When you think you need antibiotics—but really don't

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

Published: March 2014

Several medical groups have now compiled lists of conditions for which antibiotics are often misused. Here are nine examples.

1. Ear infections

The problem: Most ear infections improve on their own in two or three days, especially in children 2 or older. 

When to consider antibiotics: Get antibiotics right away for babies 6 months or younger, children from 6 months to 2 years old with moderate to severe ear pair, 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.

3. Eye infections

The problem: Doctors often prescribe antibiotic eye drops after treating some eye diseases, such as macular degeneration, with injections. But those drops are rarely necessary and can irritate your eyes.

When to consider antibiotics: If you have a bacterial eye infection, marked by redness, swelling, tearing, pus, and worsening vision.

Read more: From the American Academy of Ophthalmology.

4. Pinkeye

The problem: Pinkeye usually stems from a virus or 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

The problem: Sinusitis, too, is usually viral. When bacteria are the cause, infections usually clear up untreated in a week or so.

When to consider antibiotics: If symptoms are severe, don’t improve after a week, or get better and then worsen.

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

7. Swimmer's ear

The problem: Swimmer’s ear is caused by water trapped in the ear canal. Usually, over-the-counter ear drops help as much as antibiotics, and they don’t cause resistance. But if you have a hole or tube in your eardrum, check with your doctor first. Nonprescription ear drops could damage your hearing.

When to consider antibiotics: If the infection spreads beyond the ear or you have other conditions, such as diabetes, that increase the risk of complications. If you do need antibiotics, antibiotic ear drops work better than oral antibiotics. 

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


8. Urinary-tract infections in older people

The problem: Older people are often treated with antibiotics when a routine test finds bacteria in their urine. But if they don’t have symptoms, the drugs won’t help.

When to consider antibiotics: Before certain surgeries or when you have burning during urination and a strong urge to “go” often.

Read more: From the American Geriatrics Society.

9. Wounds from skin surgery

The problem: 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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