3 ms·

> Go to PCP with cold symptoms that haven’t cleared in 10 days It was a bacterial infection. That was the correct diagnosis. Flu (viral) doesn’t get progressiv

> Go to PCP with cold symptoms that haven’t cleared in 10 days It was a bacterial infection. That was the correct diagnosis. Flu (viral) doesn’t get progressively worse after 10 days and then get better immediately after a couple doses of antibiotics. My symptoms were in line with a sinus infection (I’ve had them before just like I’ve had flu before) and even if they are not able to diagnose correctly after 10 days, there are other tests that can be prescribed that weren’t and there was absolutely no reason to schedule an online appointment when they clearly knew that they’d need an in person check anyway.

sarchertech 1y ago
There are viruses that can last 2 weeks and mimic bacterial infections. Most cases of bacterial infection will also clear on their own after 2 weeks. There are no good noninvasive diagnostic tests to distinguish bacterial sinusitis from viral because is the presence of normal nasal flora. The standard of care is to consider antibiotic treatment after 2 weeks of symptoms for adults and 3 weeks for children. There’s a reason for these standards: As of a few years ago physicians were prescribing antibiotics for 80% of cases of sinusitis. Despite the fact that only about 1%-2% of cases actually needed it. 20% of antibiotic prescriptions in the US are for sinus infections. This is a massive contributor to antibiotic overprescription, which is why the current criteria is 2 weeks of symptoms. I don’t know what happened in your online visit, but scheduling an online visit and then if your symptoms persisted past 2 weeks prescribing antibiotics during the the online visit would have been entirely appropriate.
- darth_avocado 1y ago
  Standard of care for persistent symptoms compatible with acute bacterial rhinosinusitis for more than 10 days IS prescribing antibiotics.
  - sarchertech 1y ago
    Just asked my wife (ER doctor). She says it's 2 weeks for adults, 3 weeks for kids.
    - darth_avocado 1y ago
      I also confirmed with a MD friend of mine, 10 days or more of worsening symptoms could be indicative of bacterial sinusitis. For adults you can begin the treatment on that diagnosis. You can also start antibiotic treatments before 10 days in certain conditions but it is generally not recommended. Just because a patient shows up on 11th day with worsening symptoms doesn’t mean you have to wait 2 weeks.
      - sarchertech 1y ago
        Sure. It’s a guideline not a hard rule. Doctors have wide latitude. A doctor could give you antibiotics whenever they want. The doctor didn’t do anything wrong by asking you to wait a few days. In addition to residency, my wife is fellowship trained, she’s who PCPs end up sending patients to. She’s basically level 2 tech support (an ENT would be level 3 for this particular problem). She sees the results of this stuff all the time. And the majority of PCPs vastly overprescribe antibiotics for sinus infections. The vast majority of patients who come in saying they have a sinus infection and asking for antibiotics are wrong. Doctors are tasked with antibiotic stewardship, but people complain on review sites when they don’t get what they want, so many of them just do it.

sarchertech 1y ago

There are viruses that can last 2 weeks and mimic bacterial infections. Most cases of bacterial infection will also clear on their own after 2 weeks. There are no good noninvasive diagnostic tests to distinguish bacterial sinusitis from viral because is the presence of normal nasal flora. The standard of care is to consider antibiotic treatment after 2 weeks of symptoms for adults and 3 weeks for children. There’s a reason for these standards: As of a few years ago physicians were prescribing antibiotics for 80% of cases of sinusitis. Despite the fact that only about 1%-2% of cases actually needed it. 20% of antibiotic prescriptions in the US are for sinus infections. This is a massive contributor to antibiotic overprescription, which is why the current criteria is 2 weeks of symptoms. I don’t know what happened in your online visit, but scheduling an online visit and then if your symptoms persisted past 2 weeks prescribing antibiotics during the the online visit would have been entirely appropriate.

darth_avocado 1y ago
Standard of care for persistent symptoms compatible with acute bacterial rhinosinusitis for more than 10 days IS prescribing antibiotics.
- sarchertech 1y ago
  Just asked my wife (ER doctor). She says it's 2 weeks for adults, 3 weeks for kids.
  - darth_avocado 1y ago
    I also confirmed with a MD friend of mine, 10 days or more of worsening symptoms could be indicative of bacterial sinusitis. For adults you can begin the treatment on that diagnosis. You can also start antibiotic treatments before 10 days in certain conditions but it is generally not recommended. Just because a patient shows up on 11th day with worsening symptoms doesn’t mean you have to wait 2 weeks.
    - sarchertech 1y ago
      Sure. It’s a guideline not a hard rule. Doctors have wide latitude. A doctor could give you antibiotics whenever they want. The doctor didn’t do anything wrong by asking you to wait a few days. In addition to residency, my wife is fellowship trained, she’s who PCPs end up sending patients to. She’s basically level 2 tech support (an ENT would be level 3 for this particular problem). She sees the results of this stuff all the time. And the majority of PCPs vastly overprescribe antibiotics for sinus infections. The vast majority of patients who come in saying they have a sinus infection and asking for antibiotics are wrong. Doctors are tasked with antibiotic stewardship, but people complain on review sites when they don’t get what they want, so many of them just do it.