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LiVe Well

Do you need antibiotics?

By Edward Stenehjem MD

Nov 21, 2019

Do you need antibiotics

Every year, you and your family face a fair share of cold, flu, ear, and sinus infections. These types of illnesses make you feel extremely bad and unlike your normal self. In fact, sometimes you feel so unlike yourself that you miss work or school and might try any remedy, treatment, or medication to start feeling better again. Antibiotics are often a patient-desired solution for these symptoms.

In some cases, antibiotics improve your symptoms and help you feel better, faster.  However, in most cases, antibiotics aren’t necessary. Patients think antibiotics are a quick fix solution. But in reality, antibiotics don’t work on viruses that cause the common cold or flu, and rarely help with sinus and ear infections.

Antibiotics may:

  • Do more harm than good by causing side effects such as nausea, diarrhea, rash, and yeast infections.
  • Cause a severe form of diarrhea called Clostridioides difficile (C. diff), which can be life-threatening.
  • Become less effective when used repeatedly.
  • Alter the microbiome by causing the good bacteria in the gut to become resistant to bacteria.

If your symptoms are severe and last a long time, your doctor may recommend watchful waiting or a delayed antibiotic prescription.

What is watchful waiting?

Watchful waiting is the practice of keeping an eye on symptoms to see if they improve with time. It’s considered the best practice by most experts who treat sinus and ear infections. Doctors know most people will get better on their own with over-the-counter medicine and won’t need antibiotics.

How is watchful waiting done?

If your doctor believes that you or your child don’t need an antibiotic right away, they’ll ask you to do the following: 

  • Closely track symptoms for several days, such as temperature, pain, cough, or runny nose. Note if symptoms worsen, stay the same, or improve. 
  • Take over-the-counter medications your doctor recommends to help you or your child feel better while waiting. Make sure to rest and drink extra water. 

Your doctor will tell you how long to watch and wait. If your symptoms don’t improve or if they worsen at the end of the watchful waiting period, call your doctor for further instructions. 

What is a delayed antibiotic prescription?

In addition to watchful waiting, some patients who have symptoms of a sinus or ear infection may get a delayed antibiotic prescription from their doctor. This antibiotic can be filled at a later date if symptoms don’t improve. 

When will my doctor choose watchful waiting and a delayed antibiotic prescription?

Your doctor will recommend watchful waiting based on the severity and duration of your symptoms. This information helps your doctor determine if your symptoms will respond to an antibiotic. If your symptoms aren’t severe but they’ve been present for over 10 days, it’s safe to not immediately use an antibiotic because your symptoms will likely improve on their own. This is the most common reason your doctor will use watchful waiting and, possibly, a delayed antibiotic prescription. If your symptoms don’t improve in 5 to 7 days after seeing your doctor, consider filling your prescription or calling your doctor.  

Your doctor knows that: 

  • Antibiotics only work on germs called bacteria. They don’t help you get better faster if you have a virus. 
  • Your immune system is the only thing that will fight the viruses that cause sinus infections, colds, ear infections, and bronchitis. However, over-the-counter medication can help you feel better while your body is healing. Your doctor will help you find the right combination for you or your child.

When should I call my doctor?

During the watchful waiting time period, call the doctor right away if you have any of the following symptoms:

  • New severe pain 
  • Rising temperature 
  • Chest pain 
  • Coughing blood 
  • Difficulty breathing 
  • Confusion 
  • Severe drowsiness 
  • Shaking and/or chills

What is the benefit of watchful waiting?

Using antibiotics when they’re not needed can do more harm than good. By practicing watchful waiting and not overusing antibiotics, you’ll avoid the side effects antibiotics can cause, such as allergic reactions and diarrhea. The less antibiotics that we use, the more likely they are to work when we really do need them. 

For more information about how Intermountain Healthcare is taking a proactive approach to appropriate antibiotic usage visit