September 2008
“Doc, I know my body. I just need some antibiotics….”
Where does the time go? My last entry was in March. Summer has come and gone, and here we are in autumn. This means cold and flu season is right around the corner. Let’s look at how to prevent getting sick and what can be done to help if you do get sick.
Colds or upper respiratory infections (URI) are caused by viruses. They cause runny noses, sinus congestion, sore throats, and cough. You can expect to feel run down and may run a fever. They last for about a week and eventually go away on their own. They do not require antibiotics and should not be treated with antibiotics. Even if you have green stuff coming out your nose. Even if you are coughing up yellow stuff. The color of your sputum has absolutely nothing to do with whether or not you need antibiotics. The color means that your body is doing its job by bringing in white blood cells to fight the infection. If you feel short of breath or have been sick for longer than 7-10 days you should probably make an appointment to see one of us, but don’t expect antibiotics just because you are coming in to the clinic. We will examine you to see if you might have pneumonia or a more serious infection that may require antibiotics. Or we may give you advice to improve your symptoms while the URI is working its way out of your system.
Likewise, influenza (the flu) is a virus. Many people think of “the flu” as an illness with vomiting and diarrhea. Not true. Influenza is a respiratory illness. It causes fevers, headaches, sore throat, and bad muscle aches. Some people get quite sick with influenza. The best way to treat influenza is to prevent it in the first place by getting a flu shot. These are given in the fall months and must be given every year because the virus changes every year. A common misperception is that you can get the flu from the shot. Not true. This is simply not possible. There are medicines that can be used to treat influenza once you get sick, but they are very expensive, must be given within 24-48 hours of the development of symptoms, and reduce the duration of the illness by only a day or two. In otherwise healthy adults we usually recommend taking acetaminophen or ibuprofen for the fevers and muscle aches, and waiting it out. You can expect to feel poorly for 2-3 days, maybe feel a little better for a day or two, and oftentimes you will feel crummy for another couple of days after that. If you do not feel better within a few days, or if you have shortness of breath with your cough, we should see you to make sure you have not developed pneumonia. This is one of the more serious consequences of influenza. It is much more common in those who smoke or have other medical conditions that affect their ability to fight infection.
What about sinusitis, bronchitis and ear infections? These often follow a URI. Just because they have a name, however, does not mean we treat them any differently. Sinusitis is inflammation in the sinuses, or a cold in the sinuses. Bronchitis is really a chest cold. And most ear infections are caused by viruses. None of these generally require antibiotics. Sinusitis is best treated by drainage. Nasal decongestants, fluids, and nasal irrigation will treat most sinus infections. Cough syrups and fluids are all that is recommended for treatment of bronchitis. And ear infections in adults will usually get better on their own if given a few days. If an ear infection does not get better in 2-3 days we may recommend antibiotics if the infection involves the deeper structures of the ear. This can only be decided by an examination, so we don’t treat ear infections over the phone.
Again the best way to treat these illnesses is to prevent them in the first place. If you smoke, stop, or at least do the best you can to limit smoking during a respiratory illness. Every time you light up you irritate the tissue that is already inflamed. You also stall the body’s defense mechanism by slowing the movement of cilia. These small hair-like structures that line your entire respiratory tract (from the nose down to the tiniest airways of your lungs) are responsible for moving the mucous your body produces to cleanse itself. Nicotine stops them dead. Mucous (snot) sits in thick pools in your lungs and sinuses and cannot get out. This blockage can lead to bacterial super infection and may require antibiotics in addition to drainage.
So what’s the big deal with antibiotics? Well, it’s a very big deal. We are seeing a frightening increase in the numbers of bacteria that are extremely resistant to not one, but many, entire classes of antibiotics. This is a direct result of the over utilization of antibiotics in the past. This means that many of our antibiotics are useless for the treatment of a number of infections, such as MRSA, the Staph bug that is causing significant illness both in the hospital and the community. So if your provider does not think you need antibiotics, there is a good reason for that. You cannot “head it off,” or prevent complications, by treating a cold with antibiotics. You can get allergic reactions, some life threatening; you can get side effects from antibiotics, like diarrhea (often times caused by an increasingly difficult to treat bacteria that grows in your gut after normal bacteria are killed by antibiotics) and yeast infections; you can develop a resistance to antibiotics; but you will not prevent a secondary bacterial infection by taking antibiotics for a viral infection.
The best way to stay healthy this cold season is to eat healthy, get exercise, get adequate amounts of sleep, and wash your hands. Frequently. Consider carrying a small bottle of hand sanitizer in your purse or pack. Cover your mouth and nose (preferably with your arm, not your hand) when you cough or sneeze. Consider getting a flu shot. Talk with your provider about the Pneumovax, an immunization given to certain people at risk for a particular type of bacterial pneumonia. If you get sick anyway, give your body a chance to take care of itself. Give yourself a break. Take a nap. If you are running a very high fever ( >101.5), if you can’t take fluids because your throat is too sore, if you feel short of breath, or just want some reassurance, come see us. We will examine you and make recommendations based on sound guidelines published by experts in the field of infectious illness meant to protect the overall health of the public by using antibiotics only when clearly indicated and absolutely necessary.
Supporting you in good health,
Gail Hacker, MD
