Article by Mamata A. Kamat MBBS, MPH, CIC, Fairfax County Health Department
(Posted 2026 February)
Standing in the middle of my kitchen one morning, my husband asked me a simple question: “What do you actually do at work?”
I had been in my new role for four months and I tried to explain it in everyday terms.
“My role,” I explained, “is to support antibiotic stewardship in skilled nursing facilities. I help people use antibiotics carefully and only when they’re truly needed.”
He laughed and said, “Isn’t that what you’ve been saying for years?”
He was right, and that moment reminded me how closely my work aligns with what I’ve always believed: antibiotics are powerful medicine, and they should be used wisely.
Antibiotics are one of the greatest medical discoveries of our time. They have saved millions of lives and prevented countless complications. But like all medications, antibiotics come with risks. They can’t tell the difference between harmful bacteria and “good” bacteria, like the ones that help us digest food and keep our bodies in balance. When those helpful bacteria are wiped out, tougher germs like Clostridioides difficile (often called C. diff) can take over. C. diff may cause severe diarrhea, dehydration, hospitalization, and even death, and because it survives for a long time in the environment, may spread to others.
So when people ask, “What’s the harm in taking an antibiotic just to be safe?” The answer is sometimes: quite a lot.
Antibiotics are frequently prescribed in long-term care facilities, often inappropriately. Up to 70% of nursing home residents receive one or more courses of antibiotics in a year, and an estimated 40-75% of those prescriptions are unnecessary or inappropriate according to the Centers for Disease Control and Prevention.
Not long ago, I faced the same dilemma many families experience when caring for an older loved one. My mother, who has diabetes and other chronic conditions, came to visit us. Like many older adults abroad, she travels with her medications and worries about the cost and stress of seeking medical care while away from home.
One morning, she told me she thought she might have a urinary tract infection and asked whether she should start an antibiotic she had brought “just in case.” She said she was going to the bathroom more often than usual and felt a little confused. When I checked on her, she was alert, answering normally, and had no fever. While her symptoms were uncomfortable, nothing clearly pointed to an infection.
Testing her urine wasn’t the best option either. Up to half of older adults have bacteria in their urine without having an infection. These bacteria live there harmlessly. Treating someone for bacteria that is not causing an infection doesn’t help them. It can actually increase the risk of developing an antibiotic-resistant infection later.
Instead of rushing to start antibiotics, we chose to monitor her closely. I checked on her throughout the day, encouraged her to drink fluids, and kept a careful eye on her symptoms. By the next day, she felt completely fine. We realized her symptoms were caused by too much caffeine, not by an infection.
This small moment reflects a much bigger issue. When antibiotics are used when they’re not needed, bacteria can learn to resist them. Over time, this makes infections harder to treat. In the United States, more than 2.8 million antibiotic-resistant infections occur each year, and more than 35,000 people die as a result, according to the CDC's 2019 Antibiotic Resistance (AR) Threats Report.
We all play a role in keeping antibiotics effective and keeping our loved ones safe. So, the next time you or a loved one considers taking an antibiotic “just in case,” consider the potential harms and see a healthcare provider who can do a complete evaluation to see whether an antibiotic is needed. Perhaps keeping a close watch (active monitoring) is a better choice. Understanding the “why” behind a healthcare provider’s recommendation can help you feel confident that they are making the safest choice.
There will always be times when antibiotics are necessary but using them only when they’re truly needed helps ensure they will continue to work when we depend on them most.
Resources and References
- U.S. Centers for Disease Control and Prevention (CDC): Antibiotic Use and Antimicrobial Resistance - cdc.gov/antibiotic-use/data-research/facts-stats/index.html
- CDC: Clostridioides difficile (C. diff) Infection Information - cdc.gov/c-diff/index.html
- CDC: Core Elements of Antibiotic Stewardship for Nursing Homes - cdc.gov/antibiotic-use/hcp/core-elements/nursing-homes-antibiotic-stewardship.html
- Fairfax County Health Department / Older Adult Health & Wellness Resources - FairfaxCounty.gov/familyservices/older-adults
- Agency for Healthcare Research and Quality: Antibiotic Stewardship in Long-Term Care - ahrq.gov/antibiotic-use/long-term-care/index.html
This article is part of the Golden Gazette monthly newsletter which covers a variety of topics and community news concerning older adults and caregivers in Fairfax County. Are you new to the Golden Gazette? Don’t miss out on future newsletters! Subscribe to get the electronic or free printed version mailed to you. Have a suggestion for a topic? Share it in an email or call 703-324-GOLD (4653).