Antibiotics Use Guide

Antibiotics are powerful anti-infective agents used to treat infections caused by bacteria. They don't work against any infections caused by viruses. Viruses cause colds, the flu, and most coughs and sore throats.

What is "antibiotic resistance"?

When bacteria are repeatedly exposed to the same antibiotic, some germs can just change by themselves. Some of the changes make the germs invulnerable to antibiotic, or "resistant".

Resistant bacteria develop rapidly when antibiotics are used too often or incorrectly. Resistant bacteria sometimes can be treated with antibiotics to which the bacteria have not been exposed and have not yet become resistant.

Antibiotics for Tonsillitis (Sore Throat)

Tonsillitis is an inflammation of tonsils, which results in a sore throat. The inflammation usually extends to the adenoid and the pharynx. Tonsillitis can be caused by either viruses or bacteria. Most cases of tonsillitis go away on their own.

Tonsillitis caused by Group A streptococcus results in a strep throat. Strep throat (bacterial sore throat) is treated with antibiotics5:

  • Penicillin VK is still the choice for strep throat in the United States.
  • Amoxicillin sometimes it is more acceptable to children because of its taste.
  • Augmentin is often used to treat recurrent streptococcal pharyngitis.

Cephalosporins should be considered first-line treatment if the person has a history of recent antibiotic usage, recurrent pharyngitis infection, a penicillin allergy, or if a high failure rate of penicillin is documented in the community:

  • Cefadroxil (Duricef), cefixime (Suprax), and cefdinir (Omnicef) are FDA approved as once-daily treatment fo strep throat.
  • Ceftriaxone (Rocephin), third-generation parenteral cephalosporin with broad-spectrum gram-negative activity, indicated for cases of gonococcal pharyngitis.

Other antibiotics:

  • Erythromycin is recommended as a first alternative in persons with penicillin allergy.
  • Azithromycin has a higher cost but has a slightly higher effectiveness than erythromycin. Shorter course and one-a-day dosing make this a good alternative for patients who are allergic to penicillin.
  • Clindamycin (Cleocin) is recommended for people with multiple, recurrent episodes of Group A Streptococcal pharyngitis confirmed by rapid antigen testing or culture.

Antibiotics for Sinus infection

Sinus infection (sinusitis) occurs when the sinuses and nasal passages are infected or inflamed. Most sinus infections are caused by a virus. Antibiotics may be prescribed if the sinus infection is likely to be caused by bacteria.

It is better to wait and take antibiotics only when they are needed. Many cases of acute sinusitis will end on their own.

Preferred antibiotics for bacterial sinus infection4:

  • Amoxicillin is considered a first-line therapy for adults and children.
  • Alternative antibiotics include trimethoprim–sulfamethoxazole (Bactrim, Septra), doxycycline, Augmentin, cefpodoxime (Vantin), cefdinir (Omnicef).
  • Azithromycin, clarithromycin (Biaxin) may be prescribed for people who have beta-lactam allergy.
  • For complicated sinusitis your doctor may prescribe ceftriaxone (Rocephin), ciprofloxacin, levofloxacin, or moxifloxacin (Avelox).

Antibiotics for Ear infection

Middle ear infections (otitis media) are one of the most common children's illnesses, affecting almost all children at some point.

The type of ear infection that is usually painful and may require antibiotic is Acute otitis media.

Otitis media with effusion (OME) is a buildup of fluid in the middle ear without signs and symptoms of acute infection (otalgia, pus, and fever). Otitis media with effusion is more common than Acute otitis media. This condition in most cases goes away on its own without antibiotics.

Infections of the inner ear are less common and are usually caused by viruses. Occasionally, otitis media may spread to involve the inner ear. Dizziness, loss of balance, and affected hearing can indicate inner ear problems.

Antibiotics indicated for the treatment of Acute otitis media2-3

First-line choice

  • Amoxicillin is considered the first-line antimicrobial agent for treating acute ear infection. According to the Canadian study6, amoxicillin is more cost effective than "a watch-and-wait approach" in treating children with acute otitis media.

Second-line choices

  • Augmentin
  • Cephalosporins: Cefuroxime axetil (Ceftin), Cefdinir (Omnicef), IM Ceftriaxone (Rocephin).
  • Macrolides: Azithromycin, Clarithromycin (Biaxin)

Other antibiotics:

  • Erythromycin-sulfisoxazole (Pediazole)
  • Trimethoprim-sulfamethoxazole (Bactrim, Septra)
  • Cefaclor (Ceclor)
  • Cefprozil (Cefzil)
  • Loracarbef (Lorabid)
  • Cefixime (Suprax)
  • Ceftibuten (Cedax)

Important note:
Some ear infections will safely clear up on their own without antibiotics. Antibiotics can help children get better more quickly, but there are drawbacks. Repeated use to treat acute ear infections in children increases the chances of future recurrent ear infections by 20%, according to the Dutch researchers1.

Detailed information about antibiotics:


  • 1. Bezakova N, Damoiseaux RAMJ, Hoes AW, et al. Recurrence up to 3.5 years after antibiotic treatment of acute otitis media in very young Dutch children: survey of trial participants. BMJ. 2009; 339: b2525.
  • 2. Pichichero ME. Acute otitis media: part II. Treatment in an era of increasing antibiotic resistance. American Academy of Family Physicians. 2000 Apr 15;61(8):2410-6.
  • 3. Lieberthal AS, Carroll AE, Chonmaitree T, et al. The diagnosis and management of acute otitis media. Pediatrics. 2013 Mar;131(3):e964-99. Available at Pedictrics
  • 4. Wong DM, Blumberg DA, Lowe LG. Guidelines for the use of antibiotics in acute upper respiratory tract infections. American Academy of Family Physicians. 2006 Sep 15;74(6):956-66.
  • 5. Shulman ST, Bisno AL, Clegg HW, Gerber MA, Kaplan EL, Lee G, Martin JM, Van Beneden C. Clinical Practice Guideline for the Diagnosis and Management of Group A Streptococcal Pharyngitis: 2012 Update by the Infectious Diseases Society of America. Clin Infect Dis. 2012 Nov 15;55(10):1279-82. Available at Oxford University Press
  • 6. Gaboury I, Coyle K, Coyle D, Le Saux N. Treatment cost effectiveness in acute otitis media: A watch-and-wait approach versus amoxicillin. Paediatr Child Health. 2010 Sep;15(7):e14-8. PubMed

By HealthyStock Research Group, September 2009
Medical resources reviewed: August 2018

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All information on is intended for general knowledge only.
For medical advice consult with your physician.