That Antibiotic Sure Helped?

“If I give you an antibiotic, you will be better in 7 days.  If not, it will take a week to resolve.”

This is the “tongue in cheek” choice I offer to patients who present in the early stages of an illness that is likely to be a viral infection.  It is my way of explaining that viral infections run a course that is not affected by antibiotics and they would be wise to wait.

Antibiotics are effective treatment for bacterial infections.  Bacterial infections often occur following the initial effects of a viral infection as it stresses the immune system or causes the environment in the respiratory tract to be more hospitable to bacteria.  Bacterial infections of the respiratory system rarely occur without a preceding viral infection.  That is why doctors are urged to counsel patients to wait a few days into a respiratory illness (sneezing, cough, sore throat, drainage) before starting an antibiotic.

Consider the possibility of allergies, especially to dust, as a mimic of respiratory infections in the winter and early spring.  If your “viral infection” lasts more than a week with the same symptoms, it is more likely you are allergic to an indoor allergen like dust, pet dander or others.

Influenza is an exception to the “let a viral infection run its course” rule.  Tamiflu and other antiviral drugs shorten the duration and decrease the severity and complications of influenza if started shortly after the onset of symptoms.  That is why my highest risk patients are given provisional prescriptions for Tamiflu to fill in the event of onset of classic symptoms that would prompt a physician to treat based on a telephone description of symptoms, including shaking chills, fever over 101 degrees F, non productive severe cough and body aches.

On the contrary, taking antibiotics to “prevent” a bacterial infection is usually not a good practice.  Such prescribing is part of the reason our antibiotics are less effective due to resistant bacteria being selected and causing more and more true bacterial infections.

So, when should you expect to receive an antibiotic for your respiratory ailment?  If, after 2-3 days, your symptoms are getting worse, this could indicate that the infection has evolved from viral to a bacterial cause.  If symptoms persist for more than a week, the same conclusion is reasonable.  If there is a heavy drainage that has the characteristics of “pus” (yellow to green, thick and copious), a bacterial infection rises as more likely.  Still, such drainage can be a consequence of viral infections or allergies.  The decision can be tricky.

If you are getting worse, not getting better, have a persistent fever or increasing amounts of purulent (pus like) drainage, the benefit of an antibiotic is potentially greater.  Otherwise, your doctor’s advice to wait is probably in your best interest.  We all have a stake in preventing antibiotic resistance so that our drugs remain effective when they are truly needed.