The Washington Post recently published an article titled “Too Many People Use Antibiotics Improperly, Which Can Pose Risks.” The authors explained the findings of a new review of 31 previous studies published in the Annals of Internal Medicine that suggests that antibiotic misuse may be common among people in the United States.

Improper use of antibiotics is an issue that affects people all life stages, from infants to the aged. Unfortunately, children continue to account for a large proportion of antibiotic overuse in the United States despite a reported decrease in antibiotics prescriptions by pediatricians over the past few years.

Children are especially vulnerable to multidrug-resistant infections, known as superbugs, because of our poor understanding of exact metabolic processing of medications in young humans and limited safety data for newly approved antibiotics. Among adults, the prevalence of antibiotic misuse is nearly 70 percent in some communities here in the United States.

Worse still, improper use of these medications occurs in all sectors of the health system—hospitals, nursing homes, outpatient clinics, urgent care centers and emergency rooms. This has given rise to a crisis of antibiotic resistance and superbugs.

The reality is dire. The situation is so urgent that the CDC has stated that “antibiotic resistance is one of the most serious public health problems in the United States and threatens to return us to the time when simple infections were often fatal.” Indeed, we are at risk of falling into a league with developing nations concerning antibiotic resistance. Being originally from Nigeria, we know the reality of antibiotic misuse and its consequences firsthand.

The World Health Organization has issued a warning that the world is poised to enter a “post-antibiotic” era. In some places, that era has already arrived. In Nigeria, for instance, a news article in the journal Nature reports that some studies suggest that as many as 88 percent of Staphylococcus aureus infections cannot be treated with methicillin, once a potent weapon against the microbe. Up to 95 percent of adults in India and Pakistan carry bacteria that are resistant to antibiotics that used to be considered medications of last resort.

Antibiotics can be bought without a prescription in many countries, such as Nigeria, and the overuse of these medications is certainly fueling the evolution of superbugs. Yet insisting that antibiotics be prescribed by physicians in nations where poverty is rife and visits to a doctor are a luxury would mean denying many people drugs that they do need.

It is not clear to what extent the rise of resistance has been spurred by the use of antibiotics for growth promotion in livestock, or by the release of antibiotics into wastewater by drug manufacturers in countries such as India. Thus, another culprit is a lack of sanitation. In many areas of the developing world, wastewater from hospitals is poorly filtered, allowing the antibiotic-resistant bacteria that flourish there to escape into waterways. If people drink this contaminated water or practice poor hygiene, the superbugs can spread.

Other problems include state-sanctioned overprescribing of antibiotics. In China, for instance, hospitals and clinics receive financial incentives for prescribing, and antibiotics are overused as a result.

On the other hand, in developed countries like the United States where patient satisfaction has become paramount to the success of health care organizations, inappropriate prescribing can be a problem if physicians bow to pressure from patients; especially the pressure from parents seeking care for an ill child. A study of pediatric practices revealed that physicians were significantly more likely to prescribe antibiotics when they believed a parent expected a prescription, regardless of the diagnosis or the parents’ actual expectations. The use of patient satisfaction scores as a way to measure physician performance also contributes to concern about failing to meet patient expectations for an antibiotic prescription.

The Post also reports that, in the U.S, one of the most common scenarios leading to antibiotic misuse was people using leftover prescriptions or borrowing from a friend or family member. Even worse is the fact that in certain Hispanic or Latino neighborhoods, there’s easy access to antibiotics through flea markets and bodegas, or residents are able to get antibiotics from a relative who got them from another country where they’re sold over the counter.

The consequences of misusing antibiotics can be very risky and expensive too. When you take antibiotics that are not prescribed by a physician, they may not be effective. Also, even the right antibiotics can have serious side effects such as severe diarrhea illness. Inappropriate antibiotic use can cause liver or kidney damage. And of course, antibiotic misuse creates resistant superbugs that may be virtually impossible to treat.

To tackle this crisis the CDC is taking the issue of antibiotic misuse head-on with the Be Antibiotic Aware campaign.

Antibiotics save lives but they are not always the answer. Antibiotics do not work on viruses, such as colds and flu, or runny noses, even if the mucus is thick, yellow or green. Such symptoms may be due to a virus and an antibiotic will not make you feel better if you have a virus.

Antibiotics are only needed for treating certain infections caused by bacteria; and since taking antibiotics creates resistant bacteria, they should be used only when necessary. Antibiotic resistance occurs when bacteria develop the ability to defeat the drugs designed to kill them.

If you need antibiotics, take them exactly as prescribed. Talk with your doctor if you have any questions about your antibiotics, or if you develop any side effects.

Be antibiotic aware! And be smart about how to use them to get the best care.