The current philosophy is bizarre. You get NPs and PAs who pretend to have never heard of secondary infections, refuse to prescribe antibiotics because virus, then you’re back in a week and they magically discover bacteria.

Diagnosing an infection is inexact in most outpatient settings. The healthcare provider takes into account a number of factors based on the history and physical exam. A rapid antigen test as is available for streptococcal pharyngitis makes it straightforward. Unfortunately, that’s not the case for many infectious conditions which end up being treated empirically. For example, most upper respiratory infections’ etiology is viral in both adults and children. It’s very reasonable to prescribe medication for symptomatic relief and reassure the patient that should discomfort continue or worsen, antibiotics may be considered. Even though this should be the standard of care, many physicians and extenders still overprescribe antibiotics mostly to move the visit along or satisfy the patient. A good explanation with evidence takes longer than just acquiescing to the demand.