Most of us have taken a course of antibiotics without giving it much thought. A chest infection over the winter, a urinary tract infection, a dental abscess: a few days of tablets and life goes back to normal. Antibiotics have been so dependable for so long that it is easy to forget how recent they are, and how quickly we could lose them.
That matters more once you are past 50. Infections become more common with age, they can present in unusual ways, and the antibiotics used to treat them interact with far more of the medicines already in your cabinet. Using antibiotics well is not about refusing them. It is about making sure they still work on the day you genuinely need them.
TL;DR
- Antibiotics treat bacterial infections only. They do nothing for colds, flu, COVID-19 or most coughs and sore throats, which are viral.
- Ireland’s One Health National Action Plan on Antimicrobial Resistance 2026 to 2030 aims to cut national antibiotic consumption by 27 per cent by 2030, and roughly 90 per cent of human antibiotic use here happens in the community rather than in hospitals.
- It is the bacteria that become resistant, not your body. Resistance spreads between people, which is why individual prescribing decisions add up to a national problem.
- After 50, antibiotics carry higher stakes: greater risk of Clostridioides difficile diarrhoea, more interactions with warfarin, statins and other regular medicines, and dosing that depends on kidney function.
- A positive urine sample on its own is not a reason for antibiotics. Bacteria in the urine without symptoms is common with age and usually should not be treated.
- Prevention is the strongest tool you have: vaccination, hand hygiene, oral health and prompt wound care.
What antibiotic resistance actually means
There is a persistent myth worth clearing up first. Resistance is not something your body develops. You do not become immune to antibiotics. It is the bacteria that change, evolving ways to survive the drugs designed to kill them, and those hardier bacteria then pass from person to person through ordinary contact, food and healthcare settings.
This is why an unnecessary prescription is never a purely private matter. Every course of antibiotics applies pressure that favours the resistant bacteria in your gut, on your skin and in your airways. The more often that happens across a population, the more often a routine infection turns into one that needs stronger drugs, intravenous treatment, or a hospital admission.
The Irish picture
Ireland has taken the problem seriously at policy level. The Government’s One Health National Action Plan on Antimicrobial Resistance, known as iNAP, runs from 2026 to 2030 and sets a target of reducing antibiotic consumption by 27 per cent by the end of the decade. The HSE’s own Antimicrobial Resistance and Infection Control programme, AMRIC, published a matching action plan for the same period covering prescribing, infection prevention and surveillance across hospitals, nursing homes and general practice.
The detail that should interest anyone reading this: around 90 per cent of human antibiotic use in Ireland happens in the community, not in hospitals. That means the conversations that shape our national resistance picture are happening in GP surgeries and pharmacies, with patients like you. Every 18 November, European Antibiotic Awareness Day marks the point, but the decisions matter all year.
When antibiotics will not help
Colds, flu, COVID-19, most sore throats, most earaches and most coughs are caused by viruses. Antibiotics have no effect on them whatsoever. A cough after a chest infection can rumble on for three weeks or more, and that persistence is not evidence that you need tablets.
The HSE developed undertheweather.ie in partnership with the Irish College of General Practitioners and the Irish Pharmacy Union precisely for this. It sets out realistic recovery timelines for common illnesses, self-care advice, and the specific signs that do warrant a call to your GP. It is a genuinely useful bookmark before winter arrives.
You may also be offered a delayed prescription, sometimes called a back-up prescription. Your GP writes the script but asks you to hold it for two or three days and only fill it if you are not improving. This is good medicine, not fobbing you off, and it substantially reduces unnecessary use.
The urine test question
This one deserves its own section because it affects older adults disproportionately. Bacteria in the urine without any symptoms, known as asymptomatic bacteriuria, becomes considerably more common with age. It is a normal finding in a great many healthy people over 65.
The evidence is now clear that treating it with antibiotics does not prevent complications, does not reduce mortality, and may make future symptomatic infections harder to treat. Unless you are pregnant or due to have a urological procedure, a positive dipstick without symptoms is generally not a reason for antibiotics. If a family member is told a routine urine sample was positive, it is entirely reasonable to ask: are there actual symptoms, and what would change if we did nothing?
Side effects that carry more weight after 50
Antibiotics are not risk free, and several of their risks rise with age and with the number of other medicines you take.
- C. difficile infection. Antibiotics disturb the normal gut bacteria, which can allow this organism to take hold and cause severe, persistent diarrhoea. Risk rises with age and with repeated courses. Watery diarrhoea during or after antibiotics needs medical advice, not an anti-diarrhoeal from the shelf.
- Drug interactions. Clarithromycin and erythromycin can push statin levels dangerously high. Trimethoprim interacts with warfarin and methotrexate. Many antibiotics unsettle INR control. Always tell the prescriber every medicine and supplement you take.
- Kidney function. Doses of several antibiotics must be adjusted as kidney function declines, which it commonly does with age. Nitrofurantoin, for instance, is generally avoided when kidney function falls below a certain threshold.
- Fluoroquinolones. Drugs such as ciprofloxacin carry warnings about tendon damage, including rupture, and these effects are more likely after 60 and in anyone taking oral steroids. Their use is now restricted to situations where alternatives are unsuitable.
- Thrush and skin reactions. Common, uncomfortable, and worth mentioning to your pharmacist rather than enduring.
Taking a course properly
If antibiotics are prescribed, a few habits make a real difference:
- Take them exactly as directed. There is genuine scientific debate about optimal course lengths, and Irish prescribers increasingly use shorter courses where evidence supports it. That is a decision for your GP, not one to improvise at home. Do not stop early because you feel better and do not stretch a course out to make it last.
- Never save leftovers. Antibiotics kept in a drawer for the next time are a classic route to inappropriate use.
- Never share them, not with a spouse, not with a neighbour, however similar the symptoms sound.
- Return unused or out of date medicines to your pharmacy for safe disposal. Do not flush them.
- Check the timing rules. Some antibiotics need to be taken on an empty stomach, some are blocked by dairy, indigestion remedies or iron tablets. Your community pharmacist will tell you in thirty seconds.
Questions worth asking
Being an active participant in the decision is not being a difficult patient. Reasonable questions include: do you think this infection is bacterial or viral? What happens if I wait a few days? How will I know if it is getting worse? Does this interact with anything I already take? Is there a shorter course that would work?
Prevention does the heavy lifting
The best way to preserve antibiotics is to need them less often. Keep up to date with the flu, COVID-19, pneumococcal and shingles vaccines you are entitled to through the HSE. Wash your hands properly, particularly around healthcare settings. Look after your teeth and gums, since dental infection is a common route to antibiotics. Clean and cover breaks in the skin promptly, especially if you have diabetes or reduced circulation. If you live with a long-term condition, your annual review under the HSE’s Chronic Disease Management Programme is a good moment to discuss infection risk and vaccination status with your GP.
When to seek help urgently
Being cautious about antibiotics never means ignoring serious illness. Seek urgent medical attention for confusion or sudden disorientation, breathlessness, a very high or very low temperature, mottled or discoloured skin, passing no urine for many hours, or feeling profoundly and unusually unwell. In older adults, infection can present as sudden confusion or a fall rather than fever, so trust a change in how someone is behaving. Sepsis is a medical emergency and rapid treatment saves lives.
At Críonna Health, we believe good health after 50 comes as much from asking better questions as from taking more medicine. Antibiotics remain one of the greatest advances in medical history. Treating them as a precious resource rather than a default is how we keep them working, for you and for the people who come after you.
This article is for general information and does not replace advice from your GP, pharmacist or treating clinician.
📷 Photo by National Cancer Institute on Unsplash
