Unfortunately, in America we have gotten in the habit of giving antibiotics for ear infections, and for the vast majority of patients, they expect antibiotics to be prescribed.
There has been evidence for over a decade in Europe and Canada that supports pain relief over antibiotics for children with ear infections, and that has been their practice. There is a difference between what society and tradition say we should do — which is to prescribe the antibiotics — versus what the latest scientific information tells us to do: ease the symptoms.
For sinus infections, the evidence is very similar to ear infections. The treatments of choice for a sinus infection are decongestants, pain relievers and using a humidifier along with a nasal rinse. Antibiotics may be used if the infection doesn’t respond. But it can be difficult to determine whether a sinus or ear infection is due to a virus that won’t respond to antibiotics or a bacterial infection that might.
With throat infections, however, strep tests and throat cultures give us the luxury of being able to definitively distinguish between a bacterial or viral infection. When I know it’s a virus, I use treatments that are specific to symptoms: For example, a humidifier can relieve hoarseness and gargling with warm salt water can reduce inflammation.
Overusing antibiotics certainly has serious repercussions — most notably bacterial resistance to antibiotics. For example, my wife is a schoolteacher who had multiple infections and was treated multiple times with antibiotics early in her career. Now, she is resistant to three of the four major classes of antibiotics, so when she gets a simple bacterial infection, it is much harder to treat.
Also, the overuse of antibiotics has contributed to a number of antibiotic-resistant bacteria, such as methicillin-resistant Staphylococcus aureus (MRSA). I’ve seen a few patients who have had MRSA infections even though they were never treated with an antibiotic. So, certainly, we should be careful in regard to our use of antibiotics.