Tuesday, March 20, 2007
To prescribe or not to prescribe?
To prescribe antibiotics, or not to prescribe antibiotics? That is a question thousands of doctors ask themselves every day. It's a common scenario: A patient comes into the office complaining of what is almost certainly a viral infection. The doctor knows the infection will probably clear up on its own in a few days, but the patient asks, "What about a Z-Pak or another antibiotic?" The patient tells the doctor it always works and a previous doctor prescribed it all the time. Many doctors cave. I have sometimes caved.

The truth is the infection probably would have improved without antibiotics. Usually by the time, someone sees his or her doctor, the viral infection is already starting to go away. Right around the time the antibiotics dose of five to seven days is complete, presto: The patients feel better. Of course, they attribute that to a $70 antibiotic, instead of plain old natural history.

There are many things one can do to deal with viral sinusitis, besides antibiotics. A good decongestant, such as Sudafed, will be very helpful, as would a saline flush through the nose. It's not the most pleasant, but people who use it swear it works well. Still, researchers at the University of Nebraska Medical Center in Omaha found that antibiotics are prescribed 82 percent of the time for patients with acute sinus infections. (Full Story)

That is too often. As a result, extremely antibiotic resistant bacteria, such as the flesh-eating bacteria, are developing. So, why are doctors so willing to dole out a prescription?

I have found that patients like to walk out of the office with something in hand, so they feel like they accomplished something on their visit. If you don't give them an antibiotic, they feel like you have not treated them.

How should doctors deal with patients who demand antibiotics? What are your suggestions on how to handle this?
As a pediatric nurse in a clinic I saw a lot of the same expectations; Little Johnny with a cold or diarrhea; the parent expects a medical cure, expects to walk away with a prescription. Most parents will listen to home care advice over the phone. Most of the time all they really want is to go over the dosing to their child of tylenol or sudafed with a second person. Telehealth nursing is a growing field and an addition to their clinics that doctors should consider. A wise telehealth nurse who loves to teach will find satisfaction in not only the parents and patients she helps, but knowing she prevented drug resistant bacteria, call by call.
How about NATURAL solutions. Antibiotics only work on bacterial infection and they kill ALL the bacteria good and bad. I do believe however that since everything natural is suppressed that people will ONLY listen to doctors.
I followed my son's pediatrician's advice last year when he had an ear infection and held off on getting his script filled. On his way home from pre-school he said his head hurt and in a matter of two hours was in the hospital diagnosed with a strep infection in his blood stream. I was later told it was caused by the un-treated ear infection. I understand that antibiotics are sometimes overused but I for one will never take another chance on letting an infection run it's course. There was no warning signs prior to the headache, nothing. He was fine one minute and unable to stand within four hours.
Every year as a child growing up, I would get sick at least twice a year - once in Spring and once in the Winter. The routine was always the same, my nose would run backwards instead of forward the first day so there was really no need to blow my nose. The second day I would cough violently because of the drainage dripping down my throat into my stomach. The coughing would cause my stomach and sides to ache and of course my throat would be raw from the drainage. The family doctor at the time would eventually prescribe me either Augmentin or Amoxicillin after two weeks of this scenario (no it never went away or got better without the antibiotics - I found that out the hard way after developing bronchitis after each bout with just using over the counter medication). It wasn't until a new family physician (Dr. Brandes) treated me during one of these bouts that I was informed that my nose drains backwards and not forward which pretty much guarantees me a bacterial infection in my sinuses. I was told to not waste my money on over the counter medication because it would never work and to see the doctor for antibiotics. I could have surgery to correct the problem however there was no guarantee it would work so he didn't recommend it. He prescribed me Ru-Tabs to dry out my sinuses (miracle drug since it prevented me from experiencing that vicious cycle of me coughing from having that constant drainage down my throat) and of course amoxicillin. I eventually moved out here to Los Angeles and when I experienced that draining sensation down my throat, I went to a new doctor and informed him of what I needed. He assumed I was like those patients you describe always demanding antibiotics for every slight cough or sneeze. He prescribed me something other then I asked so after not experiencing the "cycle" as I called it for many years thanks to Dr. Brandes, I went through it again. I had to go back after a week of taking the prescribed medication because I got worse as I knew I would which really angered me because it's such a miserable experience. Since then my doctor prescribes me the Amoxicillin and something to dry out my sinuses when I request it because he saw the shape I was in when he didn't do it. I have not had to go through that "cycle" since. I can only speak for myself that after having gone through the misery of that cycle for many years - I can tell if I'm developing a cold, allergy, or if it really is a bacterial sinus infection and take the appropriate action. My suggestion is for doctors to really listen to their patients when they describe their symptoms. If it weren't for Dr. Brandes, I would still be going through that cycle today.
Dear Dr. Gupta,
I started having sinus infections in my mid 40s. They always follow a cold, the flu, or even just a bad case of allergies. I have gone as long as 3 months trying the various approaches you outline here, and in the end only the antibiotic cleared up the infection.
It's been suggested that perhaps I should see if I have developed a deviated septum, which might account for the later-in-life onslaught of infections.
What do you think?
I had my 1st sinus infection in November/December of 2006, first it was a cold which developed into a sinus infection. I had never had a sinus infection before & didn't know how to deal with getting rid of it. Went to the doctor after a week of having the cold turn into a sinus infection, he prescribed me a z-pak. Then 1 week later, I came down with UTI (Urinary Tract Infection - my 1st of that too) due to the anti-biotics that were given to me for the sinus infection. Then he prescribed me different antibiotics for the UTI.

Next time I will fight off my Sinus Infections with nasal rinses & sudafed instead of antibiotics and hoping to avoid another trip to the doctor.
I have a horrible sinus infection. I have lived with it for over 3 years. I have taken atibiotics, tried the neti pot with saline, steamed my face with clove,thyme and cinnamin. Nothing has worked. Every time I get unfunctional with it , I go to the doctor and have had no suuggestions with no hope.
I am athletic and nutrition oreintated as is my job. It is frustrating to read articles and hear people talk and never offerany real solutions. moving to florida has helped a little , but not enough to really stay.
i believe the Dr. should give the patient a full disclosure of the effects of anti-biotics before prescribing any. People are under the impression that anti-biotics are harmless and pop them like candy. Only when fully informed of the potential hazards should anyone make a reasonable decision.
I avoid antibiotics where I can. I recently contracted the antibiotic- resistant staph (MSRA) from a hospital. If such strains are prevalent due to the overuse of antibiotics, I will do without as much as possible.

I suggest doctors simply tell the patient upfront the dilemma that we face with the overuse of antibiotics. Without knowledge of why that's important, then the patient is going to continue to demand.
As a physician, I have encountered this situation many times. If I believe a patient has a viral infection, I explain that antibiotics will not effect their course. Most patients understand and accept that. I have, however, seen some patients become aggressive when they are told they or their child do not need antibiotics. Unfortunately, there are many ways for patients to obtain antibiotics without seeing a doctor or NP - through the internet, from friends, or hoarding from previous prescriptions. Educating patients about the dangers of taking unnecessary antibiotics is step one.
Health and wellness begins at the cellular level. The communication between cells enables proper gland and organ function and promotes optimal health. "Glyconutrients" are essential to this interaction. Many scientists now believe it is difficult, without proper supplementation to support the process of optimal health. To reinforce the importance of glycobiology, the medical research community has recognized it as one of the top ten breakthrough technologies that will change the world as we know it. Quote, " This is going to be the future, " declares biochemist Gerald Hart of Johns Hopkins University in Baltimore. "We won't understand immunology, neurology, developmental biology or disease until we get a handle on glycobiology". ( New Scientist, October 26, 2002.
The miricle is not in glyconutrients,the miracle is in the design of the human body to keep itself healthy if it is supported with the right nutients, and glyconutients are simply the latest of a new category of total nutrients. These nutrients would help the soldiers stay healthy with strengtened immune systems and help them heal quicker in every insult their bodies endure.
First of all, one needs to distinguish between the occasional acute sinus infection and the bona fide case of chronic sinusitis, which has severe impact on quality of life and can be associated with severe chronic conditions such as asthma.

Has anyone done an in-depth study as to why chronic sinusitis sufferers want antibiotics? I'd imagine that many of them are uninsured and can't afford a follow-up visit in case the condition doesn't clear up by itself, or turns into something more serious such as laryngitis or bronchitis. Even insured patients may not have access to treatments such as allergy shots or sinus surgery that could "fix" underlying conditions that predispose them to chronic sinus problems.

Blaming "ignorant" patients is counterproductive. For a model solution, look to the approach taken by a few doctors for strep throat: take a throat culture for lab testing, and give the patient / parent a prescription to fill in case the test comes back positive.

Find an alternative that will address the concerns of chronic sinusitis sufferers, and you'll make a meaningful dent in antibiotic overuse. Without addressing those concerns you'll just drive them into the arms of some strip-mall clinic.
Part of the problem is that some of us do wait it out, and then when we go to the doctor we have to wait it out again and then go back to the doctor for a second visit. It is very annoying to be sick or have a sick kid and they just are not getting better, and so you go to the doctor after having waited and then you leave with nothing. By the weekend you are in the emergency room with a VERY sick kid. So you end up paying for an emergency room visit and more time off work because the doctor can't tell the difference between who is really sick and who is just whiny. When you tell the doctors that you have been waiting it out they just don't listen. They assume all patients are stupid and just want antibiotics for a cold.
sure, why don't you just wait until the infection proceeds to bacterial meningitis before you prescribe antibiotics. Sometimes, you can be sure that its a bacterial infection and you should treat it as such.
My husband suffers from sinus infections 2-3 a year. The ENT that treats him offers alternative therapy out of his office. Sometimes he walks out of the doctor's office with a prescription and other times he walks out with a saline flush kit. Either way he doesn't leave empty handed.
It's all well and good saying 'no antibiotics' I am 67 and have suffered from severe chronic sinusitis due to an infection nearly 45 years ago. I can only breathe through my mouth despite 3 surgeries to try and correct it. I say 'hit it over the head'.
I would love to avoid antibiotics, but nearly every time I catch a cold I end up after a few weeks with painful sinus infections. Sudafed doesn't usually help (actually sometimes I think it makes it worse). If sinusitis is extremely painful, or prevents sleep, and/or continues for several weeks, who WOULDN'T want more help than just waiting? (BTW, I find ibuprofen works the best--it seems to reduce the swelling in the nasal passages).
I have had a long history of sinus problems & infections... Antibiotics once led me to the ER with due to a strong reaction to the med.
At that point I decided to try some natural remedies...In my case they have worked better.
To K.O. Steele of Pompano--I saw a really interesting article in a Allergy magazine about too much sugar causing constant sinus infections--as a fellow sufferer, I'm willing to try it-the author was a womn who ended up taking sugar almost completly out of her diet and that was what finally ended her constant sinus infections.
I am a medical professional and I suffer from frequent sinusitis caused by allergies. I have tried waiting for infections to go away on their own to no avail. The result is that it gets much worse and therefore requires even longer treatment (1 month or more) of antibiotics to clear the infection. I find that each new infection gets worse than the last. I once went to a physician who refused to prescribe antiobiotics because he said "they cause breast cancer". I am very thankful I have found a physician now who understands that it is not just "a cold" and treats these infections aggresively. My advice to fellow sinus sufferers is to keep seeking a second opinion.
I used to get frequent sinus and ear infections. I have a cyst in my maxillary sinus that I feel contributed to the frequency and severity. Ever since I was put on a daily Flonase regimen, the infections are less severe and frequent. I regularly flush my sinuses with saline, and know when to add 12-hour Sudafed to my daily regimen. My quality of life has improved, and I feel better not being on an antibiotic 5-7 times/year.
While I certainly agree that some patients are being treated unnecessarily with antibiotics (for many uses, not just sinusitis), there is a subset of patients with allergic rhinitis who are prone to lengthy bacterial infections. Sometimes these patients have a hard time getting adequate treatment for their infection because doctors are reluctant to overtreat. The fact of the matter is that not treating these patients can lead to bronchits, ear infections, and other conditions that force the patient to miss work and their daily activities.

I think the most important aspect in this debate is patient history. If a patient has recurrent infections and allergic rhinitis then they should be treated aggressively from the get-go, not forced to languish.
One interesting facet of sinus infections is when patients who have sleep apnea get them. It then seriously hampers their sleep as their CPAP therapy can become intolerable. What is your suggestion for handling this? Keep up the great work, Dr. Gupta.
I only expect anitbiotics when I need them. My grandmother, who loves to go to the doctor, has taken them for the past 20 or 30 years. When I am really sick, the medicine works like a charm. When she is really sick, it takes forever to get well. I think it's ridiculous to give prescriptions just to make someone feel like they've had a worthwhile visit.
I am feeling really "blah" with a cold. I know antibiotics won't help me. I plan to drink plenty of fluids, try and get plenty of rest and snuggle with my kitties. I also plan to take a decongestant. Another treatment that helps me is breating in steam when taking a shower or bath. Lately both my Mom and I have had problems with our sinuses. However, we think it's due to the extreme weather here in CNY and possibly allergies. In my opinion, one way to prevent drug resistant bacteria is only antibiotics when it's really necessary. Another thing that may help is frequent hand washing.
My 8 year old son gets terrible sinus infections after a cold or flu. We wait it our for about 7 days, and then if the drainage, nighttime cough and severe congestion continue we go to the ENT for a sinus culture. Depending on what he has growing in the sinus cavity, the doctor prescribes an appropriate anitbiotc. If we do the "natural" route, he alomst always ends up with a terrible ear infection and then a swollen eye from an absess or the sheer congestion.
I have cronic sinus infections about 2-4 a year. Once the symptons set in they only get worse until my head aches, teach hurt, and I'm drained of energy. Nothing has worked except antibiotics. I try alternate fixes for sometimes 2-3 weeks trying to avoid the antibiotics! The infection is always gone within 3 days of antibiotics. It's the only thing that works.
Neil Sinus Rinse products are the way to go. I had 4 sinus infections in a 5 month span a few years ago... family MD and I tried conservative measures of waiting out the cold, pseudafed, some nasal sprays... but still my head killed and I had drainage... so we tried round after round of antibiotics. The ENT doc prescribed an antibiotic, with Nasocort, with a round of prednisone... finally things drained out...and hte pain went away. But, the next cold again resulted in a sinus infection.

NOW>>> I swear by Neil Sinus Rinse everyday... you mix these salt crystals (premeasured) in the water... and RINSE/IRRIGATE everyday...

It's great! I have had no sinus infections... i can have a cold like everyone else and I just keep things irrigated and no longer get sinus infections.

Try Neil Sinus Rinse products! (and I am not associated with this company... just a happy camper without any sinus infections).
Antibiotic resistance is a REAL problem, and contributes significantly to deaths after surgery in hospitals. It also causes other long term conditions such as Irritable bowel syndrome, and longer more significant future infections.

Second, here is an example where the rate of prescription does not relate to recovery:

I check clinical pharma data for gross errors for a living. Through this work, I have discovered that MOST antibiotics are less than 25% effective in clearing out SINUS INFECTIONS by themselves. In fact, many antibiotics are not actually approved for this use because decongestants are generally more effective for this type of infection. Perhaps, doctors could prescribe decongestants (especially as some are no longer truly over the counter) instead in these cases, and clarify for what symptoms antibiotics should really be taken?

Also, for those worried about serious infections running unchecked, I have never heard of a severe infection without a fever. If it exists, it must be extremely rare.

If you are in doubt, check for a fever. If the fever is very high, don�t take any chances. Get antibiotics. Otherwise, it is really unnecessary and unhelpful.
I had a massive polyp develop in my sinus for 5 years. The only signs, headaches the first few years (the doctor said stress). Then, I was on so many antibiotics while doctors struggled to find what was wrong. It took two years of tests. I would have died without the antibiotics during those two years. And, once the surgeon put in a "Sinus Window", it drained properly, and the polyp did not return. No more sinus infections since then.

I did get a broken nose and some nerve problems in that side of my face (that disappeard after 5 years, no idea why). But, it saved my life.

Another example, though. Our daughter (now 3 1/2) got ear infections the first year of her life, then not after. She started complaining (getting sick about every ten days), but it always seemed to be viral. Last year, she started complaining about stinging pee and backache, so in for UTI tests that came back negative each time, so no antibiotics. It turns out that because we kept her hydrated, she got "False Negative Results" for those tests. Now, we are getting her tested for kidney damage, and she is on Keflex. I don't believe in overuse of antibiotics, or using it for viral infections. It scares me that her kidney is damaged due to false negative test results when we went in and paid doctors visits, never getting her the needed treatment.

There has to be a balance somewhere.
I can tell you why we physicians give in to patients' demands for antibiotics...just read the comments posted here. Practically everyone has some insane anecdotal experience of what causes their problems and what they need to fix it, and the Dr. is just in their way to getting what they want.

Oh yeah, I'm sure we'll all get bacterial meningitis if we don't use an antibiotic everytime! Maybe we just need to learn more about "glycobiology" and use more "natural" therapies (as if antiobiotics weren't "natural" somehow). More clove is the answer!

The truth is, patients no longer respect the physician or his/her medical training, especially if it doensn't align with their preconceived notions based on experience. Thank you webMD! And patients certainly don't care if their overuse of antibiotics helps develop a societal problem, namely drug resistance.
I was happy to see a reference to my alma mater, University of Nebraska Medical Center, in this blog. I am a nurse and sinusitis sufferer as well. I think intermittent steroid nasal spray is the most useful prescription drug. Other than that my favorite remedies are saline sprays, steam, and, most importantly, CHICKEN SOUP!
Going to the doctor and expecting an antibiotic is just plain stupid. However, most patients know their own history on what works and what does not work. A lot of times the antibiotic is the only answer. Myself, if the antibiotics are not started it turns into a upper respiratory infection that just gets worse and worse. Now for the chronic sinus infections, new thinking is that it may be an actual fungal infection and that is why antibiotics do not work. Something to think about.
I have felt for a long time now that I'm abnormal... simply because I don't take pills. It seems the entire world is medicated. I rarely get sick, but when I do, I tend to let my natural immune system do it's job. I require only one advil a day (instead of the 2 pills every 6 hours) to alleviate pain.

I think people's desire to walk away with a prescription can be traced to our lifestyles. We're too busy, can't afford to take time off, etc etc. And there are those parents (not all, but some) that don't want to take the time nursing their child back to health. A pill is quick and easy, right? Medicate them and life is easier.
I would caution patients and Drs. to take sinus infections seriously.I work in a clinic in an academic setting in Ped.A/I and we see a lot of patients that have not been treated or under treated and have required months of antibiotics to remedy this.I have also had a sinus infection come right in during a virus that swelled my soft palate and caused septicemia.We recommend sinus rinse, ibuprophen and mucinex.

I followed my son's pediatrician's advice last year when he had an ear infection and held off on getting his script filled. On his way home from pre-school he said his head hurt and in a matter of two hours was in the hospital diagnosed with a strep infection in his blood stream. I was later told it was caused by the un-treated ear infection. I understand that antibiotics are sometimes overused but I for one will never take another chance on letting an infection run it's course. There was no warning signs prior to the headache, nothing. He was fine one minute and unable to stand within four hours.

There will always be exceptions like this example, but if every case was treated with antibiotics right off the bat, it wouldn't be long before the bacteria out there causing the exceptions are so resistant to our drugs that when these serious cases do come along, there is little we can do about it, and the ultimate outcome is much worse. As a medical student, I am a firm believer in the power of educating patients, and I think most patients have no problem understanding the reason we don't always use antibiotics. I am also a firm believer in thinking of my next patient, the one that may potentially have a bacterial infection, potentially made worse by physician-caused drug resistence.
I would suggest giving them the nasal flush (saline solution). If it comes from a doctor who says it will actually be better than an antibiotic, most people will feel just as good about it as if they had received the medicine.
I thnk the whole thing really has to be very give and take. Many people, including myself, have gained a mistrust of doctors, having dealt with several that either didn't listen when they should have or jumped the gun and prescribed something too soon. It's very difficult in some areas to find a doctor that's trustworthy, so unfortunately that can cause the ones that are undue stress.

One way I think doctors could deal with this is, first of all, make sure your patient KNOWS you are listening. When you have to refute something they say, explain why. No, we're not medical experts, but that doesn't mean we can't understand the concepts if you take the time to explain them and let us ask questions. "Because I said so" never cuts it. Some people will defer to a doctor's authority without question. People like me will not. We want you to explain things. We want to know exactly what it is you're doing with us, and exactly why, and in many cases a rundown of the pros and cons would be nice if there's some risk involved in whatever you're suggesting for us.

You may be the expert, but its my body. It's the patient's health, their child's health, and you have to find a way to gain that mutual trust. For me, the times in my life when I had the best care was when I had doctors/dentists/etc who I'd had the time to develop that trust for. It's like any other relationship - you both have to be willing to work with each other. In theory, that should cut back on doctor-patient disagreements a bit.
Hi Dr. Gupta:
I think that doctors want to get rid of the patient and move on to the next one because they are so busy. They don't want to take the time to "treat" the patient. Antibiotics are easy and safe. It gets rid of the patient and the doctor also knows that the problem will go away anyway so there's no risk in prescribing the antibiotic. Instead try treating the patient: You need to get at least 8 hours of sleep, and drink X number glasses of water every hour. Take sudafed if blood pressure isn't high or some other decongestant maybe. Give samples of saline instead of drugs. Explain why antibiotics are not good: stomach upset, bowel upset, resistancy, etc. If the patient feels that the doctor actually thought about their problem and discussed it, they will be more willing to leave "empty handed" because they will feel their recovery is imminent. A lot of times when you're miserable, you just want to hear someone tell you everything will work out soon. Give a timeframe for the patient to be able to come back. Commiserate. People are busy and don't want to give up their free time to being ill. If a patient says all the other doctors give them antibiotics you can always say "my mother always told me that I am not like all the others". :)
In an attempt to reduce the number of antibiotics I prescribe, I ask my patients to allow 1-2 weeks for their symptoms to improve before seeking antibiotics. I offer supportive care like decongestants, saline spray or cough medication in the interim and recommend plenty of rest.
I have had seriuos sinus infections, one which required puncturing through under my upper lip with a needle to drain a large amount of mucous and puss to relieve pain. I was told that I shouldn't take antibiotics too often so I waited and it got worse. I say give the antibiotics and make sure the patient understands that they need to finish the course of anyibiotics even if they feel better after a day or two. Resistence to antibiotics is worse if treatments are abondoned early.
Explain the consequences of taking too many antibiotics. I know someone who takes them EVERY TIME they get sick. They are no longer effective. Last time he went to the doctor, he had to get a steriod injection! If they need to walk out of the office with something to feel like they've been treated, give them a free lollipop!
I don't understand the point of having doctors if people can treat themselves and pharmaceutical companies are eager to make money by pleasing people's cravings for RX drugs. Healthcare in the United States is going to hell in a hand basket. Americans need to start trusting their doctors and learn to "suffer" through the pain of a viral infection which no antibiotic will ever cure. When a patient walks into the ER with a flesh eating bacteria and demands treatment but no treatment exists for their problem because their body is immune to all the antibiotics on the market, patients are so quick to sue/blame doctors, hospitals, nurses, etc. And to add insult to injury, it's the patient who has created this problem for themself by demanding antibiotics throughout their entire life. Doctors suffer and sacrifice a great deal to go to medical school and to learn how the human body works. The general public needs to step back and let the doctors and nurses do their jobs. Surely there will always be a small percentage that get it wrong but the risks do not outweigh the benefits. When it's time to have heart bipass or hip replacement surgery these "all knowing" patients are going to regret that their body is immune to antibiotics...when eventually they will have to face their mortality.
Most severe inner ear infections, as distinct from sinusitis, are caused by bacteria. If left untreated, the eardrum will tear as a result of pressure buildup. The severe pain of such an infection is relieved within hours, not days, of the start of antibiotic treatment. Do you let your child suffer through severe pain and possible damage to her hearing because of the fear that future outbreaks might not be treatable by antibiotics? No, that's inane. Bacterial infections become resistant to antibiotics because the user does not complete the treatment, not because of the use of the drug in the first place. An incomplete regimen is what causes strains of bacteria resistant to antibiotics, not just the mere use of antibiotics.
I recommend reading the original article, which states NOWHERE that antibiotics shouldn't be used for sinus infections:

The only sinus infections I've ever had have come about 2 weeks after a bad cold or during particularly bad allergy season. I try a few days of self care with decongestants, humidifiers and extra fluids. If I'm not significantly better or continue to run a fever, I make a doctor's appointment.
Reading this you would think 90% of the population suffers from chronic sinus infections.

The point trying to be made here was not that we should never take antibiotics. Clearly an ear infection would be a good use of antibiotics. The flu or common cold, however is not and never will be. People come into the doctor's office expecting to "be fixed" rather than treated.

I recently went to the doctor with a viral infection (they tested for a few kinds of bacterial infections) and he kindly explained that he couldn't prescribe me anything because I had a viral infection. "Sorry, it's viral." I understood and walked out a little irritated because nothing could be done. It went away in a few days just as predicted. I am glad to see doctors being more diligent in who gets a prescription.
As a Naturopathic Physician and Acupuncturist there are many natural substances to alieviate symptoms and help the body cure itself. It may be easier to prescribe a Z-Pack but less effective.
I think TV & mag ads are doing more harm than good in telling pts what drugs to have their doctor prescribe. I think they should stop that practice. It should be illegal! I feel sorry for doctors cause some patients can be very nasty about it & they(dr's)know whats best.
Hello! I'm reading these responses with interest, and have to agree with the persons who have suggested giving the patient a saline kit to take home, or prescribing decongestants. (BTW - THanks to meth lab crackdowns, getting ahold of plain-jane Sudafed OTC at my local pharmacy often leaves one feeling as though they have signed away their firstborn... They may as well take mugshots. Prescriptions for PSE they don't question - they just hand it over.)

Leaving the office with something - anything (not necessarily antibiotics) in hand at least gives you a glimmer of hope instead of leaving empty-handed and facing goodness knows how many days/weeks of misery until you feel better & can sleep.

BTW - Sleep/rest is probably the single best thing that I do to get better, personally. My husband and I routinely give each other the "evening off" if one of us is feeling ill. Usually we can "tell" taht something is happening or an illness is threatening long before symptoms get bad. Usually it means that we've over done it & our systems are down (not surprising, most families with small children probably get much less sleep than they should, which probably contributes to increased illness). After a day or two of laying in bed or taking a day off work to bum around on the couch we feel better. THe key is allowing your system time to REST and fight the bug on its own long before symptoms become a problem.

Then, if things do get worse, I try OTC throat drops, phenylepherine, motrin, etc. If still getting worse, then I know I'm REALLY sick, and my doc usually gives me something when I go. Scrip PSE usually & motrin, which keeps things open & clear enough for the stuff to get out of my system instead of pooling in my sinus cavities. Very rarely does she do the antibiotics. RArely do I need them following this plan of action.
I would suggest the best explanation would be about the resistance to antibiotics that happens when they're used when not needed. I would hope anyone would accept that and be happy about the honesty. If they don't they have other issues that you're not responsible for.
There is a great misconception that green, yellow, or brown mucous especially mixed with blood is indicative of bacterial sinusitis. This kind of secretion indicates white blood cell death which occurs in any inflammatory condition whether its bacterial, viral, or eosinophilic. What is important is how the symptoms (congestion, drainage, facial discomfort, cough, etc.) change over time. The major acute symptoms of uncomplicated viral illnesses resolve within 7-10 days although drainage and cough may linger for an additional equivalent time period. It is estimated that only 5 per 1000 viral URIs progress into bacterial infection. Bacterial sinusitis manifests most commonly with progressively worsening symptoms following a viral URI or allergic insult. Less common presentations are persisting, nonresolving fluctuating symptoms lasting 3-4 weeks ( the cold that just won't go away), or sudden onset of severe symptoms out of proportion to a normal URI. I take the time to explain this to my patients and have a handout listing a variety of treatments (decongestants, irrigations, hydration, head elevation, etc.) to employ at the onset of a URI. At the bottom of the handout the indications for antibacterials are listed.
I believe that if a person comes in asking for a antibiotic because they have such and such problem, and their last doctor prescribed it to them and it cleared them up. Then their current doctor check to see that yes this patient does have frequent sinus infections. But for the vast majority of people who want antibiotics they are unnecessary.

The best solution to a cold is just rest, if you get the sniffles you don't need to run to your doctor. Doctor/Patient communication should address the face that colds are caused by viruses not bacteria so perscribing antibiotics will not help at all, infact it may even make them more miserable as a side effect is in some cases diarrhea
Today we know that chronic sinusitis develops when the nasal cilia fail to wash out the bacteria. Its one thing to say no antibiotic, but its better to say take adequate fluids, rest, hot tea,lemon and honey, chicken soup and pulsatile irrigation - all of which stimulate cilia to wash out the bacteria.
As a med student/ researcher I get the whole antibiotic resistence thing. I get it very well. But every year I go through this viscious cycle of getting some virus that causes congestion and makes me miserable for a week. I give myself as much bed rest, fluids, vitamins, OTC stuff, saline rinses as I can manage in an attempt to fend off what usually occurs over the next 10 days. Yup, virus goes away, congestion remains, headache, dizziness, etc follow and get worse. After being miserable for roughly two and half weeks I go to the doctor and after 3-4 doses of my antibiotics I'm doing great. I'm willing to wait it out. However, I appreciate it when I see a doctor who doesn't just brush me off like I don't know my own body. This cycle has gone on ever year since I was in grade school. I've had years of experience and pretty high accuracy rate at determining what will go away by itself and what I'm going to be making 2 trips to the doctor for. I think doctors need to do more to make the patient feel like they are being listened to, a few doctors who wrote in quite obviously have a problem with patients asking for antibiotics and seemed quite impatient in their tone. That's not appropriate. I don't want antibiotics for a viral infection, I think most people don't. They just want to be sure that's what it really is before they leave. Antibiotic resistence is a very scary, very serious issue. Now it seems like people go to one extreme or the other, either give out to many when they aren't needed, or not give out any, even when they are. Too many times I've waited it out for quite a long time only to go to the doctor, have them not believe how long I've been sick, and make me wait it out even longer. That's not right either. I had another urgent care doctor refuse to do a rapid strep test and tell me it was just viral one weekend when I went in sicker than a dog with the worst sore throat I've ever had (and there've been some bad one's). Strep tests take 5 minutes to run, I was willing to pay. (esp. after spending an hour in the waiting room wishing I was curled up in bed) I wound up at student health a few days later with a positive test. Patient's need to listen to their doctors, but need to know their doctors are listening to them too, with respect. That's what will make them listen. It's a two way street.
(also, what's being done to address what seems to be such a common problem. I've heard of someone developing antifungal nasal sprays, but what are they looking at for prevention?)
I'm 41 and have had sinus infections all my life. But I've noticed that each one is different. If there is no fever or laryngitis, I treat it with Mucinex, sudafed and Flonase. If there is fever, I add Augmentin (even though my doctor ALWAYS trys to give me Z-Pak first, which doesn't work for me).

The non-fever sinus infections usually take 3-4 weeks to clear, sometimes longer.

I like my system and, thankfully, I have a doctor who agrees with me. Communication in a non-demanding, non-threatening way with a doctor is really the best way. In other words, be nice to your doctor. They really do want to help. And there is no rule saying you can't switch doctors until you find one you like.
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