# Why did my doc prescribe multiple antibiotics at once? **URL:** \ **Category:** Factual Questions\ **Created:** [February 22, 2024, 10:59am UTC](https://boards.straightdope.com/t/why-did-my-doc-prescribe-multiple-antibiotics-at-once/997938 "2024-02-22T10:59:36Z")\ **Posts on this page:** 17\ **Page:** 1
**Author:** ![Machine\_Elf](https://avatars.discourse-cdn.com/v4/letter/m/82dd89/32.png) [@Machine\_Elf](https://boards.straightdope.com/u/Machine_Elf)\ **Post date:** [February 22, 2024, 10:59am UTC](https://boards.straightdope.com/t/why-did-my-doc-prescribe-multiple-antibiotics-at-once/997938/1 "2024-02-22T10:59:36Z")
Not seeking medical advice here, just a factual understanding of why my docs might have decided on the following treatment path. Been dealing with an infection around my eye for a couple of weeks now. Last week a doc prescribed some antibiotic+anti-inflammatory eye drops (neomycin-polymyxin-dexamethasone). Things got worse after a few days, so now I have discontinued the eyedrops and they have given me prescriptions for two separate pills. One pill contains sulfamethoxizole and trimethoprim, and the other contains amoxicillin and clavulanate. So that’s three antibiotics plus a beta-lactamase inhibitor (the clavulanate). I’ve had various bacterial infections in the past and as far as I can recall, I’ve just received simple amoxicillin prescriptions. So why am I getting the “Sherman’s March to the Sea” treatment here? I should point out that there wasn’t any kind of testing done to see what sort of bacteria might be involved. ---
**Author:** ![kayaker](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/kayaker/32/441_2.png) [@kayaker](https://boards.straightdope.com/u/kayaker)\ **Post date:** [February 22, 2024, 1:52pm UTC](https://boards.straightdope.com/t/why-did-my-doc-prescribe-multiple-antibiotics-at-once/997938/2 "2024-02-22T13:52:17Z")
> [@Machine\_Elf](#): > > there wasn’t any kind of testing done to see what sort of bacteria might be involved. Then they are relying on statistical analysis of what microbes are likely involved. By using the two antibiotics they may be covering 90% of the likely offenders. ---
**Author:** ![DavidNRockies](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/davidnrockies/32/6279_2.png) [@DavidNRockies](https://boards.straightdope.com/u/DavidNRockies)\ **Post date:** [February 22, 2024, 1:58pm UTC](https://boards.straightdope.com/t/why-did-my-doc-prescribe-multiple-antibiotics-at-once/997938/3 "2024-02-22T13:58:06Z")
FWIW, your eye doc seems to be going by the book: > **[Antibiotics in Eye Care: A Balancing Act](https://www.revieweducationgroup.com/ce/antibiotics-in-eye-care-a-balancing-act)** > > ReviewsCE.com is the home website for Review Education Group that has dozens of opportunities to earn CE credit which are available through our publications, live events and print CE courses. And, yep: they’re trying to cast as wide a net as possible while minimizing risk. Hope this regimen works. Heal quickly and fully! ---
**Author:** ![Machine\_Elf](https://avatars.discourse-cdn.com/v4/letter/m/82dd89/32.png) [@Machine\_Elf](https://boards.straightdope.com/u/Machine_Elf)\ **Post date:** [February 22, 2024, 2:13pm UTC](https://boards.straightdope.com/t/why-did-my-doc-prescribe-multiple-antibiotics-at-once/997938/4 "2024-02-22T14:13:33Z")
> [@DavidNRockies](#): > > FWIW, your eye doc seems to be going by the book: > > [Lesson: Antibiotics in Eye Care: A Balancing Act](https://www.revieweducationgroup.com/ce/antibiotics-in-eye-care-a-balancing-act) > > And, yep: they’re trying to cast as wide a net as possible while minimizing risk. > > Hope this regimen works. Heal quickly and fully! Some nasty pics there, but a very informative article, thanks. I saw “preseptal cellulitis” mentioned there, which was my official diagnosis yesterday. ---
**Author:** ![TriPolar](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/tripolar/32/3008_2.png) [@TriPolar](https://boards.straightdope.com/u/TriPolar)\ **Post date:** [February 22, 2024, 2:21pm UTC](https://boards.straightdope.com/t/why-did-my-doc-prescribe-multiple-antibiotics-at-once/997938/5 "2024-02-22T14:21:22Z")
> [@Machine\_Elf](#): > > preseptal cellulitis Don’t know anything about that disorder in particular. I had an eye infection about 1 year ago and the ophthalmologist prescribed an anti-biotic and anti-viral medication to treat it. ---
**Author:** ![gnoitall](https://avatars.discourse-cdn.com/v4/letter/g/bb73d2/32.png) [@gnoitall](https://boards.straightdope.com/u/gnoitall)\ **Post date:** [February 22, 2024, 2:32pm UTC](https://boards.straightdope.com/t/why-did-my-doc-prescribe-multiple-antibiotics-at-once/997938/6 "2024-02-22T14:32:05Z")
Unless your doctor cultured the infection and have the results back already, they don’t know the specific pathogen involved, and their first shot (eye drops, probably chosen against the single most likely culprit) didn’t do the trick. So now they’re going for the shotgun. ---
**Author:** ![Qadgop\_the\_Mercotan](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/qadgop_the_mercotan/32/83_2.png) [@Qadgop\_the\_Mercotan](https://boards.straightdope.com/u/Qadgop_the_Mercotan)\ **Post date:** [February 22, 2024, 3:26pm UTC](https://boards.straightdope.com/t/why-did-my-doc-prescribe-multiple-antibiotics-at-once/997938/7 "2024-02-22T15:26:26Z")
The really bad thing about upper facial and orbital infections is that they can make their way into the brain much more easily than infections in other locations on the head and on the rest of the body. So we tend to be a bit more aggressive in making sure such infections get treated quickly. Hence multiple antibiotic regimens. ---
**Author:** ![Common\_Tater](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/common_tater/32/13846_2.png) [@Common\_Tater](https://boards.straightdope.com/u/Common_Tater)\ **Post date:** [February 22, 2024, 5:26pm UTC](https://boards.straightdope.com/t/why-did-my-doc-prescribe-multiple-antibiotics-at-once/997938/8 "2024-02-22T17:26:54Z")
Yep - because it’s damn serious. I came down with something in the .mil during or after a deployment (eye infection) and didn’t fully appreciate initially how serious it was, potentially. We tend to get complacent about these things due to the wonders of modern medicine, once antibiotics lose their mojo there is little to be done at that point. ---
**Author:** ![Machine\_Elf](https://avatars.discourse-cdn.com/v4/letter/m/82dd89/32.png) [@Machine\_Elf](https://boards.straightdope.com/u/Machine_Elf)\ **Post date:** [February 22, 2024, 6:02pm UTC](https://boards.straightdope.com/t/why-did-my-doc-prescribe-multiple-antibiotics-at-once/997938/9 "2024-02-22T18:02:19Z")
> [@Qadgop\_the\_Mercotan](#): > > The really bad thing about upper facial and orbital infections is that they can make their way into the brain much more easily than infections in other locations on the head and on the rest of the body. So we tend to be a bit more aggressive in making sure such infections get treated quickly. Hence multiple antibiotic regimens. Does this mean my first doc was taking things a bit too casually by just prescribing neopolydex eye drops? ---
**Author:** ![DSeid](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/dseid/32/20194_2.png) [@DSeid](https://boards.straightdope.com/u/DSeid)\ **Post date:** [February 22, 2024, 8:28pm UTC](https://boards.straightdope.com/t/why-did-my-doc-prescribe-multiple-antibiotics-at-once/997938/10 "2024-02-22T20:28:04Z")
There is no way for anyone to intelligently comment on that. The prescription was appropriate for an assessment of conjunctivitis. Was it a conjunctivitis at that time and progressed to a cellulitis despite appropriate care? We cannot know. ---
**Author:** ![Common\_Tater](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/common_tater/32/13846_2.png) [@Common\_Tater](https://boards.straightdope.com/u/Common_Tater)\ **Post date:** [February 23, 2024, 2:00am UTC](https://boards.straightdope.com/t/why-did-my-doc-prescribe-multiple-antibiotics-at-once/997938/11 "2024-02-23T02:00:35Z")
One of they things the medics did in my situation, they had this device, like a big optical viewer to look into my eyeball. It was really uncomfortable, because it had to rest directly on the cornea. I think the concern was, the infection could spread to the lens of the eye and cause blindness. What were they looking for? ---
**Author:** ![Qadgop\_the\_Mercotan](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/qadgop_the_mercotan/32/83_2.png) [@Qadgop\_the\_Mercotan](https://boards.straightdope.com/u/Qadgop_the_Mercotan)\ **Post date:** [February 23, 2024, 3:19am UTC](https://boards.straightdope.com/t/why-did-my-doc-prescribe-multiple-antibiotics-at-once/997938/12 "2024-02-23T03:19:31Z")
> [@DSeid](#): > > The prescription was appropriate for an assessment of conjunctivitis. Was it a conjunctivitis at that time and progressed to a cellulitis despite appropriate care? We cannot know. Yes, this. I certainly never used meds appropriate for a facial cellulitis when it appeared to be a straightforward uncomplicated conjunctivitis. ---
**Author:** ![Qadgop\_the\_Mercotan](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/qadgop_the_mercotan/32/83_2.png) [@Qadgop\_the\_Mercotan](https://boards.straightdope.com/u/Qadgop_the_Mercotan)\ **Post date:** [February 23, 2024, 3:22am UTC](https://boards.straightdope.com/t/why-did-my-doc-prescribe-multiple-antibiotics-at-once/997938/13 "2024-02-23T03:22:41Z")
> [@Common\_Tater](#): > > What were they looking for? Tough to say there too, not knowing just what the device was. Sounds like a slit lamp with a device to check for elevated intraocular pressure but I can’t be sure. If so, they were probably looking for signs of iritis, glaucoma, corneal injuries or ulcers, and maybe retinitis. Plus a few other things. ---
**Author:** ![Dr\_Paprika](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/dr_paprika/32/3042_2.png) [@Dr\_Paprika](https://boards.straightdope.com/u/Dr_Paprika)\ **Post date:** [February 23, 2024, 3:31am UTC](https://boards.straightdope.com/t/why-did-my-doc-prescribe-multiple-antibiotics-at-once/997938/14 "2024-02-23T03:31:43Z")
For a given type of bacterial infection, you can usually list the typical causative organisms. Sometimes you have to worry about less likely but severe (or hard to treat) causes as well. To cover the bases, this may mean more medicines. Sometimes better to give a few antibiotics than miss the cause or increase the likelihood of resistance. Some antibiotics are usually given together. Trimethoprim and sulfamethoxazole both work by inhibiting bacterial folate synthesis (at the 50S subunit) so tend to be given in combination. Severe facial infections would usually be treated with intravenous antibiotics and occasional hospital admission. The goal is to use strong enough oral antibiotics to be pretty sure of getting the causative organism to avoid that. Using a steroid in the eyedrop in the setting of infection is somewhat surprising, but has its place in certain circumstances (especially after a slit lamp exam). I’d be slightly concerned if that was used to treat run-of-the-mill conjunctivitis though. Still, it’s perhaps unfair and inaccurate to comment without seeing it in person. (There is a difference between erysipelas, facial cellulitis, and periorbital and orbital infections; but one treats all of these somewhat aggressively to avoid spread to the brain, eyes or sinuses and complications like sinus thrombosis) ---
**Author:** ![kayaker](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/kayaker/32/441_2.png) [@kayaker](https://boards.straightdope.com/u/kayaker)\ **Post date:** [February 23, 2024, 1:13pm UTC](https://boards.straightdope.com/t/why-did-my-doc-prescribe-multiple-antibiotics-at-once/997938/15 "2024-02-23T13:13:58Z")
> [@Common\_Tater](#): > > they had this device, like a big optical viewer to look into my eyeball. It was really uncomfortable, because it had to rest directly on the cornea. Possibly [Gonioscopy?](https://en.m.wikipedia.org/wiki/Gonioscopy) ---
**Author:** ![jjakucyk](https://avatars.discourse-cdn.com/v4/letter/j/3d9bf3/32.png) [@jjakucyk](https://boards.straightdope.com/u/jjakucyk)\ **Post date:** [February 23, 2024, 2:12pm UTC](https://boards.straightdope.com/t/why-did-my-doc-prescribe-multiple-antibiotics-at-once/997938/16 "2024-02-23T14:12:40Z")
> [@Machine\_Elf](#): > > I’ve had various bacterial infections in the past and as far as I can recall, I’ve just received simple amoxicillin prescriptions. Before I had my tonsils removed at age 34 (groan) I was getting strep/tonsillitis infections every few months. Straight up amoxicillin did nothing but amoxicillin clavulanate (Augmentin) was actually quite effective. I suppose it’s better to start with something like plain amoxicillin. If it works against the infection then there’s no need for the heavier-hitting stuff and the risk of furthering antibiotic resistance. ---
**Author:** ![Common\_Tater](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/common_tater/32/13846_2.png) [@Common\_Tater](https://boards.straightdope.com/u/Common_Tater)\ **Post date:** [February 23, 2024, 2:13pm UTC](https://boards.straightdope.com/t/why-did-my-doc-prescribe-multiple-antibiotics-at-once/997938/17 "2024-02-23T14:13:09Z")
Yes, maybe a slit lamp. It’s a little difficult to relax sometimes, because ordinarily people don’t want anything directly resting on their eyeball for any length of time. I tried to be a good sport about it because they wanted to get somebody else trained up on it too and I agreed.