As part of LUMA’s internal medical team, Dr. Shun Pyae Min highlights how the misuse of antibiotics fosters resistance, posing a threat not only to the individual but to the community as a whole.
After six years in general practice and now working with LUMA’s insurance medical team, I’ve seen a pattern that continues to concern me deeply: antibiotics have become the default response to almost any fever or illness. Despite years of health education campaigns across Southeast Asia and beyond, this misconception remains widespread. It is time to clearly explain what antibiotics are meant to do — and what they are not.
The Misconception That Won’t Die
One of the most persistent problems in everyday clinical practice is the belief that antibiotics help with any febrile illness. They do not. Antibiotics are not supplements like vitamins, nor are they general “strengthening” medicines. They are treatment drugs designed to target bacteria — and only bacteria.
In many parts of our region, antibiotics remain easy to obtain without proper medical oversight. This leads to self-medication for conditions that are often viral in origin, where antibiotics offer no benefit at all.
Many common illnesses, particularly acute respiratory infections, are caused by viruses rather than bacteria. Viruses spread easily through coughing, sneezing, and close respiratory contact. They replicate inside our cells using our cellular machinery; some, such as retroviruses, can integrate genetic material into host DNA. Bacteria behave very differently — they can reproduce independently and cause disease by acting on tissues from the outside. This distinction matters because antibiotics are only effective against bacteria. They have no effect on viruses.
When Guidelines Meet Reality
At LUMA, our medical team reviews claimed cases from two key perspectives: adherence to policy terms and compliance with established clinical guidelines. This is not about being intrusive. It is about ensuring that medical treatment is necessary, appropriate, and evidence-based — the same questions patients should feel empowered to ask about their own care.
Clinical guidelines recommend a structured approach to antibiotic selection. Antibiotics are categorized into first-line, second-line, and third-line options based on their effectiveness, safety profile, and resistance patterns. First-line antibiotics — most commonly oral medications — are preferred because they provide the best balance between benefit and risk. They are commonly used, and can also be used empirically, when the exact causative organism is not yet known.
Second- and third-line antibiotics are reserved for specific situations: when first-line treatment fails, when bacteria are known or strongly suspected to be resistant, or when patient-specific factors require alternative options.
The important point is that escalation to second- or third-line antibiotics means accepting higher risks relative to benefits. These drugs may be more targeted or broader in spectrum, but they often carry a greater risk of systemic side effects involving the liver, kidneys, or lungs, as well as more significant drug interactions.
The Vicious Cycle Nobody Talks About
Another issue that receives far less attention is the effect of antibiotics on the gut microbiome — the beneficial bacteria that naturally live in our intestines. These organisms are not passive bystanders. They actively compete with harmful bacteria for space and resources, helping to limit infection severity. They also play an important role in immune regulation, helping the body distinguish between harmful and harmless exposures.
When antibiotics repeatedly disrupt this gut flora, several problems can follow. The loss of beneficial bacteria weakens the body’s natural defenses against food-borne pathogens and new infections. Disruption of gut bacteria has also been associated with impaired immune regulation and an increased susceptibility to infections and immune-related conditions.
This creates a vicious cycle: an infection leads to antibiotic use; antibiotics disrupt gut flora; this disruption contributes to increased vulnerability to further infections; more antibiotics are prescribed; and the cycle continues. Over time, some patients find themselves hospitalized repeatedly, despite seemingly “doing everything right.”
Hidden Risks Beyond Resistance
Antibiotic resistance is widely discussed — and rightly so. Resistance does not only affect the individual taking antibiotics. Resistant bacteria multiply and spread, creating a public health problem that affects entire communities.
There are also less visible risks. The body can react to antibiotics in ways that closely resemble illness itself — rashes, headaches, nausea — making adverse reactions difficult to recognize early. In rare cases, antibiotic reactions can progress to Stevens-Johnson Syndrome, a life-threatening condition characterized by severe skin and mucosal injury. This condition has been associated with certain antibiotics, including some broad-spectrum agents.
When the skin barrier is compromised, patients become vulnerable to secondary infections and may require care in specialized, controlled hospital environments. In addition, the offending antibiotic can often no longer be used, limiting future treatment options and making subsequent infections more difficult to manage.
The IV Question: When Less Invasive Is Better
A fundamental principle in medicine is to choose the least invasive effective treatment whenever possible. Despite this, IV antibiotics are sometimes used even when oral therapy would be safer and sufficient.
For patients, it is important to understand that when IV antibiotics are prescribed for a minor illness, this usually reflects second- or third-line treatment. There should be a clear medical reason — not only for choosing the IV route, but for selecting that specific antibiotic. Valid reasons may include documented local resistance patterns that make first-line oral options ineffective.
IV antibiotics carry risks beyond the drug itself. Every needle puncture introduces the possibility of bacteria entering the bloodstream. There is also a risk of air embolism, which can be particularly dangerous for patients with underlying heart conditions. More importantly, IV medications bypass the body’s normal absorption and regulatory processes. Oral antibiotics are absorbed gradually through the gastrointestinal tract, allowing tolerance and response to be assessed in a more physiological way. IV administration delivers the full dose directly into the bloodstream, increasing the risk of adverse effects and complications when used without clear medical necessity.
What You Can Do Today
Antibiotics are far more complex than over-the-counter medications like paracetamol. With paracetamol, dosage is the main concern, and timing adjustments are generally forgiving. Antibiotics are different. They involve multiple variables — the drug chosen, the dose, timing, frequency, and duration — all of which matter.
Skipping doses or stopping treatment early increases the chance that more resistant bacteria survive and multiply. Over time, these resistant strains become dominant, and antibiotics that once worked effectively no longer do.
If there is one mindset shift that would make the greatest difference, it is recognizing that antibiotics are prescription medications that must be used with care. When both patients and healthcare professionals commit to evidence-based antibiotic use, the result is better outcomes, fewer complications, and lower healthcare costs.
Questions Worth Asking
Before starting an antibiotic, it is reasonable to ask:
- Is this infection bacterial or viral, and what evidence supports that conclusion?
- If it is viral, why are antibiotics being considered? Am I in a high-risk group that requires this approach?
- Is this a first-line antibiotic? If not, what is the medical reason for choosing a second- or third-line option?
- Are local resistance patterns influencing this decision?
- Why is IV treatment necessary instead of oral therapy?
- What side effects should I watch for, and when should I seek immediate medical attention?
If asking these questions feels uncomfortable — or if treatment is already underway and concerns arise — seeking a second, independent medical opinion is a reasonable and responsible step.
Antibiotics save lives when used properly. Using them properly requires understanding, adherence to guidelines, and collaboration between patients and healthcare providers. The goal is not to fear antibiotics, but to respect them enough to use them wisely.
This article was written by Dr. Shun, sharing his experience on what he has seen and how antibiotics are being misused.
