Antibiotics: Not Always the Answer for Upper Respiratory Tract Infections

Cough, cold and flu season has arrived for most of the northern half of America. Doctor's offices are busier trying to squeeze patients in for sick visits. Emergency departments and Urgent Care Centers are shuffling patients in and out of examining rooms as they attempt to keep up with the increased demand for acute medical care. Some parents are getting less sleep as they listen to their children cough through the wee hours of the morning. Adults with upper respiratory tract infections try to decide whether they can afford another day off from work vs. go to work and feel miserable, as co-workers attempt to avoid them like the plague.

This time of year prescriptions for antibiotics skyrocket as doctors desperately attempt to remedy their patients that have sinus complaints. But how effective are antibiotics in these situations?

The majority of patients in health care settings that present with complaints of runny nose, nasal congestion, cough and headache have a viral upper respiratory infection (the common cold). Viruses do not respond to antibiotics (which are drugs that kill or impair bacteria). Yet many adults and parents go to the doctor's office with the intention of getting an antibiotic. Studies report that most times doctors yield to the desire of their patients and provide them with an antibiotic despite the lack of evidence of a bacterial infection.

What are some risks of taking antibiotics?

• 1) A person may have an allergic reaction to the antibiotic which can be as mild as a faint skin rash, or so severe that life threatening throat closure, breathing problems or drop in blood pressure (anaphylaxis) occurs.

• 2) Other side effects such as stomach upset, nausea vomiting, diarrhea or decreased appetite may occur.

• 3) On rare occasion a severe diarrhea syndrome may occur which is caused by a toxin generated from over growth of a species of bacteria normally found in the colon.

• 4) Yeast infection may occur in women resulting in the need for more medication.

• 5) Inappropriate antibiotic use may lead to more resistant bacterial infection of the sinuses or lung, subsequently requiring stronger antibiotic or surgical intervention.

• 6) Some antibiotics may interact with other drugs being taken at the same time and increase risk the risk of liver, kidney or heart damage.

• 7) Certain classes of antibiotics commonly used have been associated with Achilles tendon rupture (fluoroquinolones: for example Levaquin and Avelox) especially if oral steroids are prescribed at the same time.

Bacterial or Viral Cause of Upper Respiratory Tract Infection(URI)?: How do you know?

The history is most important in deciding whether a URI is likely viral or bacterial. The physical exam helps to further support the diagnosis. Odds are most URIs of 10 or less day's duration are viral. For this reason I rarely provide antibiotics without interviewing and examining the patient. I am more concerned about a bacterial URI if the patient has experienced sinus pressure or pain, nasal stuffiness and green mucus for more than 10 days. Another sign of a bacterial cause is "double worsening" described in a report by the American Academy of Otolaryngology-Head and Neck Surgery.