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• Penicillin-based antibiotics see increased prescription volume in late fall, coinciding with the start of upper-respiratory infection season.
• Amoxicillin, amoxicillin-clavulanate potassium, and penicillin V potassium are the most frequently prescribed penicillins for bacterial ear, throat, and sinus infections.
• Viral infections can damage surrounding tissues and create openings for secondary bacterial infections, which is when penicillins become appropriate.
• Antibiotic resistance develops when bacteria adapt to commonly used drugs, a problem worsened by unnecessary prescribing for viral infections.
• Healthcare providers assess symptom duration and medical history to determine whether an antibiotic is truly needed, rather than prescribing reflexively.

As fall transitions to winter and colder temperatures settle in, the volume of penicillin prescriptions climbs. Prescription data from November shows that penicillin-class antibiotics were the most commonly filled prescriptions that month, accounting for nearly 4% of all prescriptions dispensed. The five most frequently prescribed penicillins that month were:

• Amoxicillin • Amoxicillin-clavulanate potassium (Augmentin) • Penicillin V potassium • Ampicillin • Dicloxacillin sodium

Penicillin antibiotics target bacterial infections, not viral ones. Late autumn marks the beginning of upper-respiratory infection season, when sore throats, sinusitis, colds, and influenza become more common. Although viruses cause most of these illnesses, they can pave the way for secondary bacterial infections where penicillins play a treatment role.

According to Milner Staub, MD, an infectious disease specialist and associate director of antimicrobial stewardship at Vanderbilt University Medical Center in Nashville: "Anytime the body is infected with a virus, it tries to fight that virus by sending chemicals and 'fighter' cells to that area of the body to kill the virus. Unfortunately, there can be collateral damage to the surrounding body tissues, making them temporarily more susceptible to other infections, like bacterial infections."

These three penicillin medications are prescribed to address common bacterial infections including strep throat, middle ear infections, and bacterial sinusitis. Dr. Staub explains: "The general rule is, in the infections listed above, when a bacterial cause is highly suspected or confirmed, in uncomplicated cases (which are the majority), amoxicillin [and, to a lesser degree, penicillin V potassium] is often recommended. Amoxicillin-clavulanate is recommended for cases that are unresponsive or are complicated."

Although ampicillin and dicloxacillin sodium made November's top five list, they are prescribed far less frequently than amoxicillin, amoxicillin-clavulanate, or penicillin V potassium. Yi Guo, Pharm.D., a pharmacist at Montefiore Health System in New York City, notes: "Ampicillin oral is not as well tolerated in many patients compared to amoxicillin, so it's less used. And dicloxacillin covers MSSA-associated infection only." MSSA refers to methicillin-sensitive Staphylococcus aureus, a strain of staph commonly found on skin.

Distinguishing between viral and bacterial infections can be challenging, even for medical professionals. Some infections leave obvious clues—pus draining from the ear strongly suggests bacterial infection. For others, like strep throat or the flu, testing can provide a definitive answer.

When signs are ambiguous or no tests are available, physicians rely on medical history and symptom patterns to decide whether an antibiotic is warranted. Tania Dempsey, MD, a chronic disease specialist at Armonk Integrative Medicine in Purchase, New York, explains: "A virus tends to run its course within 5-7 days. But if after that time the patient continues to get worse, you have to make a clinical judgment and say, maybe there's a bacterial component here."

Antibiotic resistance develops when bacteria evolve to survive drugs designed to kill them. According to the Centers for Disease Control and Prevention, approximately 2.8 million people acquire antibiotic-resistant infections annually, and roughly 35,000 die from them. Much of this crisis stems from overprescribing antibiotics, especially for viral illnesses where they provide no benefit.

Dr. Staub emphasizes an alternative approach: "Uncomplicated URI diagnoses that we know are frequently caused by viruses can be opportunities for providers to work with the patient to create a plan. Instead of receiving an antibiotic, the patient gets prescriptions that can help reduce symptoms (if possible) and is given clear instructions about what to look for to indicate that the infection may be changing into one that does require antibiotics."

Preventing infections is the most effective way to sidestep antibiotic use. Take these precautions:

• Wash your hands thoroughly with soap and water for at least 20 seconds, especially before eating and after being in public spaces • Wear a face mask in crowded indoor settings • Prioritize adequate sleep each night • Maintain a nutritious diet rich in fruits, vegetables, and whole grains • Exercise regularly to support immune function

Scheduling your annual flu vaccination is equally important. While antibiotics don't treat influenza, the flu shot remains one of the most effective ways to avoid contracting the virus during cold and flu season.