When to say no to antibiotics

Using the drugs when you don't need them poses serious risks

Last updated: June 2015

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: 

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.

Read more: From the American Academy of Family Physicians.

2. Eczema

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.

Read more: From the American Academy of Dermatology.

Read our special investigation "The Rise of Superbugs" and see our continuing coverage of America’s antibiotic crisis.

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.

Read more: From the American Academy of Ophthalmology.

4. Pinkeye

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.

Read more: From the American Academy of Ophthalmology.

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 sort 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.

Read more: From the American Academy of Pediatrics and "Got a Sore Throat? Hold the Antibiotics."

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.

Read more: From the American Academy of Allergy, Asthma, and Immunology.

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.

From the American Academy of Otolaryngology-Head and Neck Surgery.


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.

Read more: From the American Geriatrics Society.

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.

Read more: From the American Academy of Dermatology.

Editor's Note:

This article also appeared in the April 2014 issue of Consumer Reports on Health.

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