History Main / MagicalAntibiotics

** Choosing antibiotic therapy for as-yet unidentified infections poses yet another wealth of traps for the physician. For example, vancomycin, commonly used as a one-stop bug bomb for skin and soft tissue infections, is deadly to practically all Gram-positive organisms but practically no Gram-negatives. The choice of antibiotics for pneumonia changes quite a bit depending on whether the patient has recently spent time in a hospital or nursing home. Gastrointestinal organisms behave very differently in skin and soft tissue versus their home tract. The general wisdom is to treat with the most effective and narrowest spectrum antibiotic you can; when you don't know the specific infection's resistance, you make an educated guess as to which antibiotics should cover the most common causative organisms. (Hospitals are GenreSavvy to this, and one of the jobs of the hospital's infection control department is to create and publish an "antibiogram" - a comprehensive chart of the most common bugs in the community and which drugs they're sensitive and resistant to.)

** It's worth pointing out that antibiotic resistance is complicated. It's not like all bacteria resist the same things. Penicillin is often useless against ''Staphylococcus aureus'' but great for ''Streptococcus pyogenes'' pharyngitis (a/k/a "strep throat")... but useless again for ''S. mitis.'' Tigecycline is rarely resisted but won't work against any ''Pseudomonas'' due to quirks of the bacteria's biology; cefepime is quite commonly resisted by many bacteria but works great against ''Pseudomonas.'' Giving clindamycin to a patient can actually increase the risk of ''Clostridium difficile'' infection. You treat ''C. difficile'' with metronidazole, and metronidazole is used for vaginosis as well... and may cause ''Mobiluncus'' vaginosis. And so on. Treatment isn't easy or obvious.

Any time a character develops an illness of any variety whatsoever, the medical provider will immediately insist upon throwing all manner of high-powered antibiotics at the patient in order to treat the "infection." This is a colossal fail, as there are thousands of species and dozens of classes of infectious organisms - bacteria, viruses, protozoans, fungi, yeasts, helminths [worms], parasites not otherwise specified, and so on. Of those, only bacteria are susceptible to antibiotics, and then only if that particular bacterial strain is sensitive to the prescribed antibiotic (notable examples include MRSA, methicillin-resistant ''Staphylococcus aureus,'' and VRE, vancomycin-resistant ''Enterococcus'').

** Choosing antibiotic therapy for as-yet unidentified infections poses yet another wealth of traps for the physician. For example, vancomycin, commonly used as a one-stop bug bomb for skin and soft tissue infections, is deadly to practically all Gram-positive organisms but practically no Gram-negatives. The choice of antibiotics for pneumonia changes quite a bit depending on whether the patient has recently spent time in a hospital or nursing home. Gastrointestinal organisms behave very differently in skin and soft tissue versus their home tract. The general wisdom is to treat with the most effective and narrowest spectrum antibiotic you can; when you don't know the specific infection's resistance, you use whatever it's known to have very low rates of resistance to. And when you don't even know what the infecting organism is, you use broad-spectrum antibiotics, often in combination, until you do.
** It's worth pointing out that antibiotic resistance is complicated. It's not like all bacteria resist the same things. Penicillin is often useless against Staph aureus but great for Strep pyogenes pharyngitis (that's Strep throat)... but useless again for Strep mitis. Tigecycline is rarely resisted but won't work against any Pseudomonas due to quirks of the bacteria's biology; cefepime is quite commonly resisted by many bacteria but works great against Pseudomonas. Giving clindamycin to a patient can actually increase the risk of C. difficile infection. You treat C. difficile with metronidazole, and metronidazole is used for vaginosis as well... and may cause Mobiluncus vaginosis. And so on. Treatment isn't easy or obvious.
* Many people will demand antibiotics from doctors for common ailments like colds or influenza. Although those are viral and antibiotics won't help, doctors often give in.

* Antiviral rather than antibiotic, but in ''{{Outbreak}},'' Robbie contracts the Motaba virus and is on the brink of death before they administer the virus' antiserum. She is almost completely recovered after only a day. In reality, this is far too soon to recover from a hemorrhagic fever, which causes massive internal bleeding and organ failure.

* Sadly prevalent in real life medicine, as providers frequently don't want to wait to culture an organism before attempting to treat it. A major cause of the explosion in the rates and severity of multidrug-resistant bacterial infections.
** Furthermore, it looks kind of bad if your patient dies of his infection before the culture comes back. Generally, doctors will prescribe the weaker broad-specturm antibiotics such as Amoxicillin or Azithromycin as empiric therapy, and only moving on to the harder and more specific drugs (like Vancomycin) when the culture comes back or if the patient fails to respond the therapy
*** That's not quite right. Vancomycin is actually not very powerful, but it's very broad (sort of—it covers almost all gram positive bacteria but no gram negatives). The problem is that amoxicillin is a penicillin and thus many common bacteria are resistant. Vancomycin is used in so-called empiric therapy: when you don't know what it is, you treat it with what you'll be sure will work. When the culture comes back you may switch to nafcillin (for non-MRSA). Doxycycline is also very broad spectrum, but not used quite as often in unknown illness because, again, resistance is rampant. The general wisdom is to treat with the most effective and narrowest spectrum antibiotic you can; when you don't know the specific infection's resistance, you use whatever it's known to have very low rates of resistance to. And when you don't even know what the infecting organism is, you use broad-spectrum antibiotics, often in combination, until you do.

***** Wrong , Vancomycin is a very specific drug, given only to specific organisms like Enterococcus, MRSA(Meticillin Resistant Staph-Aureus) etc. Its costly too. No one prescribes it empirically, and if they did, they are very bad doctors. Amoxyxillin and Ampicillin on the other hand are "expanded spectrum penicllins"(note that they are only expanded spectrum and not a full blown broad spectrum antibiotics) and are effective against Gram positive organisms(like usual narrow spectrum penicillins) and some gram negative organisms too like E.coli, Salmonella(and hence the term expanded spectrum antibiotics). One problem though is that resistance to Amoxycillin(and indeed the Penicillin) is so widespread that they are no loner effective on their own and are often combined with Clavulunic acid(which has no antibiotic action on its own but offers some protection against the enzymes which degrade Penicillins and hence make them active). But there are some Gram positive bacteria which have developed resistance to the entire family of penicillins as such- Namely the Meticillin resistant Staph Aureus or MRSA. Now Vancomycin is used in case of MRSA. Unfortunately, due to over use of Vancomycin, Even Vancomycin Resitant Staph Aureus(VRSA) have emerged. They are treated with Linezolid.
*** One basic case is when someone is dragged into an ER unconscious, in apparent septic shock. They're dying, and you need to treat bacteremia immediately. What do you do? Throw several broad-spectrum antibiotics at it, even when the side effects are significant.
*** It's worth pointing out that antibiotic resistance is complicated. It's not like all bacteria resist the same things. Penicillin is often useless against Staph aureus but great for Strep pyogenes pharyngitis (that's Strep throat)... but useless again for Strep mitis. Tigecycline is rarely resisted but won't work against any Pseudomonas due to quirks of the bacteria's biology; cefepime is quite commonly resisted by many bacteria but works great against Pseudomonas. Giving clindamycin to a patient can actually increase the risk of C. difficile infection. You treat C. difficile with metronidazole, and metronidazole is used for vaginosis as well... and may cause Mobiluncus vaginosis. And so on. Treatment isn't easy or obvious.
** Treating before culturing plays a small role in the spread of resistance. As long as all the bacteria die, though, it's not so bad. Starting a treatment and failing to finish the course is much worse.

**** Wrong , Vancomycin is a very specific drug, given only to specific organisms like Enterococcus, MRSA(Meticillin Resistant Staph-Aureus) etc. Its costly too. No one prescribes it empirically, and if they did, they are very bad doctors. Amoxyxillin and Ampicillin on the other hand are "expanded spectrum penicllins"(note that they are only expanded spectrum and not a full blown broad spectrum antibiotics) and are effective against Gram positive organisms(like usual narrow spectrum penicillins) and some gram negative organisms too like E.coli, Salmonella(and hence the term expanded spectrum antibiotics). One problem though is that resistance to Amoxycillin(and indeed the Penicillin) is so widespread that they are no loner effective on their own and are often combined with Clavulunic acid(which has no antibiotic action on its own but offers some protection against the enzymes which degrade Penicillins and hence make them active). But there are some Gram positive bacteria which have developed resistance to the entire family of penicillins as such- Namely the Meticillin resistant Staph Aureus or MRSA. Now Vanco mycin is used in case of MRSA. Unfortunately, due to over use of Vancomycin too, Even Vancomycin resitant Staph Aureus have emerged.

* In the last section of ''Literature/TheStand'', Stu Redman comes down with the flu. Tom Cullen, on the advice of his dead friend, finds some antibiotics and cures him. While Tom saving Stu's life is a CrowningMomentofHeartwarming, antibiotics don't cure the flu (a viral infection), and the antibiotics would be several months out of date, as it's after TheEndofTheWorldAsWeKnowIt.

*** That's not quite right. Vancomycin is actually not very powerful, but it's very broad (sort of—it covers almost all gram positive bacteria but no gram negatives). The problem is that amoxicillin is a penicillin and thus many common bacteria are resistant. Vancomycin is used in so-called empiric therapy: when you don't know what it is, you treat it with what you'll be sure will work. When the culture comes back you may switch to nafcillin (for non-MRSA). Doxycycline is also very broad spectrum, but not used quite as often in unknown illness because, again, resistance is rampant. Basically, the general wisdom is to treat with the most effective and narrowest spectrum antibiotic you can; when you don't know the specific infection's resistance, you use whatever it's known to have very low rates of resistance to. And when you don't even know what the infecting organism is, you use broad-spectrum antibiotics, often in combination, until you do.

* Related are anti-bacterial soaps or cleaning agents. They are claimed to wipe out infectious bacteria, but the only way to guarantee killing bacteria is to maintain 20 minutes of exposure. Washing your hands or 30 seconds only destroys bacteria with the weakest resistance, and later generations of bacteria will evolve with better resistance to them.

** This is true [[TruthInTelevision in real life]].
*** Especially so if the patient has been brought to the ER with suspected bacterial meningitis. (Viral meningitis can be so mild you might just think you have a nasty headache.) If the doctors do not start broad-spectrum antibiotic therapy ''immediately'', they may well lose the patient quite swiftly - they do this to keep the patient alive while they take blood and CSF (yay for needles in your spine) to find out what the bacteria actually is so they can aim their antibiotic to the particular bug. This mass-antibiotic is known as Empiric Therapy.
*** Meningitis itself - nasty disease that swells the lining of the brain, alters consciousness and in the case of some bacterial forms, comes hand in hand with septicaemia. Every time this troper's seen it on TV they have only started panicking once the rash appears, that red rash that won't disappear under a glass!! Three things: 1. the purpuric rash is generally appears only in bacterial meningitis and is a sign of severe internal bleeding, meaning that 2. if you haven't started treatment by the time the rash appears you might be way too late, and 3. while rather specific as a symptom, meningitis is not the only disease that has this rash. Seriously, don't look for the rash; the four major symptoms to watch for are fever, a stiff neck, dislike of bright lights and a severe headache. On that note, be doubly sure about the fever (since otherwise your friend could just have a hangover).

*** Well, yes and no. In the rare cases where the team actually treats for cancer, the precise medicines used are very often not mentioned. More recently, House has been in the habit of just turning cancer patients over to Wilson (an oncologist) if cancer is the final diagnosis, or having Wilson come in on the case and make the possible prescriptions if it isn't.

** Cultures take a couple of days, so the doctors use empiric treatment for the more common bacteria, while they wait for the results of the culture. For any disease causing a high fever, waiting for the cultures before treating it would leave the doctor knowing exactly what drug to use on a patient who'd been dead for days. There are PCR antigen analyses available for some pathogens that are accurate within hours, but they generally don't show up in day-to-day practice due to their overwhelming expense and lack of insurance reimbursement. A few notable exceptions to this rule include influenza, respiratory syncytial virus, ''Clostridium difficile'' and ''Streptococcus'' - all exceptionally common diseases for which the test achieves an economy of scale.
** Antibiotics being given when the doctor ''knows'' it's the common cold. Sure, some say it's to protect against "secondary infections", but really it's done so they can [[ViewersAreMorons give some sort of prescription]] to a patient - or more commonly, [[MeddlingParents to a pediatric patient's parent]] - insisting on one.
*** Some pediatricians and family practice providers are starting to avert this by giving "supportive therapy" prescriptions for acetaminophen PRN, rest and oral fluids to patients with known viral diseases such as common colds and flu, and "watchful waiting" prescriptions for likely viral problems like ear infections and sinusitis - the patient goes home with a script to be filled only if the symptoms worsen within a three-day period. Patients, by and large, are not impressed by this practice and will actually doctor-shop, going to multiple providers over several days until they find someone who'll write them that magic script.

** Of course antibacterial treatments ''might'' protect from secondary pneumonia and similar killers piggybacking on the 'flu ... but given that they didn't even have sulfa drugs operational in 1918, you really would have been whistling in the dark injecting anything.
*** In the case of the 1918 pandemic, this would've probably been counterproductive, since what made that flu strain so lethal was probably that it induced cytokine storms in sufferers which turned their own immune systems against them. Having a weakened immune system during the pandemic could actually have been a benefit because the cytokine storms would've been less severe. Of course it's important to note that the doctors dealing with the 1918 pandemic couldn't possibly be aware of this.
** At least they were still 10 years away from discovering antibiotics. If they had those for the Spanish flu, MRSA would've become a problem by 1920.
** Lest history judge them too harshly, when 20-50 million people are dying out of a population of about 1 billion, anything which current theory suggests might help will be tried. Given the number of people killed, the number afflicted was staggering and pretty much uncountable.

** And recent studies also have shown that our immune system actually ''needs'' exposure to a some mild level of external bacterial (and) viral pressure to normally function. It tends to go haywire in sterile conditions, resulting in a recent slew of allergies and autoimmune diseases brought in by our current germ-hating environment.

There ''are'' antifungal, antiviral and antiparasitic drugs, but these are hardly ever mentioned in fiction (except in medical fiction where they're likely to be a plot point). See also MagicAntidote.
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!!Examples:
[[foldercontrol]]

[[folder:Film]]
* Antiviral rather than antibiotic, but in ''{{Outbreak}},'' Robbie contracts the Motaba virus and is on the brink of death before they administer the virus' antiserum. She is almost completely recovered after only a day. In reality, this is far too soon to recover from a hemorrhagic fever, which causes massive internal bleeding and organ failure.

[[folder:LiveActionTV]]
* Played with on ''Series/{{House}}'': first prescribe the most widely useful antibiotics, then find out what they actually have before the patient's kidneys shut down because of the antibiotics.
** This is true [[TruthInTelevision in real life]].
*** Especially so if the patient has been brought to the ER with suspected bacterial meningitis. (Viral meningitis can be so mild you might just think you have a nasty headache.) If the doctors do not start broad-spectrum antibiotic therapy ''immediately'', they may well lose the patient quite swiftly - they do this to keep the patient alive while they take blood and CSF (yay for needles in your spine) to find out what the bacteria actually is so they can aim their antibiotic to the particular bug. This mass-antibiotic is known as Empiric Therapy.
*** Meningitis itself - nasty disease that swells the lining of the brain, alters consciousness and in the case of some bacterial forms, comes hand in hand with septicaemia. Every time this troper's seen it on TV they have only started panicking once the rash appears, that red rash that won't disappear under a glass!! Three things: 1. the purpuric rash is generally appears only in bacterial meningitis and is a sign of severe internal bleeding, meaning that 2. if you haven't started treatment by the time the rash appears you might be way too late, and 3. while rather specific as a symptom, meningitis is not the only disease that has this rash. Seriously, don't look for the rash; the four major symptoms to watch for are fever, a stiff neck, dislike of bright lights and a severe headache. On that note, be doubly sure about the fever (since otherwise your friend could just have a hangover).
** This trope also applies to cancer treatments. While in reality there are dozens of families of antineoplastic drugs, any of which is only effective and used on a handful of specific cancers, House's team is fond of using one-size-fits-all chemotherapy.
*** Well, yes and no. In the rare cases where the team actually treats for cancer, the precise medicines used are very often not mentioned. More recently, House has been in the habit of just turning cancer patients over to Wilson (an oncologist) if cancer is the final diagnosis, or having Wilson come in on the case and make the possible prescriptions if it isn't.
** House is one of those rare examples in fiction that acknowledges the existence of separate treatments for fungal and parasitic infections.
* Averted in a Jon Pertwee ''Series/DoctorWho'' story which has a major subplot about a deadly plague being released by the story's antagonists. The Doctor and Liz Shaw eventually find a cure by literally going through every single available antibiotic drug to see if it works in lab conditions. In the meantime the best they can do is use high doses of broad-spectrum antibiotics which are just effective enough to delay the plague's symptoms, and a character notes that this policy is causing severe side effects.
* Averted in ''Series/CombatHospital''. In the second episode, the antibiotics the hospital staff keep doling out have no effect on a local strain of bacteria.

[[folder:RealLife]]
* Sadly prevalent in real life medicine, as providers frequently don't want to wait to culture an organism before attempting to treat it. A major cause of the explosion in the rates and severity of multidrug-resistant bacterial infections.
** Cultures take a couple of days, so the doctors use empiric treatment for the more common bacteria, while they wait for the results of the culture. For any disease causing a high fever, waiting for the cultures before treating it would leave the doctor knowing exactly what drug to use on a patient who'd been dead for days. There are PCR antigen analyses available for some pathogens that are accurate within hours, but they generally don't show up in day-to-day practice due to their overwhelming expense and lack of insurance reimbursement. A few notable exceptions to this rule include influenza, respiratory syncytial virus, ''Clostridium difficile'' and ''Streptococcus'' - all exceptionally common diseases for which the test achieves an economy of scale.
** Antibiotics being given when the doctor ''knows'' it's the common cold. Sure, some say it's to protect against "secondary infections", but really it's done so they can [[ViewersAreMorons give some sort of prescription]] to a patient - or more commonly, [[MeddlingParents to a pediatric patient's parent]] - insisting on one.
*** Some pediatricians and family practice providers are starting to avert this by giving "supportive therapy" prescriptions for acetaminophen PRN, rest and oral fluids to patients with known viral diseases such as common colds and flu, and "watchful waiting" prescriptions for likely viral problems like ear infections and sinusitis - the patient goes home with a script to be filled only if the symptoms worsen within a three-day period. Patients, by and large, are not impressed by this practice and will actually doctor-shop, going to multiple providers over several days until they find someone who'll write them that magic script.
* Dr. Drew Pinsky noted on an episode of ''Loveline'' that azithromycin (known best under the brand name Zithromax) is frequently given as a catch-all treatment, and estimated that it was the appropriate treatment for maybe 10% of those cases in which he's seen it prescribed.
* The 1918 influenza pandemic. At least in the US, doctors tended to jab untested or marginally tested "vaccines" into as many arms as they could manage in the hopes that this time, they had it right. (Given that medical science of the early 1900s assumed that influenza was a ''bacterial'' disease, any cures would have been accidental.)
** Of course antibacterial treatments ''might'' protect from secondary pneumonia and similar killers piggybacking on the 'flu ... but given that they didn't even have sulfa drugs operational in 1918, you really would have been whistling in the dark injecting anything.
*** In the case of the 1918 pandemic, this would've probably been counterproductive, since what made that flu strain so lethal was probably that it induced cytokine storms in sufferers which turned their own immune systems against them. Having a weakened immune system during the pandemic could actually have been a benefit because the cytokine storms would've been less severe. Of course it's important to note that the doctors dealing with the 1918 pandemic couldn't possibly be aware of this.
** At least they were still 10 years away from discovering antibiotics. If they had those for the Spanish flu, MRSA would've become a problem by 1920.

[[folder:VideoGames]]
* ''[[SuperMarioBros Dr. Mario]]''. Thankfully, he has the cure.

* Played with on ''{{House}}'': first prescribe the most widely useful antibiotics, then find out what they actually have before the patient's kidneys shut down because of the antibiotics.

* Averted in ''CombatHospital''. In the second episode, the antibiotics the hospital staff keep doling out have no effect on a local strain of bacteria.