Why Won’t My Doctor Prescribe Me Antibiotics When I’m Sick for a Few Days?

We often receive phone calls from patients requesting antibiotics to help with their fever/runny nose and cough that started 2 days ago.  I understand why.  Patients have been conditioned over the years and feel like the antibiotics will be a quick fix. People often go to an urgent care or very busy medical practice and walk out with a prescription for a Z-pack.  After another couple of days they feel much better and attribute that benefit to the antibiotic rather than the virus running its course.

We have learned that this isn’t helping the patient but actually causing more problems.  Now a Z-pack doesn’t always work for a sinusitis even if a patient had a bacterial infection.  This is due to bacterial resistance.  Bacteria that have the ability to withstand the antibiotic will thrive and replicate and then we have bacterial resistant infections. The main cause for this is overprescribing antibiotics.  The more the bacteria are exposed to the antibiotic the more likely a resistant form can develop.  We actually have problems with a number of infections now due to resistance.

The truth is over 80% of upper respiratory infections are due to a virus.  Viruses are a different organism than bacteria so are not affected by antibiotics.  There are times when the virus causes a lot of inflammation and a secondary bacterial sinus infection or pneumonia can develop.  This is overall rare though, a study revealed bacterial infection occurs in only 0.5 to 2 percent of episodes of acute rhinosinusitis. When this does occur it is generally 10 days or greater after the patient was initially sick and was already starting to feel better before their illness worsened. These patients warrant antibiotics and generally feel much better once the bacteria is treated.  

The other reason why doctors don’t want to prescribe antibiotics unless they are needed is due to the possible side effects.  Antibiotics kill the good bacteria in our body and this can lead to diarrhea or yeast infections.  Depending on the antibiotic a patient may experience nausea, vomiting, diarrhea, tendon rupture or rashes.  It’s always best to avoid antibiotics if you can. That way they will work when you really need them.  

So when your doctor won’t prescribe antibiotics after a couple of days of an upper respiratory illness, they are just looking out for your best interest.  After a few days you will likely feel better anyway as the virus runs its course and you won’t add any other miserable symptoms.