SPECIAL FEATURE
May-2026 1 Expression
The myths fueling antimicrobial resistance
And what you should know instead
ShareAntibiotics have saved thousands of lives, but their misuse is now causing a serious problem: antimicrobial resistance (AMR). It develops when bacteria evolve to withstand the medicines that are used to kill them. In India, resistant infections cause more than a million deaths every year.
To understand why antibiotic misuse remains widespread, let us examine five common myths about the use of antibiotics and the key facts that dispel them.
Myth 1: Yellow phlegm means you need antibiotics
What people think:
If your cough produces yellow phlegm, it is likely a bacterial infection that requires antibiotics.
The truth:
Most respiratory infections, such as colds, sore throats, and bronchitis, are caused by viruses, not bacteria. Antibiotics do not work against viruses.
The color of phlegm reflects the immune system’s response to an infection, not the type of germ causing the illness. Even viral infections can cause yellow or green phlegm.
What to remember:
Most coughs lasting less than a week do not need antibiotics.
Seek medical advice if symptoms persist or worsen.
Professional strategies (for doctors):
- Use symptom-based diagnosis: Assess history, exposure, and exam findings rather than relying on sputum color.
- Avoid routinely prescribing antibiotics for coughs lasting under 7 days, unless red flags appear.
- Order tests only for persistent or worsening symptoms.
- Educate patients clearly: Reinforce that colored phlegm does not mean bacterial infection.
Myth 2: Stronger or broader-spectrum antibiotics always work better
What people think:
“Powerful” or broad-spectrum antibiotics will cure infections faster.
The truth:
Antibiotics can be narrow-spectrum, targeting specific bacteria, or broad-spectrum, acting against many types of bacteria.
When the right, targeted antibiotic is used, it treats the infection effectively while leaving the body’s helpful bacteria (especially in the gut) largely unharmed.
In contrast, broad-spectrum antibiotics disrupt the natural balance of your body’s bacteria. Such disruption can cause severe diarrhea and allow harmful bacteria to proliferate. It also promotes bacterial resistance and the transfer of that resistance among bacteria.
In India, the overuse of broad-spectrum antibiotics, especially for simple infections such as urinary tract infections, has led to a sharp rise in antibiotic-resistant bacteria, making common infections more difficult to treat.
What to remember:
The “right” antibiotic is better than the “strongest” one.
Professional strategies:
- Prescribe antibiotics based on the specific infection.
- Use narrow-spectrum antibiotics whenever suitable.
- Use culture results to guide therapy when possible.
- Review and refine treatment: Adjust antibiotics within 48 hours based on response or lab data.
Myth 3: Antibiotic resistance only affects the individual user
What people think:
Misuse of antibiotics only harms the individual user.
The truth:
Resistant bacteria spread between people, animals, and the environment through contact, water, food, and healthcare facilities.
Poor sanitation, environmental contamination, and widespread antibiotic use in animals all drive this spread. Resistance can quickly spread from one person to many, including in hospitals, leading to outbreaks.
What to remember:
Antibiotic resistance is a shared public health problem, not a personal one. Your antibiotic use can impact others.
Professional strategies:
- Strengthen infection control practices: Enforce hand hygiene and precautions in clinical settings.
- Communicate community risk: Explain that resistance spreads beyond the individual.
- Support ‘One Health’ efforts: Encourage careful antibiotic use in all health domains.
- Promote public education on antibiotic resistance.
Myth 4: Stop antibiotics when you feel better
What people think:
If symptoms improve, you can stop completing the full course of the medicine.
The truth:
Stopping antibiotics too early can leave behind resistant bacteria that survive treatment. These bacteria can rapidly multiply and cause the infection to recur, often in a more severe, harder-to-treat form.
Taking antibiotics at too low a dose or for too short a time also gives bacteria a chance to adapt and become resistant. This is why some infections, such as urinary infections, may stop responding to medicines that previously worked.
What to remember:
Always complete the full course of antibiotics as prescribed.
Professional strategies:
- Prescribe appropriate durations: Prescribe shorter, evidence-based courses when effective (example, uncomplicated UTI (~3 days); community-acquired pneumonia (~5 days).
- Emphasize adherence: Instruct patients to complete the full treatment, regardless of symptom improvement.
- Use adherence aids: Recommend reminders such as pill schedules or follow-up messages.
- Monitor treatment completion: Check adherence during follow-ups.
- Reinforce stewardship: Poor adherence increases resistance risk by about 50%, but effective antibiotic stewardship practices can reduce that risk by about half.
Myth 5: Over-the-counter (OTC) antibiotics are safe and convenient
What people think:
Buying antibiotics without a prescription is safe, convenient, and harmless.
The truth:
A significant portion of antibiotic use in India happens without proper prescriptions. An estimated 40% to 50% of antibiotic sales in the country are over-the-counter (OTC).
Self-medication often results in unsuitable drug selection, incorrect dosing, and improper duration, driving antimicrobial resistance and breeding community reservoirs.
What to remember:
Take antibiotics only if prescribed by a qualified doctor.
Professional strategies:
- Advocate for strict enforcement of prescription-only antibiotic regulations (e.g., Schedule H1).
- Engage pharmacists: Promote pharmacist training in infection control dispensing.
- Use clinical decision tools: Apply scoring systems to guide antibiotic prescribing.
- Promote structured triage in OPDs: Use standardized protocols to prevent unnecessary antibiotic use.
How can each of us contribute to the fight against AMR?
Fighting antibiotic resistance calls for everyone’s participation.
- Patients: Follow prescriptions exactly and avoid self-medication.
- Doctors: Prescribe antibiotics only when necessary.
- Pharmacists: Do not dispense antibiotics without a prescription.
- Community: Practice good hygiene and sanitation.
The bottom line
Antibiotics are powerful tools, but they must be used correctly. Misuse will make infections untreatable.
Actively challenging the myths associated with antibiotics is essential to protecting everyone’s health.
[Dr. A. Rajalakshmi is a Senior Consultant in ID and Group Lead in AMS and IPC, KIMSHEALTH, Trivandrum.]
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