Not necessarily. Perhaps he had some of the more specific signs of
acute post-viral sinusitis but, in the physician's judgment, he could
also easily improve spontaneously over the next few days, so the
doctor felt his subsequent clinical course could help make the
decision of whether to start antibiotics, and that the patient himself
would be capable of observing the course.

And, in fact, there is support in the literature now for doing just
that in the U.S. for ear infections in older children, which tend to
resolve spontaneously without antibiotics, albeit with more pain than
in kids who are treated. In Denmark, kids are brought in every day
after a diagnosis of otitis media and, if not seen to begin improving
within a few days, antibiotics are started. They see plenty resolve
without antibiotics, and they have by far the lowest rates of
antibiotic-resistant bacteria in the industrialized world. However,
they also have a higher rate of mastoiditis, which, in their social
and political climate, I suppose, is tolerable. Not so in the U.S.
Without a national medical program and with probably much less
tolerant employers, fewer parents here are going to be keen on coming
in daily to have an ear checked to try to avoid an antibiotic, with
the trade-off being more missed days of school and work, and prolonged
pain. Add to that the fact that serious suppurative complications
could increase, and we'd also probably see more lawsuits. Errors of
omission are deemed worse than errors of comission, it appears. Would
you ever hear about a parent suing a doctor for prescribing an
antibiotic for an ear infection that the parent later deemed was not
necessary? Hardly. But you could bet doctors would be sued for not
treating an ear infections that progressed to mastoiditis.

Back to the literature support for a sort of middle-ground. The SNAP
("safety net antibiotic prescription") is one given for an ear
infection that, in the physician's judgment, does not require urgent
treatment and may spontaneously resolve. The parent is instructed to
start the antibiotic within a few days if the ear still hurts, and to
throw it away otherwise if the child spontaneously improves. Parents
were satisfied, most prescriptions were not filled, few extra visits
were needed, and there was no increase in suppurative complications.
Sounds like a good idea to me, rather than a "cop-out."

PF