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Do I Need an Antibiotic?

Last Modified: October 12, 2012

Family Medicine

When it comes to respiratory tract infections, like sinus infections, bronchitis or the common cold, it seems like there is always "something going around." Respiratory tract infections are one of the most common problems that I see on a daily basis in my family practice, in both adults and children.

Sick adults and parents of sick children frequently ask me these two important questions: how do I know if I should go see the doctor, and when do I need an antibiotic?

How do I know if I should go see the doctor?

You should definitely go to the doctor if you're really sick, or if you've been sick for a really long time. What does that mean? If you have a fever above 104 degrees, are having any difficulty breathing, are in a lot of pain (for example, with an earache, facial pain or very sore throat), or have a rash with your fever, then see the doctor. Alternatively, if you have been ill for more than 2 weeks, then you should see the doctor. (I say "doctor" but in reality, many primary care offices nowadays have well-trained and experienced nurse practitioners or physician assistants who can also offer you excellent care.) These are general guidelines, but it's always OK to call the office and speak to a healthcare professional for specific guidance if you're unsure about what to do in your situation.

When do I need an antibiotic?

That question is a little harder to answer, since it depends on your particular situation. Certainly, strep throat must be treated with an antibiotic. A true ear infection ("acute otitis media," in doctor-speak) also requires antibiotics. However, the vast majority of respiratory tract infections are caused by viruses. Viruses, unfortunately, are not susceptible to antibiotics. The good news is that viral infections will run their course without treatment, but the bad news is that it can take up to 10-14 days. The only treatment for a viral infection is to rest, drink plenty of fluids, and manage the symptoms.

What if it doesn't go away in 10-14 days?

If a cold lasts longer than 10-14 days, it is possible that bacteria have moved in and taken over the infection. Fortunately, bacterial infection arises from the common cold less than 2% of the time; when it does, we can kill the bacteria with antibiotics and help you feel better! Other signs that the infection is bacterial, and would require antibiotics, include pain in the cheekbones or teeth, a sudden worsening in symptoms after 5-7 days, and yellow/green drainage (especially if it is only on one side of the nose).

Whether viral or bacterial, how do I manage the symptoms?

If you have thick nasal drainage or postnasal drip that is hard to blow out or cough up, try guaifenesin (Mucinex® or Robitussin®). If you have a stuffy nose, try pseudoephedrine (Sudafed®); I recommend against using decongestant nasal sprays, like Neo-Synephrine® or Afrin®, since your nose can get "hooked" on them after only 4-5 days. If you want to stop your drainage, try diphenhydramine (Benadryl®) or chlorpheniramine. Tylenol® or ibuprofen can help with fever and aches. [Each of these medications should be used according to the dosage information on the bottle.] Throat lozenges and salt water gargles ease a sore throat. Nasal saline spray or a Neti pot for sinus rinses can also help soothe sore, congested nasal passages. If you are pregnant, elderly or have high blood pressure, please check with your primary care provider before taking anything for your symptoms.

What about infants and toddlers?

There are no safe over-the-counter cold medications for babies and young children. You can give them Tylenol or ibuprofen, but otherwise it's nasal saline spray, bulb suction for the little noses, perhaps a cool mist vaporizer, and time. I know (as a father of four) how helpless you can feel when your young children are sick, but there just aren't many options to help them through a viral illness. Make sure they drink adequate fluids, as they may not want to eat as much food. Also, if you have a baby who is less than 3 months of age and has a temperature above 100.5, you must have the baby checked out without delay.

In summary, there is no definite way of telling the difference between viral and bacterial respiratory tract infections. Time course and severity are probably the best predictors. Now you know what to look for, when to see the doctor, and how to manage your symptoms. Hopefully the advice in this article will help you and your family through cold and flu season.

Mucinex® is a trademark of Reckitt Benckiser LLC
Robitussin® is a trademark of Wyeth LLC.
Sudafed® is a trademark of Johnson & Johnson.
Neo-Synephrine® is a trademark of Bayer Aktiengesellschaft.
Afrin® is a trademark of MSD Consumer Care, Inc.
Tyleno®is a trademark of The Tylenol Company.

This blog is not an endorsement of any product.

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