Why Didn’t My Doctor Give Me an Antibiotic?

March 27, 2017

By David Gude, M.D. 

Patients often expect antibiotics for their illnesses, not understanding that in many cases antibiotics will not make them better faster, and could cause more harm than good.

Over the past 50 years, antibiotics have been over prescribed for three reasons:
1) colored sputum or snot must indicate infection
2) antibiotics can prevent colds, allergies or flu from developing into a bacterial infection
3) antibiotics can’t do any harm.

However, medical science has clearly demonstrated all three of these presumptions are incorrect.

Color of Sputum/Snot

It had long been accepted that the normal color of respiratory secretions is clear and that any coloration indicates a bacterial infection.  Over the past ten years, medical scientists have refuted this myth.  Color does not predict the need for an antibiotic.  Key factors of a sinus infection diagnosis include; duration of symptoms (greater than 10-14 days), measured temperature (normally low grade, 100.5 ) and facial pain.  When all three symptoms are present, there is a good chance an antibiotic will be helpful.

Antibiotics Prevent Infection

Even among those physicians who long ago recognized that antibiotics were not required for a patient’s current condition; they reasoned antibiotics could prevent a bacterial infection. Colds or allergies could be prevented from becoming a sinus or bronchial infection, or bronchitis could be prevented from becoming pneumonia. Studies show this is not the case. There is no less chance of a bacterial infection by pretreating. There is, however, an excellent chance that any infection which does develop will be resistant to the antibiotic taken, thus requiring stronger antibiotics which have a greater chance of side effects.

Antibiotics Do Not Cause Harm

Sadly, this is the most unfortunate myth of the three. In the distant past, there was no such thing as antibiotic “resistance” in which bacteria overcome the effect of the antibiotics. Such resistance is now commonplace. Of greater importance, those resistant bacteria cause more serious medical conditions than sinusitis or bronchitis.  Bacteria such as MRSA (skin abscesses) and C diff (profuse watery diarrhea) are becoming more common.

Then WHY do I always feel better when my regular doctor gives me an antibiotic, and why would they prescribe if not necessary?

A fascinating article on the placebo effect was published a few years ago. It highlighted a study where patients were provided medicine and told by their doctor that the pills were inert (no active ingredient) and the bottle clearly labeled “placebo.”  However, the doctors also told them ‘I believe these will help.’   These patients did get better faster than their peers who did not receive the fake pills or counsel.  The lesson: The mind is a powerful instrument in healing and recovery.

As to why some physicians might still be practicing in a dated fashion and providing antibiotics when they are not needed, the potential answers are numerous. Doctors, like most people, want to do the right thing and also be liked and respected by their patients.  It is the path of least resistance to meet expectations which have been developed for 50 years, with doctors as willing participants.  It is not, however, best medical practice.  It is now clearly recognized and accepted by experts and public health officials that there are many downside risks of unnecessary antibiotics. For some physicians, the complications of over prescribing antibiotics may be merely theoretical, as their patients have their abscesses and explosive diarrhea treated at the urgent care center when they are unable to get a timely appointment.

Physicians spend decades in training and continuing education to recognize and treat ailments like sinusitis and bronchitis. Medical advances and research allow physicians to determine best practices in treating illness and disease, and how those practices will benefit a patient.

In the end, it comes down to this; you need to find a doctor or clinic where you feel confident, well treated and where your questions and concerns are answered.  A key part of the relationship between a patient and their health care provider is establishing a therapeutic relationship where trust is the primary component.

At Texas MedClinic, we want to Treat You Well, giving you honest, state-of-the-art medical care. Sometimes you may not agree, and choose not to see us for a similar health issue in the future. With honesty, we risk losing you as a patient. We believe your health is worth those risks.

Dr. David Gude is a family medicine specialist and COO of Texas MedClinic.

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