorter treatments make more sense – they are more likely to be completed properly, have fewer side effects and also likely to be cheaper. They also reduce the exposure of bacteria to antibiotics, thereby reducing the speed by which the pathogen develops resistance.”
Find out more about what you can do to help prevent antibiotic resistance here.
I have a recurrent resistant bacterial infection which often requires treatment with antibiotics via injections. Are there such options available in the community or does this always have to be treated in a hospital setting?
Yes, community Outpatient Antimicrobial Therapy (OPAT) service is a community team which delivers intravenous (IV) antibiotics (antibiotics via a drip) in a community setting as an alternative to inpatient care. It allows patients who are medically stable and whose only reason for admission or an extended length of stay in hospital is the requirement for IV antibiotic therapy to receive their treatment at home. The service offers a highly clinically efficient, cost effective and safe alternative to inpatient care. This service is provided locally by your local health authority.
I heard the other day that one of my friends had a C. diff infection. What is C. diff and is it dangerous?
C. diff or Clostridium difficile is a bacterium commonly found in the gut. Often when people are given antibiotics for an infection, most of the gut bacteria are killed except for C. diff which can grow in the gut to give rise to symptoms such as diarrhoea and sickness. Those most at risk are the elderly and those in poorer health. C. diff infection is normally treated with antibiotics such as vancomycin. Most people will recover with treatment but in extreme cases a C. diff infection can lead to hospitalisation and death (https://www.meht.nhs.uk/patients-and-visitors/infection-prevention/about-c-diff/).
It is important to follow these measures to alleviate any ongoing symptoms: make sure you finish the antibiotics prescribed for the C. diff; wash your hands with soap and water regularly and after you have been to the toilet; drink plenty of fluids to avoid symptoms of dehydration; do not take any anti-diarrhoea medication; wash surfaces and bedding regularly; do not share towels with anyone; stay at home for 48 hours after your symptoms have cleared up. You can find further information here: https://www.nhs.uk/conditions/c-difficile/
There are two flu vaccines available: one has four different viruses in it (the quadrivalent one) and one with three different viral strains (the trivalent one). The trivalent one also includes an additional ingredient (called the adjuvant) which helps boost the recipient’s immune response.
Therefore, older people over 65 who tend not to give such a strong immune response compared to younger people should have the trivalent vaccine.
Although you might think the quadrivalent one is the ‘better’ one, one of the four viruses it contains does not normally make older people ill, only younger people. It is therefore better for younger people to have the quadrivalent vaccine and older people to have the trivalent one with the adjuvant that helps the immune system work better. The ideal might be for everyone to get a quadrivalent one with adjuvant but that is not available. The pharmacist – or other clinic – will check your age and give you the right one.
UK poultry meat producers have stopped all antibiotic preventative treatments and the highest priority antibiotics that are critically important for humans are used only as a ‘last resort’ for chickens and turkeys. Between 2012 – 2019 there has been a 76% reduction in the use of antibiotics in the poultry industry. If you are concerned about antibiotics being used in the poultry industry why not ask your supplier the question have antibiotics been used in the rearing of my turkey?
Uncooked meat including turkey can be contaminated with bacteria such as Salmonella that can cause food poisoning. Here are some tips to avoid your Christmas break being spoiled:
1) don’t wash your turkey – contaminated splashes from the carcass might get on your hands and into your mouth
2) make sure you wash your hands, all containers, chopping boards and knives if they have been in contact with your raw turkey
3) make sure your turkey is cooked all the way through preferably by testing with a meat thermometer
4) if you have leftover turkey, keep it in the fridge after it has cooled down from the oven
5) if you freeze your turkey leftovers make sure they are thoroughly defrosted before reheating or to be used in a recipe
Probiotics and live culture yoghurts have often been promoted in preventing antibiotic-induced diarrhoea. However, the research data is conflicting. Some studies have suggested that using these products does treat the diarrhoea but equally others have not. The evidence that they can prevent diarrhoea when taken during a course of antibiotics is a little more convincing but still not conclusive. The jury is still out on this question!
Clostridium difficile (C. Diff) is a bacterial infection which causes up to 30% of antibiotic-associated diarrhoea with a wide spectrum of severity from a mild to life-threatening illness.
A fifth of cases are cured within 3 days by stopping the antibiotic. More severe cases will need specific antibiotic therapy and some will need repeat treatment.
It is highly infectious, especially in hospital and care-home settings. The elderly and those with significant underlying disease are most vulnerable. In these situations, strict basic hygiene practice often prevents the spread of infection between individuals.
Careful and effective use of antibiotics greatly diminishes the risk of this infection. Conversely, taking broad spectrum or combination antibiotics, prolonged and/or repeated antibiotic courses increase the risk of C. Diff. The use of acid suppressing therapy at the same time as antibiotics also increases the risk of acquiring C. Diff infection.
Yes, it occurs in up to a quarter of people on treatment and is more common with some types of antibiotic, particularly broad-spectrum ones. It is due to an alteration in the balance of different bacteria in the gut.
Most cases are mild and self-limiting, stopping within a few days of finishing the treatment course, but sometimes you will need to stop the antibiotics and seek your GP’s advice. Make sure you drink plenty of fluids while you have symptoms. About 20-30% of cases are caused by Clostridium difficile infection which can be more serious.
Toothache is often caused by inflammation rather than infection. Analgesics such as paracetamol and ibuprofen treat inflammatory pain – antibiotics do not fix inflammation.
Even if you have a bacterial infection associated with a dead tooth (a dental abscess), antibiotics are not usually the right answer. Antibiotics cannot easily get inside the tooth to the root of the infection. The quickest fix is usually to remove the source of the infection using a dental procedure – there are various ways to do this which you should ask your dentist about. Even when antibiotics are required for a severe infection, they should be used along with a dental procedure. Taking antibiotics when they are not necessary increases the chance that they will not work for an infection (such as sepsis or pneumonia) when you really do need to them to work.
When you have toothache, visit your dentist who can diagnose the cause and offer you appropriate options for treatment. Doctors in GP practices or A&E are not able to diagnose toothache and you are likely to be in pain for longer than if you see a dentist. If you don’t have your own dentist, call NHS111 and they will be able to help you find someone who can provide the care you need.
Sometimes my dog has had to have antibiotics. This made me wonder whether my family could also get any antimicrobial resistance from my dog or vice versa?
Antibiotic resistance can affect the health of both people and animals. In fact, many microbes (germs) do not recognise these types of boundaries, and the same bacteria, virus and fungi can be found in different types of animals, and humans. This includes our pets, such as dogs who can also get bacterial illness, sometimes requiring treatment with antibiotics. Veterinarians are becoming more focused on their use of antibiotics and significant improvements have been made by vets to reduce inappropriate use of antibiotics to decrease the risk of antimicrobial resistance in the future.
Antibiotic resistant bacteria that transfer from an animal to a human, is called ‘zoonotic’ – this just means it can adapt and survive on animals and humans. Therefore, it is possible for you to get a bacterial infection from one of your pets that is resistant to antibiotics. This doesn’t mean stop loving and caring for your pets – but it does mean that you need to take some additional basic hygiene precautions, including hand washing after touching the dog, and avoiding close contact when you are eating to reduce the risk of resistant bacteria passing from your dog and into your gut. Talk to your veterinarian if you are concerned.
Under no circumstances must you ever use medication intended for your dog, or vice versa. Even though the same types (classes) of antibiotics are commonly used on humans and animals, the doses, strength and duration will usually differ markedly.
I had a stem cell transplant as part of my cancer treatment. I was told I have ‘a new immune system’. What does this mean – will I always be more prone to infection?
Following a stem cell transplant you will have very low white blood cells (these are the blood cells that help fight infection and make up your immune system within the blood stream). This is due to the treatment you have had. When doctors or nurses say ‘new immune system’ they mean that your immune system needs to build up again i.e. building up the white blood cells within the blood stream to help fight infection. The time it takes can vary from person to person, but they may remain low for some time. Unfortunately, this means you may be more prone to getting infections. These infections/bacteria would usually cause no problem and are usually harmless to people with normal immune systems.
I was told in hospital that I carry MRSA, but wasn’t given any further information. How did I get it and what does it mean for the future?
Methicillin Resistant Staphylococcus Aureus (MRSA) is a type of staphylococcus aureus bacteria that is resistant to many antibiotics. When resistant they can still live on your skin and up your nose and cause no problems or symptoms; this is called colonisation and can happen through:
• touching the skin of a person who is colonised with MRSA
• touching a contaminated surface like a door handle, phone or work surface.
If your skin is colonised and you have an opening in your skin (when the barrier is breached) the bacteria are opportunistic and can enter the opening thus causing an infection. MRSA can also enter the bloodstream through medical procedures and devices like surgical incisions (cut to skin) or medical devices like a cannula (intravenous drip).
If you are found to be colonised with the bacteria, the doctor may prescribe skin washing with special soap for your body and/or cream for your nose. This treatment is called decolonisation.
If you have symptoms of the infection your doctor may prescribe antibiotics to treat it. If you have been told you have a collection of pus anywhere (like an abscess) the doctors may want to drain it (take the fluid out) or operate to remove it. Some infections can’t be treated with oral antibiotics (tablets or capsules) and need to be treated with intravenous antibiotics.
You can read Tony’s story about living with MRSA here.
We are drying wet laundry within an enclosed open plan living area without ventilation (eg. no windows open in the winter) but should we be worried about the build up of bacteria?
Condensation remains arguably the largest cause of dampness in indoor areas, and can eventually lead to the growth of mould. If left unaddressed, condensation can also damage property by fraying curtains, peeling wallpaper and creating a generally musty environment.
The growth of fungi like mould, is probably a greater risk to the health of those living there than bacteria build up. There are some things you can do to try to reduce the risk of bacteria or fungal spores forming. They include dehumidifiers, electric clothing racks for fast warm drying of clothes – but of course, involve investment. You can find ideas here.
The NHS website contains useful information about reducing the risk of germs spreading in all sorts of places.
It includes helpful information on laundering clothes too, such as:
Wash your hands after handling dirty laundry;
All underwear, towels, and household linens should be washed at 60C (140F) with a bleach-based laundry product to prevent germs from spreading;
Don’t leave laundry in the washing machine – any remaining germs can multiply rapidly.
The use of antibiotics has long been linked to deprivation of gut bacteria, which are needed to help build up the immune system. One study shows that the makeup and function of gut bacteria can mostly recover after antibiotic treatment in healthy people. So essentially that means we are able to regenerate our gut bacteria and environment which is important for our general health. The concern, however, relates to potentially losing some of those beneficial bacteria permanently after multiple courses of antibiotics during our lifetime. We should therefore aim to minimise the number of antibiotic courses we take wherever possible, by only taking antibiotics when absolutely necessary. Find out more about what you can do to prevent antibiotic resistance.
Vaccines are used for protection against potential future infection and designed to induce a protective immune response in your body. The specific, protective immune cells have a memory element to protect for any future infection by that particular virus. These memory cells allow for a quick response so that when exposed to that virus, you are quickly protected and can avoid becoming ill.
Antibiotics are effective for eradicating bacteria but do not have any effect on viruses. Antibiotics are used when there is a current bacterial infection present. Inappropriate use of antibiotics is a growing concern globally now, with some bacteria developing antibiotic-resistant strains, like Methicillin-resistant Staphylococcus aureus (MRSA) , ESBL E Coli or Carbapenem Resistant Enterobacteriaceae (CRE), resulting in certain antibiotics becoming ineffective. You can read more about drug-resistant bacteria here and how Antibiotic Research UK is tackling this problem.
Blood poisoning or septicaemia are both terms which refer to the invasion of bacteria into the bloodstream causing severe infection. Sepsis is a more rare, but serious complication of infection. It can lead to multiple organ failure and even death, sometimes without blood poisoning or septicaemia. The main cause of sepsis is usually bacterial infection, although sepsis can sometimes be due to fungal or viral infection ( like COVID-19). You can find out more about sepsis here.
When someone gets infected with any general flu type virus, the virus can hijack the person’s immune system. As a consequence, that person is then susceptible to getting what is called a secondary bacterial infection. It is estimated that in general between 10 – 30% of patients with a flu type virus will get a secondary bacterial infection. It is becoming increasingly clear that people who are weakened by COVID-19 are susceptible to contracting secondary bacterial infections. These can be acquired in hospital and are often resistant to treatment with antibiotics. You can explore the facts and figures published so far HERE.
Contact Patient Support
We’re the only charity with a dedicated Patient Support service for people with antibiotic-resistant infections.