Top 3 Reasons You Should Receive an Antibiotic For Your Cough or Sinus Infection!

Let’s get this straight.  There are two major culprit categories for your Sinus or Cough (We will call these URIs – upper respiratory infections):  Virus and Bacteria.  I’m sure you knew that.   Most people seem very frustrated when they are told they have a virus, as if the alternative was better.  I get it.  When we are sick, we obviously want to get better quickly.  Time off from work isn’t as fun as it used to be when we were children, sick and staying home from school remember?  I was waited on hand and foot, mom would bring models (cars not girls) so I could have something to do and watch TV all day.  That was the life.   <sigh>  Now, we have too much to do to be sick and we demand to be cured.  It seems many people forgot that the common cold sucks and needs to run its proverbial course.  A frequent conversation I hear in urgent care:

“Good news Mrs. Smith, your strep test was negative.”

“Really? Now what?”

“Well, go home get some rest, drink some fluids, have some soup, and take over the counter cold medicine if you wish.”

“What?  You are telling me I don’t get an antibiotic?”

“No, you see, with a strep test that is negative, it’s 99% a virus.”

“So, I came here for nothing?  I want an antibiotic! It always helps!”

I assume most people don’t know why an antibiotic is given.  I also realize that some people think a negative strep test and an expert opinion about their illness is simply a waste of time, which is funny, because they received a test and an expert opinion.  Seems like that’s worth the trip, no?  I get that it’s frustrating for patients to be told to go home, rest and drink fluids, but 90% of the time that’s all that is necessary.  Antibiotics only help about 10% of URIs, but are responsible for quite of bit of illness from diarrhea, c-diff colitis, dehydration, abdominal pain as well as yeast infections– in both the mouth and vagina.  Let’s not forget about Super-bugs – the resistant bacteria that won’t respond to antibiotics because they have been exposed multiple times to antibiotics inappropriately.  Knowing this, let’s talk about the top 3 reasons you should receive an antibiotic for your URI (MDs may treat differently).



If you come in frankly/obviously ill.  In the case of sinus infections, if you come in blowing pus out of your nose, your upper teeth hurt, the pressure is very intense, maybe you had a history of sinus surgery, you will receive an antibiotic from me.  If you come in with some mild pain for 1-2 days, no fevers, no nasal discharge, I will likely tell you to hold off on the antibiotic for a few more days and let the body “do its thang!”


If you were ill recently, got better, then a few days later got ill again, I will give you an antibiotic, no questions asked.  Our body has a limited number of security guards aka: fighting cells (this is how my mind works).   While all the security guards are in one location fighting infection to keep you healthy, it may miss what happening elsewhere, hence allowing a different infection to take over.  So, it’s good that your immune system got rid of that nasty primary infection, unfortunately they let something else sneak in while they were too focused elsewhere.  Rx written!


If you have been ill for more than 7 days and not improving, I will usually treat you with an antibiotic.  This is controversial among other docs, but this is how I work.  You see, the longer your system is exposed to an illness, cortisol kicks in (the stress hormone found in your adrenal glands), lowers your immune system and puts you at risk for another infection or super-infection (one on top of another).  This cortisol reaction is a little different than the “security guard” analogy.  You see, in the security guard analogy you have enough fighting cells, they are just preoccupied killing other bugs–All their attention is in one place.  Whereas with prolonged stress (broken arm, financial worries, infection), cortisol comes in and lowers your immune system.  Think of Cortisol as the Marijuana for your fighting cells–They aren’t gonna be able to do much when they are stoned, correct?  This means you are now susceptible to many other infections.  So when you are exposed to an illness for more than 7-10 days, your immune system starts to become sluggish and make you more susceptible to infection.  I will give you an antibiotic at this time.

Image result for security guards sleeping break


How do doctors know if it’s a URI is a virus or bacteria without a culture?

Viruses cause a whole body manifestation:  fever, chills, malaise, body aches, diarrhea, sore throat, cough, runny nose etc.

Bacterial causes are usually focused.  If strep throat – fever and sore throat.  usually not much else.  Pneumonia?  Cough, fever, chest pain.  Usually not much else.


Some Myths:

Green phlegm means bacteria
Possibly, but it may also mean dehydrated phlegm

Fevers mean that you need an antibiotic.
Nope.  This is a natural side-effect to your immune system working properly (look up diapadesis and TNF-alpha, IL-1 and IL-6)

Sinus infections need antibiotics
Actually most sinus infections, whether bacterial or viral will clear in 7 days regardless of antibiotic use or not

URI Viruses aren’t that bad
Have you seen the Flu–The “real” flu?  It’s nasty.  Mononucleosis can last 6 weeks and make your spleen susceptible to rupture.  Viruses suck!


Sometimes, I will give an antibiotic early to a patient so that they don’t have to come back to the urgent care and pay another co-pay.  However, I will ask that they delay the use of the antibiotic for a few days and see how the body reacts, then call me as needed.

I wish you good health!


In health,

Dr. Mike

About the author

I am a Board Certified Family Practice Physician (MD) that has a passion for the proper treatment of patients. We are more than just our physical beings. We are complex and the current medical climate is failing both patients and physicians. As a new author, I feel passionately about letting everyone know how the system is failing us, moreover, how to overcome these barriers!

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Michael Lewis, MD
I am board certified in family medicine and passionate about caring for the whole patient: mind, body, spirit. I am married to a wonderful woman Jenniffer, who is a clinical psychologist and works right here in Willow Medical Center. I have a 7-year-old daughter, Bailey who is the light of my life. I am a soul searcher for myself and others. I also love to help men reach their potential as a conscious male. I am also a musician/guitarist. I have found that nurturing this part of my brain helps me think out of the proverbial box and provide better medicine.