Anguish over Antibiotics

Having suffered with a bad chest cold for the last week, I figured this would be a good time to discuss the appropriate use for antibiotics in regards to upper respiratory infections.  By this, I refer to infections of the sinus (sinusitis), throat (pharyngitis), upper airways (bronchitis) or of the lung itself (pneumonia).  The common cold is usually referred to as rhino-sinusitis or infection of the nasal passages and sinus.  Over 90% of these infections are due to viruses.  The most important fact to understand is that antibiotics do not treat viral infections.  They treat bacterial infections.  There are times when it is appropriate to use them but for the most part they are to be avoided.

Now, one may ask, "What is the big deal about taking antibiotics?"  I have often heard, "I just get this twice a year and if I get my Z-pack, I do well."  However, after talking to the patient, I often come to the conclusion that their infection is likely viral.  I can assure you, that my life would be much easier if I just sent out the prescription for an antibiotic.  I have often wished I could give someone "placebocillin."  I would tell my patient to take these sugar pills twice a day for ten days and I know that chances are they will be feeling quite well by then.  There are three reasons to be wary in taking an antibiotic.  The first is a chance that you may develop an allergy to the medication.  Rarely can this be life threatening.  The second is the risk of developing diarrhea associated diarrhea, the worst of which is called, clostridium dificile colitis which is triggered by taking antibiotics and can be very difficult to clear and very serious.  The last is the risk that bacteria can develop resistance patterns due to being overexposed to antibiotics.  This is already began to be a problem.  We may not be too far away from a time when certain infections will have no available antibiotics that can be used to treat them.

What, then, are the symptoms which would suggest that antibiotics are appropriate?  First strep throat requires the use of an antibiotic.  The symptoms are fever and a sore throat.  Strep does not cause a cough. There is not much sinus involvment either. If you have a fever and a sore throat with a bad cough, that is not strep.  Bacterial sinusitis is characterized by a fever, sinus related facial pain in the prescence of yellow or green secretions.  Usually, these infections are secondary, meaning that they begin as a virus but with time (usually 10-14 days) bacteria can get trapped in the sinuses and start a new infection.  Commonly, a patient will tell me that they started with a cold, started to improve and then got worse again.  It is also important to know that colored secretions in and of themselves do not indicate a bacterial infection.  In fact, such are expected starting about 4-5 days after the beginning of a cold.

Resistant Bacteria

Bronchitis only requires antibiotics in the setting of an asthmatic, smoker or certain other lung diseases.  Such infections are quite common and can last a very long time.  Patience is the key.  If one is making gradual improvement, even if painfully slow, it is imperative to wait it out, letting our body clear the infection on its own.  Now if one developes chills, fever, pain with breathing or shortness of breath, it is time to go see your doctor and make sure pneumonia has not developed.

Lastly, pneumonia almost always requires an antibiotic.  Even if it is precipitated by a viral infection, it is common that pneumonia develops into a secondary bacterial infection.  The prime example of this is seen with influenza.  The deadly epidemic of 1918 was fueled mostly be pneumonia from staph that came after the influenza was contracted.  If you have symptoms to suggest pneumonia as listed above, it is always appropriate to be evaluated by a physician.