You are correct. Any antibiotic can cause problems and people need to be aware of those problems. Self medicating is a double edged sword.

In my years of clinical practice, azithromycin was more likely to cause fungal problems from a single treatment course. It came onto my radar when, according to many colleagues that were alternative practitioners whose brains I frequency picked and applied their knowledge, saw a huge rise in people seeking their help after being prescribed Z-paks for sinus infections. People suffering with downstream gut symptoms sought their help with these problems - some had become chronic. I found it interesting how the alternative practitioners were dealing with the consequences of more traditional mainstream therapy. The whole gut biome connection was just gaining traction and it gave me pause - this was not part of my training. This was several decades ago and our knowledge base on this topic has increased tremendously. At the time however, most of my more mainstream colleagues dismissed the idea. Many unfortunately, still do not consider it as important.

Any scripts for antibiotics I gave were judicious, always came with warnings, and mitigation strategies to prevent gut flora upset. Z-paks I found were very effective at dealing with sinus infections - which I could always expect a rise in cases during the fall and winter months when the heaters started getting cranked up. I live in a low humidity climate and the heaters dry the air out even more. A simple xylitol nasal spray works wonders at preventing the problem. I cannot speak for others, but this was my experience.

The rise in C-diff complications was an attention getter for me as it relates to antibiotic use. Up to that point, the condition had been very rare. What was happening in these patients and why the sudden increase? I attributed it to the fact that Americans already had altered gut flora and the antibiotic simply broke the camel's back. Thankfully, I personally did not have a patient that suffered with the problem after coming to see me. I did however, have a few patients that did have prior experience with C-diff and the stories of their experiences were horrendous. Surprisingly, some were hospitalized after being treated for dental infections. Dentistry writes a great deal of prescriptions for antibiotics - with little or no counsel to deal with the gut issues. But, dental infections can be very serious and must be dealt with. Altered gut flora due to poor diet, medications, and toxic overload, makes the likelihood of C-diff and other opportunistic infections much greater. People need to be aware of these risks when they decide to treat themselves or seek professional treatment. Consumer beware.