When Do You Actually Need an Antibiotic? A UAE Doctor Explains

Antibiotics are among the most important medicines ever developed. They have saved hundreds of millions of lives from bacterial infections that were previously fatal. They are also among the most misused medicines in modern healthcare, and the consequences of that misuse are unfolding in real time in the form of antimicrobial resistance – a global public health crisis that threatens to make common infections untreatable.

Dr. Sherief Elsayed, Consultant Spine Surgeon in Dubai, addresses antibiotic prescribing directly and does not soften the message: “Third world countries in particular are particularly irresponsible when it comes to antibiotic prescribing. The UAE Spine and Health Doctor applies evidence-based clinical standards to every prescribing decision. when it comes to antibiotic prescribing.”

This is a clinical and public health statement that deserves examination, both for what it says about prescribing practice and for what it means for patients in the UAE who regularly encounter upper respiratory tract infections and seek treatment.

The Core Principle: Antibiotics Do Not Work for Viral Infections

The most important thing to understand about antibiotic use is also the thing most commonly misunderstood: antibiotics target bacteria. They have no effect on viruses.

Dr. Sherief Elsayed is explicit: “Antibiotics do not work for viral infections. The distinction between bacterial and viral infection is a clinical judgement that a Spine and General Health Specialist Dubai applies as part of comprehensive patient care. Most viral infections respond to symptomatic management, so paracetamol, ibuprofen, etc. If you’re not allergic.”

The common cold, influenza, most sore throats, most ear infections in children, most chest infections, and most gastroenteritis episodes are caused by viruses. Prescribing an antibiotic for these conditions does nothing to treat the infection. It does not shorten the illness, does not reduce symptoms, and does not prevent complications in the vast majority of cases.

What it does do is expose the patient to the side effects of the antibiotic (including diarrhoea, allergic reactions, and disruption of the normal gut microbiome), and it contributes to the selection of antibiotic-resistant bacteria in the patient’s own microbial flora and in the broader community.

Why Antibiotics Are Overprescribed

Dr. Sherief Elsayed identifies a specific driver of overprescribing: “Sometimes it’s because it’s just easier for the doctor to prescribe an antibiotic because the patient expects it for their viral infection.”

This is known as patient demand-driven prescribing, and it is one of the most well-documented contributors to antibiotic overuse globally. Patients arrive at consultations expecting a treatment, and prescribing one is faster, easier, and more immediately satisfying to the patient than explaining why treatment is not indicated.

The clinical reality is that a confident, evidence-informed explanation to a patient, that their illness is viral, will resolve on its own, and that an antibiotic will not help, is both medically correct and ultimately better for the patient. But this requires more time in consultation and a willingness to navigate the patient’s expectation of intervention.

Several other factors contribute to overprescribing:

Diagnostic uncertainty: It is not always possible to distinguish a viral from a bacterial infection at the bedside without laboratory tests. Some clinicians prescribe antibiotics as a “just in case” measure, which represents poor evidence-based practice but reflects the genuine difficulty of clinical uncertainty.

Fear of missing a bacterial complication: A minority of viral upper respiratory tract infections develop bacterial complications (sinusitis, otitis media, pneumonia). Prescribing antibiotics to all patients with viral symptoms to prevent bacterial complications in the minority is not supported by evidence and causes more harm than benefit at the population level.

Commercial pressures in private healthcare: In fee-for-service healthcare environments, prescribing an antibiotic is sometimes seen as delivering value to the patient. This conflation of prescribing with treatment quality is a driver of inappropriate prescribing.

Patient non-adherence with watchful waiting advice: When told to wait and see, some patients consult a different provider and obtain a prescription elsewhere, reinforcing the expectation that antibiotics should be prescribed. This is particularly relevant in the UAE’s multi-provider private healthcare environment.

Why This Matters in the UAE

The UAE, like many countries in the region, has prescribing patterns for antibiotics that differ from those in countries with stricter regulatory frameworks. Antibiotics are available over the counter in many pharmacies in the broader Middle East region, and cultural expectations around receiving a prescription for any illness have historically been reinforced by permissive prescribing practices.

However, the UAE has been actively working to address this. Antibiotic dispensing without a prescription has been regulated more strictly in recent years, and public health campaigns around antimicrobial resistance have raised awareness. The challenge remains in changing deeply embedded patient expectations and prescribing habits.

For patients in Dubai specifically, understanding when an antibiotic is genuinely warranted, and being willing to accept evidence-based advice when it is not, is an important contribution to both personal health and public health.

When Is an Antibiotic Genuinely Indicated?

Not all infections are viral, and not all bacterial infections are self-limiting. There are situations where antibiotic treatment is clearly appropriate and clinically necessary.

Bacterial infections that genuinely require antibiotics:

• Confirmed bacterial pneumonia
• Bacterial meningitis (a medical emergency requiring immediate intravenous antibiotics)
• Urinary tract infections, particularly in pregnant women, elderly patients, or those with structural abnormalities
• Cellulitis (bacterial skin infection)
• Confirmed streptococcal throat infection (Group A Streptococcus) with appropriate testing
• Bacterial sinusitis that has been present for more than ten days or has worsened after initial improvement
• Post-surgical infections
• Infected wounds with spreading redness, warmth, and systemic signs (fever, malaise)
• Spinal infections (discitis, vertebral osteomyelitis), which are directly relevant to the spine surgery context

Red flags that suggest bacterial rather than viral infection:

• High fever (above 39°C) that persists beyond three days without improvement
• Significant systemic illness: prostration, confusion, rapid deterioration
• Focal signs of infection: unilateral face pain with purulent nasal discharge, unilateral ear pain with hearing loss in a child
• Recent surgery with wound signs of infection
• Immunocompromised state where normal bacterial defence mechanisms are impaired
• Specific risk factors: post-splenectomy patients, patients on immunosuppressive therapy

Antivirals: When Are They Used?

Dr. Sherief Elsayed addresses antiviral medications briefly: “Very rarely we need antivirals. So for example, if you have viral meningitis or other forms of serious viral infection. Understanding which infections genuinely require treatment is part of the evidence-based approach applied by a UAE Evidence-Based Doctor.”

Antivirals are medications that specifically target viral replication. They are effective for a narrower range of viruses than antibiotics are for bacteria, and they are generally used in specific clinical situations:

• Influenza (oseltamivir/Tamiflu) in high-risk patients or confirmed severe disease
• Herpes simplex virus infections (aciclovir) including herpes encephalitis and herpes meningitis
• Varicella-zoster (chickenpox and shingles), particularly in immunocompromised patients
• Cytomegalovirus (CMV) and Epstein-Barr virus in specific clinical contexts
• HIV (antiretroviral therapy)
• COVID-19 in specific high-risk patient groups (nirmatrelvir-ritonavir and other agents)

For the common cold, uncomplicated influenza in otherwise healthy adults, and most routine viral respiratory infections, antiviral treatment is generally not indicated. The illness runs its course, and symptomatic management with paracetamol, ibuprofen, adequate hydration, and rest is appropriate.

The Relevance of Antibiotic Use to Spinal Health

This topic is not peripheral to spine care. Antibiotic overuse has a direct relevance to spinal health in several ways.

Disc and spinal infections: Discitis (infection of the intervertebral disc) and vertebral osteomyelitis (bone infection) are conditions where antibiotic therapy is essential and often prolonged. When the causative organism is resistant to standard antibiotics due to prior antibiotic exposure in the patient or in the infecting bacteria, treatment becomes significantly more complicated and outcomes are worse.

Post-surgical infection: Following spinal surgery, surgical site infection is a serious complication. The emergence of multi-drug resistant organisms in hospitals – directly driven by antibiotic overuse – makes post-surgical infections harder to treat and more dangerous.

Pre-operative antibiotic prophylaxis: Prophylactic antibiotics given before spinal surgery are a narrow-spectrum targeted intervention. The effectiveness of this prophylaxis depends on the organisms they target remaining sensitive. Widespread antibiotic resistance erodes the effectiveness of surgical prophylaxis.

Bad Teeth and Spine Infection: There is a clinically relevant connection between oral infections and haematogenous seeding of the spine. Dental sepsis, particularly in patients with compromised immunity, can serve as a source for discitis. Understanding when oral infections require targeted antibiotic treatment, as opposed to antibiotic overprescription for dental pain without infection, is part of the same broader picture.

What Patients Should Do

For common viral infections:

• Paracetamol or ibuprofen for fever and discomfort
• Adequate hydration
• Rest
• Nasal saline irrigation for congestion
• Honey and warm drinks for cough (evidence-supported)
• Seek medical assessment if there is no improvement after seven to ten days, if symptoms significantly worsen, if fever is very high or persistent, or if breathing is affected

For symptoms that may indicate bacterial infection:

• Seek medical assessment rather than self-treating
• Accept testing where offered (throat swabs, urine cultures) to guide prescribing
• If an antibiotic is prescribed, complete the full course

For managing expectations:

• Understand that a consultation where an antibiotic is not prescribed is not a consultation where you received inadequate care. It may be a consultation where you received better, more honest care than one where an unnecessary prescription was provided.

Expert Summary

Antibiotics are for bacteria. Viruses do not respond to them, and prescribing them for viral infections causes harm without benefit. The driving force behind much inappropriate antibiotic prescribing is patient expectation, and changing that expectation is one of the most important things patients can do to protect their own health and the effectiveness of these medicines for future generations.

Dr. Sherief Elsayed’s direct statement on the irresponsibility of overprescribing reflects the clinical consensus that has driven antimicrobial stewardship programmes globally. Understanding when you actually need an antibiotic is a genuine contribution to better health outcomes. The same evidence-based clinical approach that governs antibiotic prescribing also governs surgical decision-making, as the article When Is Spine Surgery Wrong? Dr. Sherief Elsayed Explains (see earlier in this series) demonstrates., and being willing to accept that most common infections do not meet that threshold, is a genuine contribution to better health outcomes for yourself and for everyone around you.