When You Should Skip Antibiotics

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If your head is pounding, your sinuses are jammed, or your throat hurts like hell, you may be tempted to hit up your doctor for some antibiotics. For decades, docs have doled out these drugs to patients who have symptoms of sinus infections, sore throats, bronchitis, and even the common cold. But the truth is that for a vast majority of respiratory ailments, antibiotics don't do a thing to help — and they may even make you sicker.

Although there are certain bacteria-caused illnesses that do require antibiotics, such as pneumonia, strep throat, inner ear infections, and a small fraction of severe sinus infections, these ailments are much rarer than you'd think, says Dr. Jeffrey A. Linder, an internal medicine doctor at Brigham and Women's Hospital in Boston. In most cases, he says that congestion, coughing, and other misery-making symptoms are caused by a virus, not by a bacterial infection that could be zapped by antibiotics.

Even so, doctors often write unnecessary scrips. "There is rampant overprescribing of antibiotics for respiratory issues," says Linder. "But I get why it happens. As a doctor, you want happy patients. It's very unsatisfying for someone to take time off of work, pay a copay, and then have the doctor say, 'Yes, you have a cold that might last two weeks. Just rest and take fluids.' The medical system makes it so hard for patients to access their primary care doctor that you almost want to give them a prescription just in case."

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But there are major issues with the "just-in-case" plan: "You're putting a chemical in your body that has no chance of helping you but a real chance of hurting you," Linder says. "Antibiotics can cause skin rashes and other allergic reactions, and because they also kill off all of the good bacteria in your gut, they can cause diarrhea." Additionally, antibiotics can actually cause a severe antibiotic-resistant infection called C. difficile, which triggers nausea, fever, and chronic diarrhea that can even require colon removal.

On top of all that, taking antibiotics can make you more resistant to antibiotics in the future. And the more of these drugs that are used unnecessarily by all of us, the more antibiotic-resistant superbacteria that develop, rendering these drugs ineffective for people with life-threatening illnesses who truly need them. The bottom line: Don't take antibiotics unless absolutely necessary. Here are four cases where it is not. 

Sore throat
Linder says the only common cause of a sore throat that requires antibiotics is strep throat, which isn't actually all that common. "Doctors are giving antibiotics to 70 percent of people who come in with a sore throat, even though only 10 percent actually have strep," he says. "We have very good tests to determine strep, but sometimes even when a test is negative, a doctor will prescribe them. That decision just make sense. You should only take antibiotics if the test is positive."

Linder says there are clinical criteria you can use at home to see if you even need to come in for a strep test. "If you have a cough or runny nose, but no fever, no swollen glands in your neck, and no white spots on your tonsils, the probability of you having strep is so low that it's not even worth testing," he says. "But if you do have a fever, swollen glands, and white spots, you should go to the doctor. It can take as little as 10 minutes to confirm strep."

Sinus infection
More than one in five antibiotics prescribed to adults are for sinus infections. But according to Linder, only about 20 percent of sinus infections actually require these drugs. "Most of the other 80 percent are viral," he says. "Some are probably bacterial, but they just get better over time on their own." Linder says antibiotics should only be considered if symptoms are severe, including a fever over 102 degrees, or they get worse as time goes on or last longer than 10 days.

If you don't have a fever and your symptoms have been present for just a few days, Linder says the best thing you can do is keep your sinuses open using a saline wash and, if necessary, a nasal decongestant like Sudafed. "But it's much more important to keep the sinuses open than it is to get drugs in there," he explains. "When they are open, you'll feel better and you'll get better. Even for bacterial sinus infections, flow is more important than drugs. If you're socked in and noting is draining, drugs won't even get to where they need to be."

Common cold
The common cold is by definition a viral infection, yet Linder says it's among the top four respiratory issues that doctors prescribe antibiotics for. Not only do these drugs not cure it — no drugs do — because there is no cure for the common cold. Over-the-counter painkillers, decongestants, and cough syrups may help alleviate some symptoms, but your immune system is doing the real work, fighting off the infection on its own. So the best ways to help your body heal are to rest, drink fluids, and keep your nasal passages open—definitely don't seek out antibiotics. Linder says that, although it's rare, bacterial sinus infections can come on after you've had a cold. So if you feel like you were on the mend but then suddenly get sacked with severe sinus infection symptoms, you might want to head to the doc to make sure.

Bronchitis is another ailment for which patients often request and receive antibiotics — even though they don't work. "There is good evidence that antibiotics do not help acute bronchitis, which is an infection of the medium- to large-sized airways that usually results in a cough that can linger for three weeks," Linder says.

Rather than simply prescribe you antibiotics, Linder says it's the doctor's job to differentiate bronchitis from pneumonia, which is an infection of the small airways that does require antibiotics. "With pneumonia, there is usually a fever, a rapid pulse, and rapid breathing, whereas acute bronchitis doesn't usually cause these symptoms," he explains. "In a physical exam, the doctor will listen to your lungs. If he hears anything abnormal or has any doubts, then he will do chest X-ray to make sure it's not pneumonia. If we eliminated the use of antibiotics for bronchitis, we could go a long way," toward cutting down on overprescribing.