7 Frequent Illnesses That Do Not Require Antibiotics

Antibiotics have become a “cure-all” for many people in this country. A number of physicians freely give them out even when they are not necessarily indicated.

Some physicians believe that patients will be more satisfied if they just give the antibiotic rather than educating patients on the reasons the antibiotic is not necessary. But the truth is that most patients appreciate the education, and many people don’t want to take a medication if it’s not going to make them better. There is some research to support this claim.

The purpose of antibiotics is to kill bacteria. They are useless against any and all viruses.

This brings up a good point. How do I know if I have a virus or not? Viral illness accounts for much of the sickness we experience in our lives. From colds to sinus infections, to ear infections, to bronchitis, viruses account for a majority of these maladies, as much as 99%.

So if viruses account for the majority, then why such widespread antibiotic use? Perhaps it is the fact that we do not have rapid testing that confirms bacterial versus viral infection.

For now, physicians need to rely on the patient’s story and their physical exams. Many times, this should lead down the road of supportive care without antibiotics.

Furthermore, antibiotics can cause side effects and resistance. Side effects of antibiotics can be very unpleasant, so why take them if you don’t need to. From abdominal cramping, to diarrhea, to allergic reactions, antibiotics can cause a full spectrum of adverse reactions.

Resistance on the other hand is harder to understand. Needless to say, if we use too many antibiotics, the bacteria evolve and the antibiotics no longer work. We need to be good stewards of antibiotics for the next generation.

7 frequent conditions that generally do not require antibiotics

Bronchitis

The CDC has shown that most bronchitis is viral. The common cold can cause a cough as the virus moves down toward the lungs.

Just because you are coughing does not mean you have pneumonia and most patients do not require antibiotics for this condition.

However, if you have a high fever, persistent cough, or other concerning symptoms, you should be checked out by your doctor to make sure you have not developed a worse infection such as pneumonia.

Sinus infection

Sinus infections generally occur from viruses as well. When the sinuses become plugged, they cause symptoms of congestion, pressure, and sometimes pain. Patients can experience yellow and green mucous.

This does not mean that you have a bacterial infection. Generally supportive care is appropriate. However, if the infection is persisting past 3 weeks or you are experiencing high fevers, an antibiotic may be warranted. It goes without saying that 2-3 days of symptoms is not reason to run to the doctor for an antibiotic.

See my related post on How to Kill A Sinus Infection Without Going to the Doctor.

Ear infections

For years, we have been treating ear infections with antibiotics.

But a number of studies have found that many ear infections are viral and will improve on their own, without antibiotics. I have personally found ear infections in my own children and waited without antibiotics. To this day, they have never taken an antibiotic.

There are reasons to treat, which include a severe infection, recurrent infections, or a high fever. But most will resolve on their own.

Pink Eye

Pink eye is a common infection affecting millions of people in the United States each year. Though antibiotic eye drops were considered to be the mainstay of treatment, a recent study showed that most pink eye is viral and antibiotic eye drops are not indicated. In my practice I have adopted avoidance of antibiotic eye drops in a majority of cases and my patients have done well with this treatment.

In fact, antibiotic eye drops can actually irritate the eye making the condition worse. Of course, there are some conditions requiring antibiotics, so if there is a concern, you should check with your doctor.

Influenza

As in, a really bad cold. Influenza is a virus and antibiotics do not help.

What about Tamiflu? Well this is a completely different discussion but the best study to date shows that Tamiflu may decrease symptoms by at most 16 hours. This is after having the flu for 10-14 days and it needs to be started optimally within 48 hours of symptom onset. For more information on Tamiflu, read this article.

Either way, antibiotics are not indicated.

Sore throat

Most sore throats are viral. But in cases of strep throat, the standard is still to prescribe antibiotics.

Though the rapid strep test produces a number of false negatives, the general feeling is that if it is negative, you do not need an antibiotic. A culture can be sent (which takes about 24-48 hours) if there is significant concern and then treated if positive for strep. Another thing to remember is that strep does not generally cause a cough or congestion.

A number of years ago, a study was done creating a set of rules known as the Centor criteria. The criteria include fever, tonsillar exudate (white mucous on the tonsils), lymph node swelling, and NO cough. For every one of these that is true, the odds of strep throat increases.

If none of these symptoms are present, then your odds are pretty low that strep throat is the culprit and antibiotics are not necessary.

Eczema

Eczema can certainly cause some redness and many times the rash can break open the skin causing some drainage. Though this can look pretty bad, generally the rash is inflamed, not infected. Steroid creams can be very helpful for more moderate to severe cases and generally work without the need to take antibiotics.

Conclusion

I have a personal story about my life to share. Before medical school, any time I had a cold, I would call my doctor and he would phone in an antibiotic. I would take it thinking it would make me better and I would get better, usually within a couple of weeks. But as I went through medical school and residency, I started to learn that viruses generally last up to 2 weeks. If I had just waited out the cold, it would have likely gone away on its own, in the same time period, without an antibiotic. It has now been 14 years since I started medical school and I can tell you that I have not taken one antibiotic since. I have had a number of colds, some much worse than others. But I have always recovered.

I implore you to educate yourselves on your illness and discuss antibiotics with your doctor. I believe we CAN change the culture of antibiotics and become smarter to improve our health and the health of our society.

 

Do you think we have an antibiotic problem in our country? Leave your comments below.