And, apart from their being useless against viruses ... the bacteria have become increasingly resistant, to the point of the antibiotics being ineffectual or nearly so against many of them ...

... and the research people haven't come up with new generations or new types of infection fighters to provide effective treatment, and many are saying that we may well have much greater troubles down the road than we've known for generations.

ole joyful

"Why do they persist in doing this?"

If I had to guess, I'd guess it has something to do with the format of managed care, records, and the ever present possibility of the prospect of litigation.

Listing a patient's symptoms, writing diagnosis of 'possible infection', and following that up with a prescription might look a lot better on paper if something goes wrong, rather than something like 'diagnosis not certain, will continue to observe'. A better CYA but perhaps not better in reality, when one looks at the big picture of antibiotic over use.

Sinus infection is quite frequently a bacterial infection which is treated with antibiotics. I do take antibiotics for sinus infection when producing discolored mucous. Bacterial infections often piggyback with a viral infection. I have had a bad sinus infection move down into my bronchial tubes and progress to pneumonia. I definitely want to stop that bacterial infection at the sinus infection and not try to stop the pneumonia. So offering antibiotics is not unusual in this case.

I agree with you 100% but I also agree with Raven. As someone with asthma and 3 bouts of pneumonia in my life, I will start antibiotics if I get a painful in my lungs cough. Haven't had to do this for a couple of years, but I know what happens if I get a bacterial infection in my lungs.

Another thought is that government reimbursement is tied to patient satisfaction scores. If a patient leaves angry that they didn't receive the drugs they wanted and leaves you a bad review it could end up costing you in actual reimbursement.

My father was a physician back in the days before managed care. He lost patients because he used to refuse to prescribe antibiotics for viral infections. So the understanding on the part of the physician is there, and was even 30, 40, and 50 years ago.

I agree it can be tricky, although I read quite a bit on the subject yesterday, and most of the big medical centers said sinus infections are usually viral. They also said while viral infections can lead to bacterial ones, most remain viral and will resolve within 14 days.

I'm watching my own, concerned that I might have the same experience you describe, Raven. My sinus infection is slightly better today, but it has moved to my bronchial tubes (plus I've lost my voice). The Augmentin is waiting for me at the pharmacy should I decide to take it.

Joyfulguy, Lucille, Sleeperblues: Good points, all.

Under-prescribing/under using is another issue with antibiotics that doesn't get as much press. People stop taking the antibiotics when they start feeling better even though they're told it's essential to take the whole prescription. Then they treat themselves with the leftover five pills. In both cases, they're only killing the least of the bacteria and leaving the strong to survive and breed. Add to that prescribing professionals who are so anxious to not over-prescribe that they give a minimal prescription for a bad infection, which leads to several rounds of antibiotic without killing the root infection, as well as associated fungal infections, disruption of the natural flora, etc., all while strengthening the bacteria.

ETA: Sinus infections didn't used to be called "infections" if they were viral. It's also true, however, that a healthy person may be able to fight off a bacterial secondary infection in the sinuses with the same treatment as for the virus -- rest, fluids, warmth, immune boosters (chicken soup, antioxidants, etc.) -- and that it should resolve within a couple of weeks. In those cases, however, antibiotics will also work, will save people a lot of discomfort and lack of productivity, and prevent it from developing into a worse infection or spreading, which makes it much much harder for a prescribing pro to not use them (i.e., because they're appropriate, even though possibly unnecessary). Of course, they could culture them and choose the right antibiotic, but Augmentin is usually it, and culturing a sinus infection can be very difficult and unpleasant.

I tak antibiotics for sinus infections also. I know everyone says it, but I know when I have an sinus infection and not just extremely bad stuffed up nose. I never have a fever with it though oddly enough.

About 4 years ago I got extremely sick. Fever, my face, eyes, cheeks, ears, neck, teeth, throat, everything hurt. And a raging migraine on top of that. I finally was able to get into the dr. I had a sinus infection, both ears infected, thrush and an infected throat. They didn't say I had strep throat, so I'm not exactly sure what "infected throat" is, or if that's just another name for strep.

I do agree antibiotics are way over used, but I also agree with Lucille, I think there's a whole lot of meds distributed and tests run because the medical profession is so worried about our very sue happy society anymore. People sue for everything now.

Quick update: Based on what's coming from my bronchial tubes, I do not want this to move into my lungs. So I'm off to get the antibiotic. Dammit.

Had sinus infections a couple of times in the last year and a bout of Bell's palsy. A help although not a complete cure is a Neti pot. I use one on a regular basis and find it to be beneficial.

Almost a year ago was the first time in probably 20 years that I have had an antibiotic prescribed for me. I had a sinus infection and my husband was coming home from the hospital after being there a long time from his stroke. I could not get in to see my regular doctor but went to the Med Center. The antibiotic really worked well for me.

Sue

After having had a serious case of C-diff, which was cured thank God, I know to be extremely careful with antibiotics and make sure they are only an acceptable kind and that I do so only under advisement of the specialist who treated me. If you've ever had a superbug you will quickly become educated in this regard. I contracted C-diff in a way many people do--taking a powerful antibiotic (clindamycin) routinely given after dental surgery (and acne cases, among other things). Be careful out there, folks!

I don't think this urgent care facility has a physician. There's someone they call "doctor," but his doctorate is in nursing. He did a great job of stitching up my hand a few years ago.

I had to look up C-diff, Cassandra. It sounds awful, and I'm glad your case was cured.

On the way to the pharmacy this after I remembered the last time I had a sinus infection and bronchitis. It was a long time ago--back in the 80s--but I remember it well. It just hung on for ages, seeming to resolve and then returning with a vengeance, until I finally got treated with antibiotics.

Feel better soon! I've never gotten rid of a sinus infection without an antibiotic. I also had a combo of illnesses about 15 years ago and would have died without my husband taking care of me and forcing me to the doctor. I was so sick, I just wanted to lie in bed and die.

I recently saw a PA for the first time here in Oregon. My MD is now on a 'team' and I get care from several 'team members....nurses, PA's, I think 7 members. Benefits are that those younger 'team members' are better at keeping up the paper-work like follow-up apps for specialists etc. than my MD. (and, yes, I often forget to remind his office when they don't happen) Down-side....those suggestions that I "might want" i.e.. an inhaler" incase I get a cold and need it. ????It's been several years since I have had pneumonia and haven't needed one since 2009/10. Am I being 'warned' that might not be able to see my MD when I need to??? Usually see him within a day or (never happend) two. Then, try (numerous times) to convince the pharmacist that the inhaler is 'just a fillable prescription' until I need it....ended up being picked up by DS when picking up other prescriptions. Life is just not simple anymore....and I have an inhaler that will most likely expire before I need it (maybe wishful thinking, since I got the new pneumonia as well as flu shot this year)

Many of us in healthcare are frustrated by the greater emphasis on "patient satisfaction" over quality of care. Yes, I feel my hospital administrators care more about if you were happy about your experience, than if I diagnosed or treated you correctly.

http://www.theatlantic.com/health/archive/2015/04/the-problem-with-satisfied-patients/390684/

"When Department of Health and Human Services administrators decided to base 30 percent of hospitals’ Medicare reimbursement on patient satisfaction survey scores, they likely figured that transparency and accountability would improve healthcare. The Centers for Medicare and Medicaid Services (CMS) officials wrote, rather reasonably, “Delivery of high-quality, patient-centered care requires us to carefully consider the patient’s experience in the hospital inpatient setting.” They probably had no idea that their methods could end up indirectly harming patients.

Beginning in October 2012, the Affordable Care Act implemented a policy withholding 1 percent of total Medicare reimbursements—approximately $850 million—from hospitals (that percentage will double in 2017). Each year, only hospitals with high patient-satisfaction scores and a measure of certain basic care standards will earn that money back, and the top performers will receive bonus money from the pool."

ANTIBIOTIC

Very nice of you to provide this information for people to refer to.

Patients are customers as well as patients. In most places, patients can and will go to other providers and institutions if they are unhappy with the services or the experience they had.

Having surveys and assessing customer experiences is what's done at most other businesses. With the medical field in particular, patient satisfaction has been too long ignored.

I welcome the surveys I receive and ALWAYS return them with honest answers because I find it's a small way to thank caring service providers and to let their superiors know when they're doing a good job. It's also a way to highlight those who need to put more effort into their bedside manner or customer dealings, as the case may be.

Don_socal, I'm a big fan of the neti pot. I was just saying to my daughter yesterday that they're so much more widely recommended today than they were when I got our first one in the 1980s.

Mdln, thanks so much for sharing those pages. I haven't started the Augmentin yet, and will probably wait till tomorrow to make a decision on that. I've been feeling dramatically worse in the early morning--between 4:00 a.m. and whenever I get up--and I'll be interested to see how I feel tomorrow. Right now my sinusitis is much better (I can actually breathe through my nose, sort of, although I can't taste much), and I feel less sick. But I've just about completely lost my voice, have a cough, and it's obvious the infection has migrated downward from the sinuses.

Yesterday's P.A. said firmly that if the nasal discharge is yellow or green, it's definitely a bacterial infection. This brings to mind the CNP who told me an MRI emits just as much radiation as a CT scan. It's a shame "information" like this gets handed out.

Very interesting about the patient surveys and their purpose. I can see their benefit following a hospital stay, but really, after just a prescribed blood draw in the lab? Seems like paperwork overkill, but because of the financial ramifications mentioned, I'll complete them all. We do have an excellent hospital and urgent care is a satellite of it, so want to keep those folks happy by getting paid what they are due.

I went without antibiotics for awhile, until my provider gave in. After they gave me the scan, they figured out I have pansinusitis (an infection in sinuses on both sides of my head). I've had it since before JULY. Obviously antibiotics weren't given, but should've been.

Sounds like the answer is: maybe they should slow down and actually listen more to figure out who needs antibiotics? I surely did. I'm on day 15 of a 21 day round (think about how long a typical round is, 7-10 days? right?). She also said, this infection is unlikely to clear up with one round. Probably because they waited so long to get me well. Dang them. Oh, and I quit having bathroom problems, my hair quit breaking, my nails are growing again. I'm really wondering how sick am I?

I still don't know what I'm doing. I had a difficult night with lots of coughing and choking, and then at some point I couldn't cough, and that was worse. At times it felt like my throat was going to turn inside out with the effort. A few times I sounded like a barking seal, and I remembered the croup my son had as a child.

Hot tea helped this morning, and I'm still drinking it (no caffeine). I felt generally worse than yesterday, though, and started the Augmentin. Then I read that adult croup, while rare, can happen, and is always viral.

I feel like I'm being punished for saying harsh things about antibiotic overuse.

(((alisande))) Let's just think it is viral and there is nothing you can do anyway except pamper yourself and get hugged. So we're on it. You pampering and me hugging. Get well dear one!

Aw, thank you, Rob!

Good wishes for a rapid recovery, Alisande.

ole joyful

Thanks, Joyful! My voice is starting to come back, so that's good news. (To me, anyway. LOL)

don_socal, good reminder. I had a neti pot, then this sinus rinse was recommended to me. I use it all the time, I think it works better than the neti pot, just my opinion :) I was also told by my allergist to use distilled water and to make sure I use the salt packets made for the neti pot/sinus rinse bottle. Regular salt is too strong for the delicate nasal passages and can leave a residue.

http://www.target.com/p/neilmed-pharmaceuticals-original-sinus-rinse-kit-packets-50-count/-/A-13342400?ci_src=17588969&ci_sku=13342400&ref=tgt_adv_XS000000&AFID=google_pla_df&CPNG=PLA_Health%2BBeauty%2BShopping&adgroup=SC_Health%2BBeauty&LID=700000001170770pgs&network=g&device=c&location=1024622&gclid=Cj0KEQiAyvqyBRChq_iG38PgvLgBEiQAJbasd4uVPqNMlqDBS-QJyKV4Dl8xeb5kRg0usZP4kvQEFhYaAsfB8P8HAQ&gclsrc=aw.ds

And when the forehead, face, cheeks, ears, temples, neck etc. really ache this thing is like magic. Zapped in the microwave for about 2 minutes and wrapped around neck/across forehead and eyes, it's damn near a miracle the relief it gives.

http://www.kohls.com/product/prd-235892/earth-therapeutics-anti-stress-comfort-wrap.jsp?ci_mcc=ci&utm_campaign=BATH%20%26%20BODY&utm_medium=CSE&utm_source=google&utm_product=12226038&CID=shopping15&ci_src=17588969&ci_sku=12226038&gclid=Cj0KEQiAyvqyBRChq_iG38PgvLgBEiQAJbasdybQr8r5U03APaBzDWo1Nkcp9OafrVPm7W2K07g3NUIaAmBH8P8HAQ&gclsrc=aw.ds&dclid=CKLSrPOevckCFctANwodZ2ANwA

That sinus rinse is the best thing on the planet. I cannot get my mom to use it, but I swear by it. My infection was so bad, I was using it four times a day and relief only coming for a 30 minute or so break each time. But it helped.

Thanks for the tips, Katlan. I was taught to use a neti pot 30 years ago by physicians at the Himalayan Institute. I don't know what they recommend today, but back then I was told to use non-iodized salt in lukewarm tap water. Looks like the sinus rinse product contains non-iodized salt and baking soda. I'll bet it's possible to make this up at home, in prescribed proportions. I'll have to look into it.

I use the sinus rinse bottle--with non-iodized salt and DISTILLED water. It's important not to use tap water. And heat it in the microwave for 30 seconds (8 ounces. 4 ounces would be 20 seconds).

2 cups distilled (or boiled-sterile) water

1 teaspoon salt

1/4 teaspoon baking powder

2 tablespoons white vinegar

Mix and warm slightly in microwave. (Don't get it too hot!) Sniff up or (better) use squeeze bottle to propel into nasal passages. Bend head forward; tilt head to both sides to wash sinuses. Expel into sink.

Or...much easier, buy the packets of pre-mix.

My pulmonary MD washes her nasal passages every evening, routinely, same as she washes her face and brushes her teeth.

When we married, my DH 'came with' a nasal inhaler -- one of those menthol stick-things? He had a lot of sinus trouble until I got him to ask the MD about this thing. "Throw it out! It's reinfecting you!" (Just as I suspected...and that was the end of the endless infections.)

Edited: ACK! I meant to type 2 TEASPOONS white vinegar!

Vinegar and baking powder in your nose? I hope it doesn't bubble!

Or maybe only baking soda would bubble. But what's the purpose of baking powder, except as a leavening agent?

Rob, why is it important not to use tap water? I've been using tap water for 30 years. Maybe it depends on the quality of your tap water? We have our own well, and it tested perfectly every time when we had the tofu business.

Do you boil it? Here's an article that agrees with my pulmonary medical group. But it's easier to use the bottled distilled than boiling the water.

You may have missed the link I put in the middle of the sentence above to WebMD.

Web md Neti Pot

Good article, Don, but I'm surprised it tells you to blow your nose--with no mention of how to do it. I was cautioned never to blow in the usual fashion immediately after nasal irrigation because it will blow any remaining liquid into your ears. Ouch! Instead, I was taught to blow without touching my nose into the sink or a paper towel. After a short time, blowing normally should be okay.

If I bend over and blow my nose, it takes the pressure off my ears. I started doing that because later in the day, I'd bend over to pick up something I dropped and saline water would drip out. But I found this weird trick doing that :)