Here’s When It’s Smart to Skip Antibiotics, According to Doctors

For some common conditions, these meds are way overprescribed. Here’s what to do instead.

uring the 15 years that Maureen Lake of Denver was a special education teacher, she had four or five urinary tract infections a year. “I couldn’t get to the bathroom when I needed to go, so I’d hold it for hours and develop an infection,” she says. When she felt the telltale stinging sensation, she’d contact her doctor, who’d call in an antibiotic prescription to her pharmacy. “The antibiotics cured my symptoms but gave me terrible diarrhea. By the end of a course of treatment, I was drained and fatigued—literally pooped out,” Maureen says.

Then, a few years ago, she switched doctors, and the next time Maureen developed a UTI, she was taken aback by what her doc said. “She didn’t want to prescribe antibiotics right away, because she wanted to see if my body could clear the infection on its own,” Maureen recalls. “She gave me a prescription but asked me to hold off on taking it for at least two days.” The doctor also advised downing eight to 10 glasses of water daily and loading up on vitamin C.

This didn’t sit well with Maureen. “I’d always heard that UTIs could turn into serious kidney infections if you didn’t treat them,” she says she told her doctor. “She understood my concern and said I should monitor my symptoms and start the drugs immediately if I started getting a fever or chills.”

After 24 hours on the no-antibiotic protocol, Maureen felt better, not worse. Within a few days, her symptoms went away. “I was surprised. I fully expected to fill that prescription,” she says. “The few times since then that I’ve had UTIs, I’ve beaten them on my own. It was eye-opening for me—all those antibiotics I took were probably unnecessary. Waiting it out works just as well.”

The Case for Skipping Antibiotics

As concern about antibiotic resistance continues to rise, there’s a growing movement to use the watch-and-wait approach as the first-line treatment for a number of common ailments. This can feel uncomfortable, even negligent, to those of us who are used to being given antibiotics for every sniffle and sore throat. But many of the pills we’ve swallowed over the years have likely been useless. Common infections for which antibiotics are prescribed are frequently caused by viruses, which don’t respond to them. And even when an illness is caused by bacteria, as in the case of many UTIs, research now shows it can often clear up without medication. “I don’t know where we got the impression that our bodies can’t fight simple infections on their own, but they can—and there are good reasons to let them,” says Jeffrey Linder, MD, a professor of medicine at Northwestern University’s Feinberg School of Medicine.

At least 30 percent of the antibiotics prescribed during office and emergency room visits are unnecessary, according to the Centers for Disease Control and Prevention. And while the medications can be lifesaving in certain circumstances—say, for sepsis or a staph infection, either of which can move quickly and be deadly—they’re not without risks. Of the drugs involved in adverse reactions severe enough to send people to the ER, 16 percent are antibiotics, according to a 2016 study in the Journal of the American Medical Association. “Antibiotics can cause rashes, yeast infections, and diarrhea—sometimes a life-threatening type caused by Clostridioides difficile (C. diff), nasty bacteria that can flourish in your gut when you kill off the good bacteria with antibiotics,” says Dr. Linder.

So how did we come to expect a prescription for every ailment? In part, it’s because we tend to want our docs to do something about our symptoms. And patients “don’t necessarily distinguish between bacteria and viruses. They just want to feel better quickly,” says Brad Spellberg, MD, chief medical officer at the Los Angeles County-USC Medical Center and an expert on antibiotic resistance. “On the physician’s end, it’s sometimes difficult to distinguish between viral and bacterial illnesses based on symptoms, so doctors err on the side of giving patients what they want and expect.”

Patients are also, well, impatient, Dr. Linder adds. “They often say things like, ‘I can’t be sick right now.’ They don’t want to accept that they might not feel great for three weeks,” he says. “But for straightforward ailments in otherwise healthy people, the best treatment is often keeping an eye on your symptoms to make sure they’re not getting worse, using over-the-counter remedies to feel better, and letting your body do the rest.”

Not that you should ignore your symptoms: Watching and waiting is best done with a doctor’s supervision, lest you miss a bigger issue. But if you have one of the following common conditions and a doctor offers you an antibiotic, ask if it makes sense to wait. Here’s how the antibiotic-free approach works:

Skipping Antibiotics with Bronchitis

The symptoms: a lingering cough, often with colored mucus, that can set in after an upper respiratory infection

Why wait? Fully 71 percent of people who see their doctors for bronchitis receive an antibiotic, according to a study conducted by Dr. Linder and his colleagues, but these drugs are almost always unnecessary. “We have 40 years of randomized controlled trials showing that antibiotics don’t help people recover from acute bronchitis,” he says. It’s overwhelmingly caused by viruses, not bacteria, and is largely the result of the body’s immune response to the infection, not the infection itself. “The virus causes inflammation and your body makes green or yellow mucus, which is why you develop that annoying hacking cough,” says Dr. Linder. “But that’s normal—it’s like when you cut yourself and get a scab. When you have a lung infection, you cough. And it takes a while for the lungs to heal.”

How long it takes to recover: 3 weeks on average

What to do to feel better: Get plenty of rest to bolster your immune system; drink eight to 10 glasses of water, soup, or juice every day; use a humidifier or stand in a hot shower and breathe in the steam to loosen phlegm; take lozenges to soothe the tickling sensation in your throat; consider a cough medication at night to help you sleep.

Signs that you may need further treatment: Spiking a fever greater than 101.5°F, wheezing, having chest pain not related to a pulled muscle from coughing, or feeling worse in general—all of this could indicate pneumonia, for which you need an antibiotic.

Skipping Antibiotics with a Sinus Infection

The symptoms: a low-grade fever with copious nasal discharge and facial pain or pressure

Why wait? About 71 percent of sinus-infection patients receive antibiotics, though 90 percent to 98 percent of infections in adults are caused by a virus. According to the CDC, antibiotics may not help even in the rare bacterial case: A 2012 study in the Journal of the American Medical Association found that the recovery of patients treated with 10 days of antibiotics differed little from that of those who took a placebo.

How long it takes to recover: Seven to 14 days, though you should start feeling better in a few days if it’s a routine viral infection, says Priya Nori, MD, medical director of the Antibiotic Stewardship Program at Montefiore Health System. “The reason watch and wait works is because viral infections have a predictable life span: You feel terrible for a few days, then start improving,” she says. “About 2 percent evolve into bacterial infections and need an antibiotic.”

What to do to feel better: Rinse your nasal passages with salt water, using either a neti pot or prepacked saline spray, several times a day. To reduce stuffiness, use over-the-counter nasal decongestants with oxymetazoline or oral decongestants with pseudoephedrine. A nonsteroidal anti-inflammatory can ease the pain. Rest a lot.

Signs that you may need further treatment: A fever higher than 100.4°F, symptoms that are getting worse after 10 days, repeated sinus infections in the course of a year, or symptoms so severe that you don’t get relief with over-the-counter medications.

Skipping Antibiotics with a UTI

The symptoms: pain when you pee, feeling like you need to go even though you just went, fever of less than 101°F

Why wait? It may be noninfectious cystitis—inflammation of the bladder not caused by a UTI. Cystitis is usually caused by an infection, but if you have the classic symptoms without the fever, you may be having a reaction to a medication or irritation from feminine hygiene sprays or spermicidal jellies. The symptoms are so uncomfortable that many patients want to take immediate action. “Most people start antibiotics before they know they have an infection, because they don’t want to wait for the culture to come back,” says David Shusterman, MD, a urologist at NY Urology in New York City. Almost half of women with negative cultures are given meds, adds Betsy Foxman, PhD, a professor of epidemiology at the University of Michigan School of Public Health.

But though true UTIs are typically caused by bacteria, the majority of uncomplicated infections go away on their own without antibiotics. When German researchers compared women who took an antibiotic with those who simply took ibuprofen for three days, they found that two-thirds of the women on ibuprofen recovered without needing antibiotics (the rest were given antibiotics to clear up the problem). As for whether waiting led to the kidney infection patients like Maureen Lake feared, of the 248 women in the ibuprofen group, only five developed kidney infections, and these were mild and responded to antibiotics. In comparison, of 246 women who were given antibiotics from the start, one went on to develop a kidney infection nonetheless. The bottom line is that kidney infections are rare, says Dr. Shusterman. “But it’s good to have an antibiotic on hand so you can start taking it if your symptoms get worse.”

How long it takes to recover: In the German study, 39 percent of women who waited it out were symptom-free by day four and 70 percent were well by day seven; in the antibiotic group, 56 percent felt better by day four and 82 percent by day seven.

What to do to feel better: “The biggest issue with watching and waiting is the pain, but ibuprofen can help, says Foxman. Pyridium, Azo, and Uristat are medications that soothe the lining of the urethra, reducing pain during urination. Drink loads of water, says Foxman. “Frequent urination will help get rid of the bacteria.” Large amounts of vitamin C might limit the growth of bacteria, although the approach hasn’t been proven to effectively treat a UTI.

Signs that you may need further treatment: fever; worsening abdominal, flank, or lower-back pain; or nausea and vomiting.


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