Office Talk: Just a Virus!

Question:Is my upper respiratory infection really ‘just a virus’?


Answer: Probably.

Oh, the war on the unnecessary use of antibiotics. I get exhausted just thinking about it. And if I said everything I wanted to on the subject, this post would take all day. But seeing as I’m working this afternoon, where I’ll probably need to talk a few people off of the antibiotic ledge, I don’t have the luxury of doing that. But I do want to touch on a few myths while we’re still in the midst of cold/flu season. Most people have accepted that antibiotics won't treat the common cold. But beyond that? Skipping the antibiotics can still be a hard sell.

1)If my cold turns into a sinus infection, I definitely need antibiotics: Not so! One recent study estimated that only 2% of acute sinusitis episodes are caused by a bacteria. Most often, the same viruses that can cause the common cold, invade the sinuses. How can you be rid of viral sinus infections? Saline nasal rinse (the unsung hero of the nose), Decongestants (Claritin-D, Zyrtec-D or plain Sudafed--which is the ‘–D’ in other products), Nasal steroid sprays (like flonase, which is often used for allergies) and time. And when I mention saline nasal rinse, I’m talking about the RINSE, not the mist. It has to go up one side and out the other. Sound fun? It’s a party. A party that works.

I don’t want to downplay that there are occasionally circumstances where sinus infections can get serious and cause complications as the infection spreads. Or that there are times you would use antibiotics. If you have that cluster of symptoms (facial pressure, headache, upper teeth pain, ear pain and congestion) that so often heralds sinusitis, here are a few of the points of history we use to determine if you might need antibiotics:
-duration of symptoms for greater than two weeks
-initial improvement, followed be re-worsening
-Purulent nasal discharge (no, this does not mean green drainage. Viruses are just as capable of producing green drainage. I’m talking pus-like drainage.)
-True fevers over 100.4
-One-sided symptoms (one sinus is more painful or tender than the rest)
-You are getting married in a few days. Kidding! Sort of. We joke that the bride always gets antibiotics.

If you are unsure, or are worried that things are getting worse, always check with your doctor.

2)If my cold turns into bronchitis, I definitely need antibiotics: Wrong again! Most of these infections are viral. But most people don’t realize that viral bronchitis lasts three weeks. Three whole weeks. This is a long time to be coughing, and most people get fed up after 5 or 6 days and figure it must be time for antibiotics. There is a supplement called pelargonium (found in a product called Umcka and sold at whole foods) that has actually been shown to shorten the duration of viral infections like bronchitis. I recommend that to most of my patients. It’s sort of like Zinc for the common cold. One of the few things that actually has some efficacy.

There are a few exceptions to the viral rule: A)Pertussis, or whooping cough, which is making a resurgence in communities. And, oh, what a nasty bug it is. Made nastier by the fact that it acts like a run of the mill cold during the first few days that are the only time treatment will reduce symptom duration. B)Mycoplasma (a.k.a walking pneumonia) and Chlamydia Pneumonia(a.k.a. not the STD) Infections. These too can seem like a cold in the early stages, which also makes them harder to recognize and treat early. Always talk to your doctor if you are feeling short of breath, are coughing to the point of throwing up (which can be indicative of pertussis) or just aren’t sure if you need to be concerned.

Also, if a fever is present, this may actually indicate flu or pneumonia, because bronchitis doesn’t usually cause a fever.

3)Antibiotics would help me, but you are withholding them to protect communities against bacterial resistance.

This is another one I see a lot. I get the feeling that people think we’re holding back effective treatment so that we don’t hasten bacteria’s goal of outpacing our research to kill them. I can see how this would breed resentment. But the truth is that our primary interest is our patient. We generally don't prescribe them because we know that in the majority of cases, they don't work better than placebo. They don't kill viruses. Additionally, there are plenty of possible harms for the patient as well. Among them: diarrhea (sometimes a potentially dangerous variant called C. Diff that has moved from the hospital to the community), allergic reactions, and a wiping out of your good gut flora. I know that I avoid them for me and my kids unless it’s really necessary.


I am very grateful that we live in an era where we have antibiotics. There are times when antibiotics are necessary. And life-saving. And so I don’t mind a bit if people come in when they feel sick to find out if this might be one of those cases. In fact, I think that’s totally appropriate. Frequently I have other prescriptions to help alleviate their symptoms while the body fights the infections. But if your doctor advises that you don’t need antibiotics for your upper respiratory infection, or asks you to wait a few days before taking antibiotics, at least remember that the odds are in favor of their being right and that they probably have your best interests at heart. And that since it is by far the easier thing to just quickly hand out the drugs, a 'no antibiotic' discussion that takes twice as long may actually indicates that your doctor cares more about your health!

**So, what about you? Do you feel annoyed when your doctor tells you that you don't need antibiotics?**