By Sara Myers, MD
As a primary care physician, some of the most common complaints I see are cough, sore throat, runny nose, congestion, and/or fever. These symptoms are usually caused by one of the common cold viruses (rhinovirus, adenovirus, metapneumovirus, RSV, influenza, etc.). Most patients present on day two or three of the illness, wanting treatment to speed their recovery, often because they can’t afford to miss much school or work, and they usually ask for an antibiotic.
Since the discovery of penicillin in 1928, we have greatly benefited from the ability to treat bacterial and fungal infections that killed patients prior to this discovery. Unfortunately, these microorganisms have developed resistance to these medications, making them more difficult to treat. A major contributor to this has been the treatment of presumed viral illnesses with antibiotics. Some antibiotics have anti-inflammatory effects which may be what helps the patient feel better. In reality, it is likely that the antibiotics bided time while the body’s immune system took care of the virus itself.
I’ve found that taking a minute to educate patients that antibiotics are not the best course of action for mild symptoms can make a big difference in their perception when considering their future health needs. I counsel them that symptoms such as illness lasting more than 10 days, objective fever (>100.4 over the course of several days), facial pain or sinus pressure, purulent nasal discharge or drainage, exudates present and/or swelling of the tonsils may necessitate antibiotics, but basic cold symptoms do not. Of course, some patients are disappointed with this recommendation, but there are always remedies we can suggest. Decongestants, antihistamines, non-opioid analgesics, nasal sprays, an ipratropium inhaler, and cough suppressants can help their symptoms, while not adding to antimicrobial resistance and other complications related to antibiotics (disruption of normal GI flora, risk of C. difficile infection, allergic reactions, etc.). And we can reassure the patient by letting them know that we will follow-up if their symptoms don’t improve.
Acute upper respiratory infections account for greater than 25 million primary care visits per year in the US. Most are viral and do not necessitate antibiotic prescriptions. We still have a lot of work to do to change the general public’s perception about antibiotics. Even in this busy day and age of medicine, I believe providing a little education is always beneficial in the interest of all of our future health situations.
Sara Myers, MD is a primary care physician in practice with Norwood Clinic.
