Expert Blog

When Do You Need Antibiotics?

When Do You Need Antibiotics?

BY: Dr. Edward Pullen

Fall is a busy time in a family physician’s office, thanks to the return of cold and flu season. And while it can be pretty miserable dealing with a sore throat, stuffy nose and cough, most upper-respiratory infections are caused by viruses and are self-limiting. This means the illness just has to run its course -- and doctors like me have little to offer except a diagnosis, reassurance and tips on self-care.

Patients are often disappointed when I decline to prescribe an antibiotic, and some patients try to convince me to prescribe one just in case. Sometimes they feel like they’re not getting the best care if they leave my office without a prescription. But the truth is that antibiotics combat bacteria, not viruses, so they do not help with viral illnesses like a cold or the flu.

What’s more, we are seeing more and more side effects of antibiotic use in recent years, the most serious and dramatic of which is Clostridium difficile colitis, which can result in severe diarrhea, abdominal pain, fever, bloody stool, nausea and dehydration. Indiscriminate use of antibiotics has also led to the emergence of so-called “super-bugs,” like MRSA (methicillin-resistant staphylococcus aureus), which are resistant to antibiotics. Even C. difficile is becoming increasingly antibiotic-resistant, making it more difficult to treat.

Of course, there are several times when you do need antibiotics and should take them. Your physician is the best person to make that determination, but how do you know if you should see your doctor?

Antibiotics may be warranted when:

  • You have severe sore throat with fever, as this could indicate strep throat.
  • An apparent cold seems to worsen after several days, especially if it’s associated with fever, productive cough or severe facial pressure and pain. This could indicate a complicating bacterial illness, such as pneumonia or a sinus infection.
  • You have any illness associated with severe shaking chills, high fever and malaise.

Antibiotics are rarely helpful when:

  • You have multiple upper-respiratory symptoms, including runny nose, sore throat, cough, nasal congestion and little or no fever.
  • Gastrointestinal symptoms, like nausea and vomiting, are the primary symptoms.

So if you’re down with a cold or the flu and your doctor believes that a virus is to blame, don’t push for antibiotics just to see if they will help. Instead, try to be patient and thankful that your immune system has the ability to fight off viruses all on its own.

Dr. Edward Pullen blogs frequently for Live Right Live Well. He is a board-certified family physician practicing in Puyallup, Wash. In addition to practicing full-service family medicine since 1983, he writes the medical blog

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