Think you need antibiotics for that cough or sinus infection? Think again

Cold season is just around the corner and with it comes the coughs, sore throats and runny noses that make us miserable.

It has long been known by doctors that the vast majority of these common respiratory infections are caused by viruses. And antibiotics only kill bacteria, and have no effect on viruses. Yet many people still expect (and receive) antibiotics when they don’t really need them.

What’s so bad about unnecessary antibiotics?

First of all, medication you don’t need is always a potential problem.

Medication can cause side effects that make you feel even worse than the thing you’re taking the medication for, and in extreme cases can cause a bad allergic reaction. Antibiotics are especially problematic because they are designed to kill as many bacteria as possible. That means they kill not just the bad bacteria that are causing trouble, but also the good bacteria that your body needs to stay healthy.

Ever had diarrhea or gotten a yeast infection after a course of antibiotics? Wouldn’t it be even worse if you never needed the antibiotics to begin with? Certain antibiotics can even predispose people to getting serious infections from dangerous bacteria like C. difficile.

As well, on a population level, everyone taking antibiotics all the time has contributed to the evolution of drug-resistant superbugs, which are getting increasingly hard to treat and are a threat to all of us.

But what if I feel REALLY sick?

Believe it or not, viruses, too, can make you feel totally awful.

Upwards of 95% of coughs, sore throats, sore ears and nasal congestion are caused by common viruses that your body can take care of on its own. Antibiotics will not kill the virus, or shorten the duration of symptoms caused by a viral illness.

Now don’t get me wrong – you should still see your doctor to get checked out if you feel like this infection is worse than usual. Your doctor can assess whether any further testing is needed, ensure that there isn’t a bacterial infection, and may have some good advice on over the counter or prescription medication that can make you more comfortable while your body fights off the infection.

But that other doctor gave me antibiotics the last time I felt this way!

There are a few reasons why you may have gotten antibiotics in the past:

Things in medicine change all the time as we learn more about the human body and what makes us sick, so while it may have been standard to treat certain infections with antibiotics before, it’s isn’t anymore.
Unfortunately, there aren’t a lot of easy tests to distinguish viral from bacterial respiratory infections. Some, like strep throat (caused by Streptococcal bacteria), can be diagnosed with a simple throat swab, but others, like ear infections, are basically impossible to differentiate. Sometimes, when there is uncertainty in the diagnosis, a lot of doctors (and I’m guilty too) will err on the side of prescribing antibiotics, even when they know there is a good chance they aren’t necessary. Call it the “trying to cover all the bases” principle: giving you an antibiotic covers you in case it’s a bacterial infection and if it’s viral, well you’ll get better on your own anyway. Either way, we’re trying to help you feel better, even if it means over-treating you with medication you might not need.
Doctors are often rushed and have little time to spend with each patient. Quite frankly, handing out antibiotic prescriptions is MUCH faster than talking to someone about the most likely cause of their infection and giving them advice on how to feel better. Combine this with the fact that some patients are very insistent on getting antibiotics and feel as though the doctor “did nothing” if no prescription was given, and you have a recipe for continued over-use of antibiotics with viral infections.

Well when should I be concerned about my respiratory illness?

There no harm in seeing the doctor to have your lungs listened to or your ears examined – it’s the expectation that you get a prescription at the end of the visit that is the problem.

Doctors will be more likely to consider antibiotics necessary under certain circumstances. Fever is often a sign that can distinguish between viral and bacterial causes, but remember, your doctor will want to know the actual temperature of the fever, not simply that you “felt sweaty.” Unless it’s at least 37.5º C or 99.5 F, you don’t have a fever. Feeling progressively worse instead of slowly getting better can be a warning sign too, or not improving at all after 2 or more weeks. Certain chronic conditions like COPD or auto-immune disorders might also need treatment with antibiotics right away.

Bottom line: Your doctor wants to help you.

They get nothing from you feeling terrible (except lost sleep for both of you!). Don’t resent your doctor for not giving you antibiotics for your respiratory infection. Instead thank them for taking the time to thoroughly assess your condition and use up to date evidence to avoid giving you unnecessary medication. We need to protect and preserve our antibiotics from being made useless by drug-resistant bacteria, and that’s something we all have a role to play in.

About the author

Michelle Cohen, MD

Dr. Michelle Cohen is a family physician trained in Toronto who left the big city behind for a quiet farm in the country. She has a family practice in Brighton, Ontario and works in the emergency department of Trenton Memorial Hospital as well as the sexual health service at the Haliburton, Kawartha Pine Ridge Public Health Unit. She is an assistant professor in the Family Medicine Department at Queen's University's Health Sciences Faculty. She blogs about farm life at www.evamaefarm.com/blog and can be reached via email. See all of Michelle's articles.