By Choosing Wisely Staff
An April 2015 Consumer Reports survey of 1,000 adults found that doctors often prescribe antibiotics when the drugs aren’t necessary, such as for colds, the flu, and many sinus infections.
Several major medical organizations, including the American Academy of Family Physicians and the American Academy of Pediatrics, as part of a project called Choosing Wisely, have recently tried to correct the problem by identifying conditions for which antibiotics are often misused and explaining when the drugs are, and aren’t, needed. Here are nine key conditions to consider, as compiled by Consumer Reports Choosing Wisely staff.
1. Ear infections
- Most ear infections improve on their own in two to three days even without drugs, especially in children 2 or older.
- When to consider antibiotics: The drugs may be needed right away for babies 6 months or younger with ear pain, children from 6 months to 2 years old with moderate to severe ear pain, and children 2 or older with severe symptoms.
- Learn more: This Q&A sheet provides answers to commonly asked questions about using antibiotics for a child who has fluid in the middle ear. It is designed as a Q&A sheet for parents.
- The problem: Eczema causes dry, itchy, red skin. Doctors may try to control it with antibiotics. But antibiotics don’t help the itching, redness, or severity. To control eczema, moisturize your skin and avoid things that irritate it. Ask your doctor about a medicated cream or ointment to relieve itching and swelling.
- When to consider antibiotics: Consider antibiotics only if there are signs of a bacterial infection, such as bumps or sores full of pus, honey-colored crusting, very red or warm skin, and fever.
3. Eye infections
- Doctors often prescribe antibiotic eyedrops after treating eye diseases, such as macular degeneration, with injections. But antibiotic drops are rarely necessary after such treatments and can
irritate your eyes.
- When to consider antibiotics: If you have a bacterial eye infection, marked by redness, swelling, tearing, pus, and vision loss.
- Conjunctivitis usually stems from a virus or an allergy, not bacteria. Even when bacteria are responsible, pinkeye usually goes away by itself within 10 days.
- When to consider antibiotics: If you have bacterial pinkeye plus a weak immune system, or severe or persistent symptoms.
5. Respiratory infections
- The problem: Colds, flu, and most coughs and cases of bronchitis are viral. Strep throat is bacterial, but less than 15 percent of sore throats in adults are strep. So if you have a sore throat, get a strep test to find out.
- When to consider antibiotics: If symptoms last longer than 10 to 14 days or a doctor diagnoses a bacterial illness.
6. Sinus infections
- Sinusitis is usually viral. And even when bacteria are the cause, the infections often clear up even if they are not treated in a week or so.
- When to consider antibiotics: If symptoms are severe, don’t improve after 10 days, or get better but then worsen.
7. Swimmer’s ear
- Caused by water trapped in the ear canal, over-the-counter eardrops usually help as much as antibiotics, without the risk of those drugs and without causing resistance.
- When to consider antibiotics: If you have a hole or tube in your eardrum, check with your doctor. In that case, certain antibiotic eardrops are a better choice. Oral antibiotics may be necessary if a bacterial infection spreads beyond the ear or you have other conditions, such as diabetes, that increase the risk of complications.
8. Urinary tract infections in older people
- Doctors often prescribe antibiotics when a routine test finds bacteria in the urine. But if they don’t have symptoms, the drugs won’t help.
- When to consider antibiotics: Before certain surgeries or when you experience burning during urination and a strong urge to “go” often.
9. Wounds from skin surgery
- They pose a low infection risk, and antibiotic ointment doesn’t make it lower. Petroleum jelly is cheaper and less likely to cause irritation.
- When to consider antibiotics: If the wound appears infected, with redness, pain, pus, or swelling, or is in an area prone to infection, such as the groin.
This article also appeared in the April 2014 issue of Consumer Reports on Health. Reprinted with permission.
More about Antibiotics
- Learn about The Rise of Superbugs
- Learn about Using Caution When Taking Antibiotics and other materials from Choosing Wisely
- Read more posts on antibiotic resistance from Amy Moyer and Ginger Skinner
- Cold or Flu. Antibiotics Don’t Work for You.
- Antibiotics Aren’t Always the Answer – For Parents (flyer)
- Antibiotics Aren’t Always the Answer – For Parents (brochure)
- Snort. Sniffle. Sneeze. No Antibiotics Please.
- Six Smart Facts About Antibiotic Use