Prescription for antibiotics

I suggest that if we simply reduced our usage of the word “antibiotic,” and instead used the word, “antibacterial”, the evolution of drug-resistant strains of bacteria would slow. The reason is that many people (most people, in some countries) think antibiotics are effective against viruses and they pressure their doctors for prescriptions.

Why do so many people think antibiotics kill viruses? To most people, the word “antibiotic” sounds like exactly like the kind of drug that might be effective against all types of organisms, even viruses.  That’s because the word is composed of the roots, “anti” and “biotic“, which together mean, “kills life.” That’s not an accident, of course — once upon a time, that’s exactly what the word meant.  For example, here’s a screenshot of a 1901 book (The American Illustrated Medical Dictionary, by William Alexander Newman Dorland):

Definition of antibioticThe above view is mirrored on Google, which defines antibiotics as able to destroy microorganisms (to most, that includes viruses).

Definition of antibioticHundreds of other print and online definitions also suggest broad efficacy of antibiotics (i.e., beyond bacteria). Together with the original meaning of the word, it’s really no surprise that the public persists in believing that “antibiotics” can actually treat viral and other non-bacterial infections. (Even script writers for The Walking Dead think so.)

When and why did the word “antibiotic” change meaning? The answer is that a microbiologist in the 1940s (details) started using “antibiotics” in a new way, one that restricted the efficacy of the compounds to only bacteria. Biologists and physicians adopted this usage. The problem is that the rest of the populace still retains the original definition. This is not a rare situation: 32% of Americans, 43% of UK citizens, and 60% of Europeans believe (incorrectly) that antibacterials are effective against viruses.

Therefore, to easily reduce the over-prescription of antibacterials, the obvious first step would be for physicians to avoid using the word “antibiotic,” and instead opt for the word “antibacterial”. “Antibacterial” (the word) has been around since 1890s, so it’s not like I’m proposing anything shocking here. Here’s a graphic that displays how “antibacterial” already fits in nicely with the names of other anti-infectives:Diagram of different anti-infective drugsAdmittedly, getting certain people to drop the use of “antibiotic” might take some time. All the entities fighting resistance are composed of microbiologists, physicians, and other over-educated types who have grown up using the word “antibiotics.” They would be likely to view my suggestion as silly. Getting them on board would be easier if I had data, so if you happen to do research on public misconceptions over science, I would be truly grateful if somebody could conduct a poll that looks at word choice on respondents’ beliefs. My hypothesis is that if you asked people either, (1) “Are antibacterials effective against viruses?” or (2) “Are antibiotics effective against viruses?”, the percentage answering “yes” to (1) would be a measurably lower number. It would make for an easy publication and would help motivate others (CDC, e.g.) to consider moving away from the word “antibiotics” in public health outreach. It would be an almost cost-free action that could help reduce the evolution of resistant strains of bacteria.

If you’re an internist or pediatrician, below is a downloadable graphic you can print and hang on your wall for patients to see. Or print it poster size and hang in the waiting room.

guide to anti-infective drugs

8 Responses to Prescription for antibiotics

  1. Asem Shehabi says:

    I agree 100% with proper use of antibacterial drugs instead antibiotics which may confuse uneducated person on the correct meaning of antibiotics.

  2. Yerg says:

    Colin, I agree with you. I really like the poster which links common names such as “cold” with infectious agents such as “virus”. What I agree with is asking the public to colude on solving the problem rather than protecting ones own sense of superiority by pretending that one is explaining and perhaps ENJOYING the continued ignorance. Ironically, I would wager that more people would if you were being agreeable about it. Inspiring is a better plan than convincing. Could you try asking doctors to colude with you on changing the misleading name of this set of infection fighting agents rather than trying to get the public to remember not to be misled by the popular name?

  3. Jan Wegner says:

    Unfortunately you’re assuming most people know the difference between bacteria and viruses. They don’t. Just ask them.

    • Oh, believe me, I agree. I’ve met doctors who don’t know the difference, though when pressed they suddenly remember and are embarrassed. Switching to “antibacterial” and “antiviral” in outreach programs and in doctors’ offices would be a better approach to educating the public. Currently the battle is BOTH the confusion about bacteria vs virus AND confusion about what antibiotics actually work on. My proposal is to eliminate the “antibiotic” confusion INSTANTLY, simply by using “antibacterial”, instead.

  4. Kelsey says:

    I stumbled to this page from your articles about poster design. I totally agree. I think this is a fantastic suggestion. I’m a physician and I’m telling my friends.

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