April 3 , 2007
Eric Steele, MD
There is growing evidence that Americans get antibiotics for many infections that do not need antibiotics. The list now includes many ear infections, most cases of bronchitis in otherwise healthy adults and children, many sore throats, and all common colds and cases of “the flu.” Now many sinus infections should be added to the list of things that usually do not require antibiotics, according to ear / nose / and throat specialist physicians (ENT physicians). That might seem like no big deal, but there are more than 3,000,000 visits by patients for acute sinus infections in the US each year, and the treatment cost exceeds 2.5 billion dollars.
Antibiotics are prescribed far too frequently to treat acute sinus infections, according to a study published in March in the medical journal for ENT physicians, the sinus experts. These experts point out that “The (medical) literature repeatedly shows that viruses are by far the most frequent cause of acute rhinosinusitis (the technical term for acute sinus infection).” Despite the fact that all physicians, nurse practitioners, and physician assistants – and many patients – know that viruses are immune to antibiotics, studies suggest these health care providers prescribe or continue antibiotics for more than 80% of patients with acute sinusitis.
Why would those smart health care providers be prescribing antibiotics so frequently for acute sinusitis despite the infection likely to be immune to the medicine? For several reasons:
It is not always clear that the infection is caused by a virus, so the provider may prescribe the antibiotic just in case;
Patients often want an antibiotic, believing that is what it will take to cure their sinus problem, and frequently having gotten an antibiotic in the past for the same problem. Most patients don’t want to leave an appointment they may have paid for with the words “It’s just a virus” ringing in their ears.
What’s the answer? Remember a few things:
Most colds, flus, sinus infections, ear infections, bronchial infections / bronchitis are caused by viruses, which you cannot kill with a hammer and certainly cannot kill with an antibiotic. Whether you take an antibiotic or not for viral infections you will get better in the same amount of time. Time, pain medicine, plenty of rest – all the things your mother told you to do – are the best treatment, the safest treatment, and the cheapest treatment;
If you are seeing your physician / nurse practitioner / physician assistant for one of these problems, and they are prescribing an antibiotic, ask if you really, really need that medicine. Chances are good you do not;
If you / your family member seems very sick, don’t try to guess whether it is a virus, or a bacterial infection that really does need antibiotics. Call your health care provider, tell them what is going on, and consider letting them make the call.