US doctors have to do everything to keep patients happy. CMS rules their careers with satisfaction metrics. Hospital ADMINS really push it on them. Complaints lead to job loss.

I saw a Dr the other week (to rule out Covid and strep) and despite testing negative for both and telling me I just had a cold she offered me antibiotics. I declined, not wanting to be part of this problem, but was taken aback that she would basically try to push them on me.

This is just weird. Not living on the US and people here take taking antibiotics seriously, because they often have nasty side effects like messing around with digestion, making you otherwise feel like shit. People don't ask for strong antibiotics just for a common cold or the flu.

The way it was explained to me is that the physicians know it very well but they're exhausted from arguing with patients who demand antibiotics anyway.

>We spread manure from farm animals over produce fields

You do not want to stop this. Topsoil is a damn complicated thing, and bacteria and other decomposers are critical to freeing up and breaking down organic material to keep the nutrient cycle going. Try growing a plant in a sterile soil, and you end up having to maintain it on artificial fertilizers instead of being able to let microbiota do their thing.

I've got a hunch part of our degradation in crop nutrition and loss of topsoil quality is probably stemming from overuse of chemical fertilizer, as well as fundamental microbiome depletion from overuse of antibiotics in industrial farming processes. The unfortunate part being there may not be much to be done about it if there is a desire to maintain our current population carry capacity, because replenishing of it would require reversion to less short-term efficient agriculture, but more long term sustainable methods.

They are cheaper than the tests to determine whether they're needed.

Z-pak (azithromycin) is not the recommended antibiotic for bacterial sinus infections nor pneumonia (common bacterial infections associated with upper respiratory infections) per most guidelines. Interestingly though, it does have anti-inflammatory properties in addition to its main antibacterial effect. When I see a clinician prescribe a Z-pak (urgent cares are notorious for having a low threshold for prescribing Z-paks), part of me wonders if it's to avoid overuse and potential resistance to appropriate antibiotics and placate patients who want a quick fix.

The downside is that since they feel better from the anti-inflammatory effect, its supports their initial thought they needed antibiotics and in the future will always think they need them, even though they very likely only have a viral infection.

I think some of those 'kits' countries were distributing to people early-on (before the vaccine) contained stuff like doxycycline.

Secondary infections of bacterial pneumonia were common with COVID iirc.

When I was in Peru, they kind of prescribed antibiotics for everything. Persistent cold? Antibiotics. Like that.

Source: lived there with Peruvian partner for 18 months.

Death from COVID, and other pneumonic (pulmonary) diseases, can be commonly a result of secondary infection by bacteria. Our bodies are not the best at handling two different types of threats at the same time. See https://www.nature.com/articles/s41598-021-92220-0 for instance.

P.S. Note that the situation was unclear in 2020-2021 -- for instance from a quick lookup see https://pubmed.ncbi.nlm.nih.gov/34354682/. So patient management was different per region -- as it was a guess.

Some of the antibiotics have also proven antiviral and/or immunomodulatory effect, e.g. azithromycin [1] or levofloxacin [2].

[1] https://pubmed.ncbi.nlm.nih.gov/34015317/

[2] https://pubmed.ncbi.nlm.nih.gov/32546446/