When you’re sick, it makes sense that you want a pill to just make all the symptoms go away, which is probably why some doctors continue to prescribe antibiotics even when they aren’t necessary and may, in fact, cause harm. It probably doesn’t help when a pharmacy perpetuates the myth that we should just take antibiotics whenever we might be sick.

Journalist Felix Salmon spotted this subway ad for New York City-based Capsule Pharmacy, which hand-delivers prescription drugs in NYC:

For the record, the ad states, “Someone sneezed? It’s OK, we’ll be right over with some very, very strong antibiotics.”

The problem is, as many people have pointed out, a sneeze — let alone someone else’s sneeze — is not an indication of something you should treat with antibiotics.

Here’s a helpful chart from the Centers for Disease Control and Prevention:

A 2016 report from the Pew Charitable Trusts provides more granular information on how likely it is that a common ailment requires antibiotics:

A sneeze could be an indicator of a bacterial sinus infection, but there’s also a one-in-three chance that it’s viral, meaning your antibiotics are just putting you at risk for a Clostridium dificile infection and helping to create drug-resistant bacteria (more on all of that below).

That sneeze — which again, is not your sneeze — could just be allergies, which can often look like someone has a cold or other nasal condition. If someone sneezes near you because they are having an allergic reaction, (A) you’re not going to catch someone else’s allergy and (B) antibiotics won’t stop that person from sneezing.

Even something like bronchitis, which sometimes has a bacterial component, should not generally be treated with antibiotics.

For decades, the CDC has advised against using antibiotics to treat acute bronchitis, and the Healthcare Effectiveness Data and Information Set — a set of performance measures used by the healthcare and insurance industry — says the antibiotics prescribing rate for acute bronchitis should be zero. Yet a 2014 study found that doctors were still prescribing the pointless drugs 71% of the time.

What’s The Harm?

Unlike other prescription medications that can have immediate and potentially lethal side effects — or lead to a nationwide addiction epidemic, like the case of opioid painkillers — the problem with antibiotics overuse are less in-your-face, though the consequences could be dire.

Overuse of antibiotics is a leading contributor to the development of drug-resistant bacteria. Penicillin and other once commonly used antimicrobials are now largely ineffective. In their place, physicians have had to turn to drugs formerly thought of as last lines of defense against bacterial infections.

A recent CDC study found a nearly 40% increase since 2006 in a class of antibiotics known as carbapenems, drugs usually reserved for patients exhibiting resistance to multiple antibiotics. Similarly, the use of vancomycin, a particularly harsh antibiotic of last resort, saw a 27% increase between 2006 and 2012, attributed to the increasing need to treat methicillin-resistant Staphylococcus aureus (MRSA).

Last summer, a CDC report highlighted the increasing numbers of drugs that are becoming less effective at treating gonorrhea, with each drug’s effectiveness dropping as it was used more frequently.

It’s gotten to a point where — following the discovery of a bacteria resistant to more than a dozen antibiotics — CDC Director Dr. Tom Frieden cautioned that “We risk being in a post-antibiotic world.”

In addition to antibiotic resistance, which is a global problem, there are more personal concerns about taking these drugs when you don’t need them.

Taking antibiotics can kill the healthy bacteria in the gut, allowing more harmful bacteria, such as Clostridium difficile, to grow in its place, potentially resulting in diarrhea, fever, nausea, and abdominal pain. In 2015, it was estimated that some 15,000 Americans died as a direct result of a C. difficile infection.

According to the CDC, adverse reactions to antibiotics are a common cause of emergency room visits for children and teens.

“It’s imperative that patients receive the right dose of the right antibiotic, for the right amount of time and only when necessary,” says Lauri Hicks, Director of the CDC’s Office of Antibiotic Stewardship. “When antibiotics are inappropriately prescribed and used, we jeopardize the health of patients, and we jeopardize the effectiveness of the antibiotics available to fight serious infections.”

We’ve asked Capsule to comment on this ad but have not yet heard back. If the company chooses to respond, we will update.

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