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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.
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Antibiotic Resistance
Gallstones can cause blocking of the bile duct which can cause the gall bladder to become infected and inflamed. Symptoms of gall bladder infection (cholangitis) include:
- pain in your upper abdomen that travels towards your shoulder blade
- a high temperature
- jaundice
- chills
- confusion
- itchy skin
- generally feeling unwell
Your doctor will start you on a course of antibiotics to help get rid of the inflammation and infection. Once this has settled, they can perform surgery for removal of any stones causing the blockage. Therefore, it is important to take the antibiotic correctly at the given time and to complete the prescribed course.
Levofloxacin belongs to a group of antibiotics called fluoroquinolones and tendonitis is one of the common side effects of this group of antibiotics. The Medicines and Healthcare products Regulatory Agency (MHRA) advise that ‘treatment should be discontinued at the first signs of a serious adverse reaction, including tendon pain or inflammation’. Therefore, you should stop taking the antibiotics and see a doctor if you experience tendonitis. You will receive an alternative antibiotic treatment.
Further information can be found here.
A few people do experience tendonitis during and after they have taken Levaquin. Tendonitis is a known side effect of Levaquin. In these situations, if the symptoms don’t resolve then please see your doctor.
Impetigo is a highly contagious bacterial skin infection commonly occurring in young children. This skin infection is mainly caused by Staphylococcus aureus (S. aureus) bacteria. Treatment is typically topical antibiotic creams or oral antibiotics if creams are not effective. Antimicrobial resistance has become a worldwide concern and needs to be addressed when selecting treatment for impetigo patients.
If the impetigo infection is not healing with antibiotics, your doctor might take a sample of the liquid produced by a sore for testing. This will show what types of antibiotics would work best on it. Your doctor may refer you to a specialist doctor (dermatologist) for further tests. You will then be offered alternative treatment options.
The best ways to prevent impetigo is to stay clean and healthy. Other tips to avoid impetigo include:
- Keep hands clean: wash hands regularly. Use alcohol-based sanitizer if you don’t have soap and water.
- Practice good hygiene: clip your (and your child’s) fingernails regularly to avoid scratching. Sneeze into a tissue and then throw the tissue away. Bathe daily (or as often as possible), especially for children with eczema or sensitive skin.
- Avoid scratching: don’t scratch cuts or wounds. If your child gets a cut, scratch or wound, keep them from scratching it.
- Clean wounds: clean cuts, scrapes and injuries with soap and water. Then put an antibiotic cream or ointment on the wound.
- Keep linens clean: wash underwear, towels and sheets in hot water.
If you or someone you love has impetigo that is not healing with antibiotics due to resistance, you can find support here.
The NHS states the following with regards to bacterial vaginosis:
Bacterial vaginosis (BV) is a common cause of unusual vaginal discharge. BV is not a sexually transmitted infection (STI), but it can increase your risk of getting an STI such as chlamydia.
BV is not a serious condition. Bacterial vaginosis is usually treated with oral antibiotics, gels or creams if symptoms are present. If you keep getting it (you get it more than 4 times in a year), you may be given an antibiotic gel that you put in your vagina. You may need to use this for a few months to help stop bacterial vaginosis coming back. Your GP will recommend how long you need to treat it.
Despite being used extensively, Group A Streptococcal (GAS) infections are not resistant antibiotics. Penicillin and amoxicillin are first-line antibiotics for GAS infection. However, doctors often use alternative antibiotics to penicillin, such as clarithromycin and azithromycin (macrolide antibiotics) to treat GAS infection, particularly for people who are allergic to penicillin. GAS infection responds well to first line antibiotics of penicillin and it is vital that antibiotics are started immediately if GAS infection is suspected.
It is important that antibiotics are taken correctly, for the correct infection and correct length of time in order to prevent antibiotic resistance to GAS infection. The following are ways in which you can prevent antibiotics resistance:
- Do not share your medication with others
- Take the medication exactly as your doctor tells you
- Do not save them for later. Talk to your pharmacist about safely discarding leftover medicines
- Do not take antibiotics prescribed for someone else. This may delay the best treatment for you, make you even sicker, or cause side effects
- Talk with your doctor and pharmacist if you have any questions about your antibiotics prescribed to you
Further information on Group A Streptococcal infections and antibiotics can be found here.
The good news is, there are several different Strep treatment options for people with a penicillin allergy. Guidance from NHS England states children with penicillin allergy should be prescribed antibiotics belonging to a group called Macrolides. These include Clarithromycin and Azithromycin and are available in liquid form. The antibiotic course is usually 5 days in children.
It is important to discuss with your GP the type of penicillin allergy your child has and the nature of the reaction to penicillin. This will determine the choice of alternative antibiotic to penicillin your GP will prescribe. Local antibiotic guidelines may differ as to which particular antibiotic is prescribed. Make sure you discuss all the options with your GP to get the best treatment.
Further information on Group A Streptococcal infection can be found here.
You asked us to explain what Invasive Group A Strep (or iGAS as its sometimes called) is. It’s where a small proportion of (usually) children can develop an invasive infection. Bacteria enters the bloodstream and can cause sepsis or deep seated infections. Signs to watch for are:
- Persistently high temperature
- Pinkish or red body rash where the skin feels like sandpaper
- Strawberry tongue
- Drowsiness
- Not wanting to eat or drink
The recommended treatment for Strep A infections is a 10-day course of penicillin. The risk of developing iGAS is reduced the earlier the antibiotics are started.
Group A Streptococcal bacteria usually live in the mouth and nose. The bacteria are spread by coughing and sneezing. Droplets land on areas we then touch or if we are close enough to breathe them in. Some cause ‘Strep throat’ which feels like a sore throat. Others infect the skin through tiny cuts or sores, to cause impetigo or cellulitis. Strep A is currently being seen as Scarlet Fever in higher numbers of children than usually seen this time of year.
Scarlet fever is usually a mild infection but spreads easily. Symptoms to look out for include sore throat, headache, high temperature and sometimes a rash which has a sandpapery feel. This usually looks pink/red in colour but can be hard to see on darker skins. The NHS advice is to contact your doctor or NHS111/NHS24 if you suspect your child has scarlet fever.
Treating early with antibiotics is important to reduce the risk of developing into a more serious infection like pneumonia or a bloodstream infection which can be harder to treat. You are also advised to keep your child at home for 24 hours after starting antibiotics to avoid spreading the infection to others. You can find more information here.
Fabimycin is a new, man-made antibiotic found to kill hundreds of bacteria that are resistant to common antibiotics. Fabimycin is one of many tested compounds which successfully eradicated a range of gram negative bacteria including Klebsiella pneumoniae, E coli and even Acinetobacter baumannii.
However, it is still at the clinical trial stage in the USA. So, it is not available for prescribing in the UK yet. It has shown great promise in killing different types of resistant bacteria, but needs to go through human trials now. These will determine whether it can be used safely and effectively in humans.
It is safe to take Penicillin and Clarithromycin at the same time. Both these antibiotics work in different ways and are effective against different types of bacteria. As you are at a higher risk of developing an infection due to removal of spleen, it is important that you carry on taking Penicillin for this.
Antibiotic resistance can develop as a result of inappropriate use, prolonged courses of antibiotics and taking antibiotics incorrectly. Therefore, it is important that you take the Clarithromycin for the prescribed course length and at the correct times during the day. You can find more information on antibiotics resistance on Antibiotic Research UK website under the patient support section.
Vaccines are a great defence in preventing future antibiotic resistance. Many routine vaccines such as meningitis or typhoid, help prevent bacterial infections. If a person does not get the infection in the first place, then there is, therefore, no need to treat with antibiotics, hence reducing the amount of antibiotics that are used.
If you have started taking an antibiotic for an infection which testing subsequently shows you are unlikely to have, then it is sensible to stop that antibiotic. The risk of bacteria becoming resistant to antibiotics is increased the longer they are exposed to that antibiotic.
If the antibiotic isn’t needed, stopping it can limit exposure. This will hopefully prevent bacterial resistance developing.
If you are stopping taking your antibiotics early, you should then return the remaining pills to the pharmacy for safe disposal. Do not flush away or throw down the sink into the water system. This will also help reduce the risk of bacteria developing resistance within our environment.
Always consult your doctor before stopping antibiotics early.
Cellulitis is a skin infection caused by bacteria. It results in pain, swelling and discoloration to the area of infection on the skin. The discoloration, which can be red, purple or darker than the area of skin and looks like a rash, is caused by the toxins released from the bacteria. Flucloxacillin is a common treatment for cellulitis.
After a course of treatment has been completed and cellulitis symptoms have resolved, in some cases the rash or redness to the skin can remain. This is because it can sometimes take longer for it to go, even after the bacteria has been killed.
It is therefore important to seek advice about the rash or redness from your doctor. They will be able to access you and your symptoms. Then they can determine whether you still have an active infection or not.
Penicillin allergy is one of the most commonly reported drug allergies. However, around 95% of patients with a penicillin allergy label have not experienced a true allergic reaction. It is possible to test for a penicillin allergy to see if you are genuinely allergic.
It is important to be able to distinguish whether you have a true allergy to penicillin or are just experiencing side effects of penicillin. A true penicillin allergy has any of the following:
- Occurs immediately or within 1 hour of taking penicillin
- Hives
- Localised swelling
- Wheezing/shortness of breath
- Anaphylaxis
Side effects to penicillin are not true allergies and therefore should not be a reason for avoiding penicillin if it is required. The following are side effects to penicillin:
- Nausea/vomiting
- Diarrhoea
- Headache
- Vaginal itching
Penicillin allergy testing on the NHS is very rare unless it is carried out by a specialist. However new guidelines by the British Society for Allergy and Clinical Immunology (BSACI) have recently been issued about penicillin de-labelling for healthcare workers, so this is something that may become available routinely in the future. For further information on getting a test for penicillin allergy, speak to your doctor, pharmacist or contact the patient support service at Antibiotic Research UK.
The treatment offered for a UTI to people who are allergic to penicillin will depend on their history and nature of the reaction. It is recommended that they avoid all antibiotics belonging to the penicillin family. These include:
- Amoxicillin
- Ampicillin
- Flucloxicillin
- Co-amoxiclav
- Penicillin V (Phenoxymethylpenicllin)
- Penicillin G ( Benzylpenicillin)
- Piperacillin + Tazobactam (Tazocin)
- Temocillin
Furthermore, antibiotics belonging to the cephalosporin family should also be avoided. This class of antibiotics are closely related to penicillin. These antibiotics include:
- Cefalexin
- Cefuroxime
- Ceftriaxone
- Cefotaxime
- Ceftazidime
It is important that your doctor is aware of your allergy and also what happens when you take penicillin. This is very important when determining which antibiotics can be prescribed for you to treat your UTI without triggering an allergic reaction to penicillin.
For further information on penicillin allergy please refer to the patient support section, where you can find a patient support leaflet on this topic. We have lots support available for people who suffer with antibiotic resistant UTIs too.
Antimicrobial stewardship is a programme in a healthcare setting promoting the appropriate use of antibiotics. It also aims to improve patient outcomes and reduce the spread of multi-drug resistance organisms. Proper antimicrobial stewardship helps to reduce antimicrobial resistance and prevent a global health crisis.
The goal is:
- to use the RIGHT antibiotic
- for the RIGHT person
- at the RIGHT time
The primary goal of antimicrobial stewardship is to get the best clinical outcomes while minimising unintended consequences e.g. resistance and adverse effects of antimicrobials.
The time to take your antibiotics and whether you take them before or after food will depend on the type of antibiotic you are taking. Antibiotics that are taken at the incorrect time increase a patient’s risk of suffering from nausea, diarrhoea and vomiting. Taking them incorrectly can also increase your chance of developing antibiotic resistance.
In some instances, taking antibiotics with food may help to reduce stomach issues. These include antibiotics such as amoxicillin and doxycycline. Nevertheless, this approach won’t work for all antibiotic treatments. Some antibiotics, such as tetracycline or flucloxacillin, should be taken on an empty stomach.
- BEFORE food: Penicillin, Flucloxacillin
- AFTER food: Metronidazole, Trimethoprim, Doxycycline, Nitrofurantoin
- EITHER before or after food: Amoxicillin, Ciprofloxacin
It is also important to remember that certain foods may interact with particular antibiotics. You might have to avoid specific foods during your treatment and for some time after.
Some antibiotics are supposed to be taken at the same time each day. Others must be taken at set times so that the effect is spread out evenly over the course of the day. Always seek advice from your pharmacist if you are unsure of when to take your antibiotics or how to take them.
Staphylococcus aureus is a major cause of skin infection. A large number of strains are resistant to penicillin, such as flucloxacillin (1st line of treatment if no allergy) making this infection problematic to treat.
It is possible that your staphylococcus aureus skin infection can’t be treated successfully with flucloxacillin. If that is the case, get advice from your GP about getting skin swabs sent to microbiology. The results from microbiology will give alternative treatment options that the infection is most sensitive to. They may even give options that require you to have antibiotics in the hospital via the I.V. route.
For further information on skin infections, please refer to the Antibiotic Research UK, patient support page.
Using clarithromycin together with statins (called simvastatin) is not recommended. Combining these medications may significantly increase the blood levels of simvastatin. This can lead to liver damage and a rare but serious condition called rhabdomyolysis that involves the breakdown of skeletal muscle tissue.
You should let your doctor know immediately if you have unexplained muscle pain, tenderness, or weakness. Always seek advice from your doctor when starting antibiotics. They will be aware of your medication history and prescribe antibiotics most appropriate for you.
One of the side effects to taking antibiotics is diarrhoea, this is because treatments can disrupt the balance of the ‘good’ bacteria in your gut which can lead to loose stools.
Antibiotic-associated diarrhoea is defined as having loose, watery stools three or more times per day during your treatment. This may begin about a week after starting antibiotics or, diarrhoea can also develop in the weeks after finishing your treatment.
Although all antibiotics can cause loose stools, some types are more closely associated with the condition. Antibiotics that have a higher likelihood of causing diarrhoea include:
- penicillin, such as amoxicillin and flucloxacillin
- cephalosporins, such as cephalexin
- clindamycin
You should contact your doctor urgently, if you’re taking antibiotics and have the following symptoms:
- more than five episodes of diarrhoea in a day
- blood or pus in your stool
- fever
- abdominal pain or cramps
For further information or questions on antibiotic associated diarrhoea, please contact the patient support team via the link:
https://www.antibioticresearch.org.uk/patient-support/find-support/
Most medicines should be stored at room temperature (around 20◦C). Most manufacturers suggest storing antibiotics below 25◦C. It is very important to read the labelling advice with regards to which temperature your antibiotics must be stored under. This is because some antibiotics lose their effectiveness when stored incorrectly and some may change form and become difficult to use.
Take a look at our tips for storing antibiotics in hot weather conditions:
- Not in the bathroom cabinet – bathrooms can be hot and humid, which could affect the stability of antibiotics
- In the coolest and driest place of your house
- Away from direct sunlight
- Kept in original packaging and containers
- Kept in airtight containers if it’s humid
- In an insulated bag if travelling in a car during hot days
If you think your antibiotics may have been exposed to higher-than-recommended temperatures, speak to your pharmacist for further advice.
According to the NHS, trimethoprim should not be taken if you have a history of anaemia. Furthermore, haemolytic anaemia is listed as a side effect of trimethoprim.
Haemolytic anaemia is a condition where red blood cells are destroyed faster than they are replaced. Although this is a rare side effect, it is important that you discuss this with your doctor. That way, appropriate antibiotic treatment can be administered.
Having a long-term catheter increases the risk of developing urinary tract infections (UTIs). The NHS advise the following to prevent contracting a catheter associated UTI:
- wash the skin in the area where the catheter enters your body with mild soap and water every day.
- wash your hands with soap and warm water before and after touching your catheter equipment.
- make sure you stay well hydrated – you should aim to drink enough fluids so that your urine stays a pale colour.
- avoid constipation – staying hydrated can help with this, as can eating high-fibre foods, such as fruit and vegetables and wholegrain foods.
- avoid having kinks or bends in the catheter. Make sure any urine collection bags are always kept below the level of your bladder.
UTIs caused by using a catheter are one of the most common types of infection that affect people staying in hospital. This risk is particularly high if your catheter is left in place continuously (an indwelling catheter).
Symptoms of a UTI associated with using a catheter include:
- pain low down in your tummy or around your groin
- a high temperature
- feeling cold and shivery
- confusion
Always speak to your GP or community nurse if you think you have a UTI, as you may need a course of antibiotics.
Advice from NHS is that “It’s a good idea to avoid drinking alcohol when taking medicine or feeling unwell. But it’s unlikely that drinking alcohol in moderation will cause problems if you’re taking the most common antibiotics. However, some antibiotics can have side effects such as feeling sick or dizzy, which might be made worse by drinking alcohol.”
Although modest alcohol use doesn’t reduce the effectiveness of most antibiotics, it can reduce your energy and delay how quickly you recover from illness. So, it’s a good idea to avoid alcohol until you finish your antibiotics and are feeling better.
Alcohol should be avoided when taking the following antibiotics:
• Metronidazole – drinking alcohol with metronidazole can cause very unpleasant side effects. You may experience feeling and being sick, stomach pain, or hot flushes. You may also have a fast or irregular heartbeat, headaches, feeling dizzy and feeling drowsy
• Doxycycline – alcohol can affect this medicine. It may also be less effective in people with a history of drinking heavily
Always ask your GP or pharmacist if you’re unsure whether you can drink alcohol while taking antibiotics.
Acid reflux can be a side effect of doxycycline. It is important that you take the antibiotic with a large glass of water. You should also sit upright for 30 mins after taking it. This can help reduce the side effects on the stomach.
Other side effects of doxycycline include:
Skin sensitivity to sunlight – it is important you take the appropriate precautions to protect your skin from sun damage. Cover your skin when outdoors and wear sunscreen. Sun sensitivity is a common side effect of antibiotics.
Headaches – make sure you drink plenty of water. Simple painkillers like paracetamol or ibuprofen are safe to take with doxycycline.
Nausea and vomiting – take doxycycline after a meal or snack to help prevent acid reflux. Avoid dairy products, like milk, cheese or yoghurt for a few hours before or after you take it.
A known side effect of taking antibiotics is vaginal thrush. Antibiotic treatments can also kill beneficial bacteria, leading to an overgrowth of yeast in the vagina. Vaginal thrush can cause pain and discomfort in that area. Furthermore, overgrowth of yeast/yeast infection can cause vaginal dryness which may also cause discomfort.
It is very important that you discuss your symptoms with your doctor or pharmacist. They can advise you about the most appropriate treatment. Treatment for vaginal thrush is available from pharmacies to purchase over the counter.
Methenamine is not an antibiotic but a urinary antiseptic. It can be useful in preventing recurrence of urinary tract infections.
Previous systematic reviews found it to be a possible option instead of antibiotics but stated more studies were needed. Long term, low dose antibiotics is the usual approach to prophylaxis in women with recurrent UTIs as recommended by national and international guidelines.
However, antimicrobial resistance has been directly linked to antibiotic consumption. So, development of non-antibiotic alternatives is important. A recent study published in March 2022 found that methenamine might offer an appropriate alternative. For some women with a history of recurrent UTI, it has been a helpful treatment.
Nitrofurantoin is an antibiotic commonly used for the treatment of UTI. It may turn your urine dark yellow or brown. This discolouration is normal and a known side effect that is not harmful. Your urine should return to its usual colour after you finish taking the antibiotic. You should always consult your doctor if you have any concerns relating to antibiotics and their side effects.
For further information on resistant UTIs please refer to the about antibiotic resistant urinary tract infections page here.
Ciprofloxacin belongs to a group of antibiotics called fluoroquinolones. Common side effects of ciprofloxacin include:
- feeling sick (nausea) after taking the tablets or liquid
- diarrhoea after taking the tablets or liquid
Very few people taking or using ciprofloxacin have serious side effects. You should stop taking ciprofloxacin and tell your doctor straight away if you have:
- muscle weakness, pain or swelling in your joints or tendons. This often begins in the ankle or calf, but could also be in your shoulder, arms or legs. It can occur in the first 2 days of taking ciprofloxacin or even several months after stopping. It is more common in children
- pain or abnormal sensations (such as pins and needles that do not go away, tingling, tickling, numbness or burning) or weakness in your body, especially in the legs or arms
- severe tiredness, feel anxious or very low in mood, or have difficulty sleeping or remembering things
- ringing in your ears (tinnitus), loss of taste, or seeing double, or have any other changes in your sight, smell, taste or hearing
- diarrhoea (perhaps with muscle cramps) that contains blood or mucus – if you have severe diarrhoea without blood or mucus for more than 4 days, you should also speak to a doctor
- a faster or irregular heartbeat, or heartbeats that suddenly become more noticeable (palpitations)
- sudden breathlessness, especially when you’re lying down
- swollen ankles, feet or stomach
- seizures or fits (this side effect can happen if you have epilepsy)
You should discuss the side effects with your doctor or pharmacist if you have any concerns as they will be aware of your medical history.
For further information on resistant UTI please refer to the ‘about antibiotic resistant urinary tract infections’ page.
We can split antibiotics into distinct groups. Which group they belong to will determine which bacteria they are most effective against. Bacteria that cause infection in the urine differ from bacteria that cause skin infections. This will mean that you may be taking two types of antibiotics at the same time to treat each infection.
Antibiotic resistance can develop with inappropriate use, prolonged courses and incorrect doses of antibiotics. However, it is important to treat infections with antibiotics when you develop them. Your doctor or pharmacist will be able to advise you if taking two types of antibiotics at the same time is okay. For further information on antibiotic resistance please refer to the ‘causes of antibiotic resistance’ section on the Antibiotic Research UK website.
Unfortunately, nausea and sickness is a common side effect of taking antibiotics. Having antibiotics via the IV route would not necessarily avoid this side effect. Furthermore, IV antibiotics are not without side effects and should only be used for severe infections that do not respond to oral antibiotics. The most common side effects of IV antibiotics include:
- Rash
- Itching
- Diarrhoea
- Redness at the site of needle
- Nausea/stomach upset
If the symptoms of nausea with antibiotics are severe, your doctor may prescribe anti-sickness medication to help with this. You should always seek advice from your doctor and discuss options that will help with the symptoms and control the side effects of taking antibiotics long term.
Oral thrush is a yeast infection that some people get after taking antibiotics. It is common to get yeast infections after this treatment as it also kills the healthy bacteria that keep yeast under control. This can lead to an overgrowth of the yeast that causes oral thrush even after your course of antibiotics is finished.
Here are some general tips the NHS recommends on how to prevent oral thrush:
- take care of your teeth: brush twice a day, clean your dentures, and go for regular check-ups even if you have dentures
- brush your gums and tongue with a soft toothbrush if you do not have any teeth
- sterilise dummies regularly – for babies
- sterilise bottles after each use – for babies
- rinse your mouth after eating or taking medicine
- go to regular check-ups if you have a long-term condition like diabetes.
If you have further question relating to antibiotics or antibiotic resistance, please contact our patient support team via:
- email: patient.support@antibioticresearch.org.uk
- phone: 07367784114
There are a few options available for bronchiectasis treatment. According to the National Institute for Health and Care Excellence (NICE) the usual course length for antibiotics taken orally is 7-14 days. This is longer than the usual course length of 5 days for a chest infection. The longer course length is usually used to prevent recurrent infections and admission into hospital for severe exacerbations.
Your doctor may also ask for a sputum sample to check whether the infection is caused by bacteria and to ensure that the correct antibiotic is being used to treat the infection.
You can find further information on respiratory tract infections in the patient support section of Antibiotic Research UK website. Please click on the link below:
The research on this is very limited. Reversal of antibiotic resistant infection is not simple, it involves changes within populations rather than individual people. Antibiotic resistance traits can be lost, but this reverse process occurs more slowly and can take a long time. Therefore, it is very important that antibiotics are used appropriately and only for bacterial infections.
You can find further information on antibiotic resistance and UTIs in the patient support section of Antibiotic Research UK website.
Please click on the link below:
There are multiple tests for a recurrent UTI your doctor might ask you to complete. If you are suffering from a recurrent UTI your doctor will ask for a urine sample which will be sent off to a microbiology lab for testing, to test which bacteria is causing the infection. The lab will test the sample against a number of antibiotics to check which antibiotics the bacteria is sensitive to, and then the most appropriate antibiotic can be prescribed to treat the infection.
Furthermore, if you are suffering from recurrent infections that your doctor thinks may be caused by an abnormality in your urinary tract, you may have an ultrasound, a computerized tomography (CT) scan or magnetic resonance imaging (MRI). Please seek further advice from doctor who will be able to advise you best about which tests for your recurrent UTI are necessary based on your history and any medical conditions.
You can learn more about antibiotic resistant UTIs here. Plus, if you need additional help, please reach out to our Patient Support Service.
Sometimes, you may be prescribed a long course of antibiotics for treating your UTI. However, antibiotics should only be taken if there are signs of an active bacterial infection. It is important that urine samples are sent off for microbiology results, to see which bacteria is causing the infection and which antibiotics will be most sensitive to treat the infection.
Recurrent UTIs usually require longer courses of antibiotics as the infection tends to be more difficult to treat. The usual course length of uncomplicated UTI is 3 days. However, your doctor may prescribe a course length of 7 days for a recurrent UTI.
Governing bodies such as NICE and Public Health England have jointly published antimicrobial prescribing guidelines for a range of common infection topics, which include recommendations on the choice, dosage and course length of antibiotics. The guidance reminds prescribers to use the shortest effective course.
It is important that you seek advice from your doctor and ensure that urine samples are being tested routinely if you have a recurrent UTI. Antibiotic course length can differ and your doctor or specialist will be able to decide best what is appropriate based on past infections, your medical history and current symptoms.
If you have an antibiotic resistant UTI, you can find information and support here.
You asked us about hydroxychloroquine interactions with antibiotics, and our experts are here to help.
A recent Medicines and Healthcare products Regulatory Agency (MHRA) drug safety article has published that there is an increased risk of side effects on the heart when hydroxychloroquine or chloroquine is taken at the same time as certain antibiotics.
These antibiotics belong to a group of drugs known as macrolide antibiotics and include antibiotics such as clarithromycin, erythromycin and azithromycin. The MHRA advise “Seek urgent medical help if you have any signs of problems with your heart (for example, palpitations, fainting, chest pain, or unexplained breathlessness)”.
It is important to discuss the safety of taking any antibiotics at the same time as hydroxychloroquine or chloroquine with your doctor. This conversation must occur before starting antibiotics.
You have some options when it comes to the treatment of a frequent UTI. Generally, there will be 3 steps your doctor is likely to take when treating recurrent UTIs:
- Send urine sample for testing and treat infection with a short course of antibiotics.
- Trial preventative treatment with antibiotics, which usually involves low dose of antibiotics given for longer periods of time (months).
- Referral to a specialist (urologist) to investigate further for any underlying causes.
For further information on UTIs please view the patient support service on Antibiotic Research UK website under the specific infection section.
Flare up of COPD can be caused by a chest infection due to either bacteria or viruses. Therefore, it is important to send off a sputum sample for testing before starting antibiotics. If the infection is viral, then antibiotics will not be needed for treatment.
However, your GP will be able to advise you accordingly based on your sample results and symptoms, therefore it is always important to get advice from your GP or healthcare professional before starting antibiotics.
Find out more about what you can do to help prevent the spread of antibiotic resistance.
Phage therapy involves using a specific virus (phage) which can infect the bacteria itself. Currently, it is the view of our science committee that it is still experimental with no evidence-based clinical trials having been undertaken that gave a positive outcome. Phage studies have been conducted more widely in Eastern Europe but not so much in the UK and more clinical trials and research will need to be conducted before we can start to consider it as a treatment option for resistant infections.
You may or may not still have the infection after your UTI treatment. Often the symptoms may be due to residual inflammation as well as habits that formed during the urinary tract infection episode. Many patients report that they are still urinating more frequently than normal and notice this more before bed when they aren’t distracted by something else.
It is important that you get advice from your GP if you still have UTI symptoms after completing your antibiotic treatment. You may require further help if the infection is still present. Further testing maybe required so it is always important to seek advice from your GP.
You should never share your antibiotics with someone else. Different infections can be caused by different bacteria. For example, chest infections and urinary tract (water) infections are caused by very different infection, as are infections of cuts and wounds. Therefore, the antibiotics you are given for one infection might not treat the bacteria that cause your friend or family member’s infection. Some infections are also caused by microbes called viruses (e.g. coughs, colds and most sore throats) and antibiotics do not work against these. Taking antibiotics in this way can promote antibiotic resistance, which can make current and future infections more difficult to treat.
Don’t forget, the antibiotics were prescribed specifically for you and they may not be suitable for your friend or family member due to allergies, other medicines they might be taking, or other underlying health conditions. Instead of sharing your antibiotics, you can reassure them that your antibiotics might not be the right ones and they should see their community pharmacist for minor ailments, or see urgent medical attention from a GP, NHS 111, or urgent care if they are worried.
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. It shows if any resistant bacteria are living in your gut. If they are, health professionals will let you know and also given written information about it. 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.
Please do not dispose of antibiotics in your household waste. Don’t pour them down the sink or flush them down the toilet either! 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. There, the pharmacist will dispose of them safely and free of charge.
Unfortunately yes, there is a connection between antibiotic treatment and sun sensitivity. Some antibiotics (and other medicines) can make you more sensitive to sun exposure. This can cause sun burn and rashes more easily than you normally expect. 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, can also cause sun sensitivity, but less commonly so.
If you have been taking one of these types of antibiotics, protect yourself again sun exposure. 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. 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. It’s recommended that you avoid using sun beds or UV lamps for other beauty purposes until the course has finished and the antibiotics are out of your system.
If you have any concerns, please talk to your doctor. They can offer additional advice on managing sun sensitivity during your antibiotic treatment.
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.
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 culture then this will need to be looked at in detail by your doctor. 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 examinations to find out the cause for your symptoms. Always seek medical advice from your doctor if you are unsure of ongoing symptoms.
If you’re suffering with an antibiotic resistant UTI, you have our sympathies. But, you are not alone. Our Patient Support Service is available to patients and their families to help them manage the ongoing condition. We offer a range of resources to give you answers and reassurance. Find out more here.
UTI treatments for men 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, 3 days for women.
It is always important to consultant your doctor about course length of antibiotics. Your treatment will be customised to 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:
- Diabetes
- 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.
We do not advise stopping a course of antibiotics early without first seeking medical advice from a professional. 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.
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.
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 Clostridium difficile 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 infection; 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: 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 Clostridium difficile infection 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 a Clostridium difficile infection.
Diarrhoea caused by taking antibiotics occurs in up to a quarter of people. It 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.
Do you find yourself asking why your dentist won’t prescribe a antibiotics for toothache? It’s likely because toothache is often caused by tooth inflammation rather than infection. Analgesics such as paracetamol and ibuprofen treat inflammatory pain. Antibiotics do not fix the tooth inflammation so aren’t effective for treating toothache.
In some cases, you might have a bacterial infection associated with a dead tooth (a dental abscess). But, antibiotics are still not usually the right treatment. 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 a dental antibiotic is required to treat tooth pain caused by a severe infection, they should be used along with a dental procedure. Taking antibiotics unnecessarily increases the chance that they will not work for an infection in the future. If you were to suffer with sepsis or pneumonia in later life, you will need antibiotic treatment, so why risk antibiotic resistance today?
When you have tooth pain, visit your dentist so they can diagnose the cause. They’ll then offer the most effective solution for treating your toothache. 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.
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 who can also get bacterial illness. So, sometimes your dog might need 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.
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.
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.
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 when drying laundry indoors. 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. Healthy gut bacteria are vital to help build up the immune system. So, in some cases, there is the cause for concern over immune system recovery times following a course of antibiotics.
One study shows that the makeup and function of gut bacteria can mostly recover after antibiotic treatment in healthy people. So, that means we are able to regenerate our gut bacteria and environment which is important for our general health. How long immune system recovery takes after a course of antibiotics depends on the person.
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. Make sure to only take antibiotics when absolutely necessary. There are lots of little changes you can make to help prevent further antibiotic resistance. We’re working hard to raise awareness for antibiotic resistance, create new treatments and support patients living with resistant infections.
Both vaccines and antibiotics and are very useful in helping us stay healthy. But, there are several key differences between vaccines and antibiotics that we think you should know.
Vaccines offer protection against potential future infection. They 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 again. This means 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. Some bacteria have developed antibiotic-resistant strains, like Methicillin-resistant Staphylococcus aureus (MRSA), ESBL E Coli or Carbapenem Resistant Enterobacteriaceae (CRE). This means that certain antibiotics are now ineffective.
You can read more about drug-resistant bacteria here, discover how Antibiotic Research UK is tackling this problem, and learn a little more about bacterial vaccines here.
Blood poisoning or septicaemia are both terms which refer to the invasion of bacteria into the bloodstream causing severe infection. Sepsis is a rarer, 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
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