As I tell all my patients, if I don't give you antibiotics for this cold, you'll get better in 14 days. If I do give you antibiotics, you'll get better in 2 weeks. Of course, there are exceptions to this rule, but patients are as much the problem as physicians. I see patients all the time who come see me after three days of being congested and with a sore throat. When I send them away with simple self care advice, they look at me like I killed their cat or something. A few days later they'll go to the urgent care down the street, another $80 of health care dollars are burned, and they get antibiotics anyway.

As a Pharmacist, the main problem I see with Amoxicillin is patient compliance. Anything dosed more than once a day for more than about 5 days often isn't taken as directed. This can result in treatment failure and promotes the emergence of resistant strains. For many patients a short course using once a day azithromycin may be a better choice. The Physician/PA who evaluates the patient needs to evaluate the patient's likelihood of completing the ordered treatment when selecting the antibiotic ordered.

One thing that is overlooked in this review is that several patients/families claim a penicillin and/or cephalosporin allergy. In that case, you are left with few options, macrolides being the most common one. I don't know the exact number, but I would guess that the number of persons claiming a penicillin/cephalosporin allergy or intolerance is at least 15%, so the fact that macrolides accounted for 18% of prescriptions is not surprising at all (and maybe not as inappropriate as the article would make this seem).