We are amidst the cold and flu season, and the expectation for antibiotics is so common that I find myself spending most of my time explaining why antibiotic use for colds are inappropriate. It’s time that I feel people would benefit from resting at home, letting their bodies recover. Sometimes I wish I could create a PSA or scream at the top of my lungs that
Colds are caused by a virus! Antibiotics are for bacterial infections. Get some rest, fluids and let your body heal naturally!
(I also have a few choice words for anyone who continues to inappropriately prescribe antibiotics for a cold and perpetuate the unreasonable demand… Should I tell you how I really feel?)
I am absolutely thrilled that the American College of Physicians (ACP) and the U.S. Centers for Disease Control and Prevention (CDC) recently published an article in the Annals of Internal Medicine that gave specific recommendations to physicians for appropriate scenarios to prescribe antibiotics. The article recommended the following valuable guidelines:
- NOT prescribe antibiotics for patients with the common cold. (AND I REPEAT, CLINICIANS SHOULD NOT PRESCRIBE ANTIBIOTICS FOR THE COMMON COLD)
- NOT perform testing or initiate antibiotic therapy in patients with bronchitis unless pneumonia is suspected.
- Test patients with symptoms suggestive of strep throat by rapid antigen detection test and/or culture for group A Streptococcus and should treat patients with antibiotics ONLY if they have confirmed streptococcal pharyngitis.
- Reserve antibiotic treatment for acute rhinosinusitis for patients with:
– persistent symptoms for more than 10 days
– onset of severe symptoms or signs of high fever (>39 °C)
– purulent nasal discharge or facial pain lasting for at least 3 consecutive days
– or onset of worsening symptoms following a typical viral illness that lasted 5 days that was initially improving (double sickening).
The article also states that sinus infections usually clear up without antibiotics even if bacteria are to blame, and that antibiotics in these cases cause more adverse effects. The guidelines also recommend the following remedies for symptom relief:
Analgesics for pain
Antipyretics for fever
Systemic or topical decongestants
Saline nasal irrigation
Cough suppressants (dextromethorphan or codeine)
First-generation antihistamines (diphenhydramine)
The cold virus will eventually run its course. Often catching a cold happens during times of high stress and lack of sleep, so it’s important to allow yourself to rest.
Antibiotic resistance is a serious health threat and not to be taken lightly. Again, it requires a commitment from both physicians and patients. So save yourself some time and healthy gut bacteria and stay home and rest. Your cold will get better and if not, I’ll be here to help.
Let me know your thoughts in the comments!
The World Health Organization has declared this week to be “World Antibiotic Awareness Week,” which is dedicated to bringing awareness to the global health epidemic of antibiotic resistance. It’s also “Get Smart About Antibiotics Week” here in the United States. According to the CDC 2 million people in the United States become infected with antibiotic resistant bacteria and 23,000 people die from such infections each year. What’s worse is that antibiotic resistance continues to increase.
“To give you an idea of how high the pressure is to prescribe antibiotics, I didn’t get a job once because during the interview I told the lead physician that I only prescribe antibiotic prescriptions when they are warranted.”
Following Darwin’s theory of the survival of the fittest, bacteria normally evolve in such a way that they evade destruction by antibiotics. However, inappropriate antibiotic use in healthcare settings and increasing antibiotic administration to farm animals is creating a rising number of “superbugs” such as MRSA and drug resistant E. coli. Even simple urinary tract infections are becoming difficult to eradicate. The few effective second line treatments that are available are usually expensive and require hospitalization. Antibiotic resistance is only a part of the problem, as antibiotics are also not free of side effects. Certain antibiotics can cause vomiting and diarrhea, tendon rupture and even heart arrhythmias. Since antibiotics also decrease the beneficial bacteria that live within our bodies, yeast and the bacteria Clostridium difficile, which are normally contained by our body’s “good” bacteria, can overgrow and lead to deadly infections.
“It wasn’t the antibiotic that cured your cold; it was likely a tincture of time and possibly even the placebo effect.”
So why is there an inappropriate use of antibiotics? Ask any doctor and you will find that there are high expectations from patients for antibiotic prescriptions, especially for colds. However, many people do not realize that colds are usually caused by viruses and viruses are not treatable with antibiotics. (It wasn’t the antibiotic that cured your cold; it was likely a tincture of time and possibly even the placebo effect.) Healthcare providers are also at fault. Many providers give into pressure from patients, sometimes writing antibiotic prescriptions and advising patients not to fill them just for patient satisfaction. To give you an idea of how high the pressure is to prescribe antibiotics, I didn’t get a job once because during the interview I told the lead physician that I only prescribe antibiotic prescriptions when they are warranted. I was also threatened once by an asymptomatic patient who wanted antibiotics because her son had a cold.
So what can be done to decrease antibiotic resistance? Prevention is always key to avoiding any disease in the first place. Eating a healthy diet, managing stress, getting adequate sleep and staying physically active are all great ways to boost the immune system and promote overall health. Consistent hand washing is also paramount as our hands are a primary means of spreading germs. It’s also important to take antibiotics exactly as prescribed. This means that the leftover antibiotic originally given for a skin infection, which should have been completed in the first place, may not cover that urinary tract infection.
It’s up to physicians to educate patients on the risks and benefits of antibiotics use. I find that most of my patients feel comfortable when I educate them about their symptoms and reassure them that I will be available to prescribe antibiotics if necessary. As for patients, your involvement and accountability for your health could be the reason you and your family members survive an antibiotic resistant infection in the future. As always, make sure to see a healthcare provider if you think you need antibiotics.