As fall approaches, so does the cold season. This is the time that many of us develop those pesky runny noses and coughs.
None of us want to suffer unnecessarily and a common theme I hear in the office is “I don’t have time to be sick.” Many will go to the doctor in search of an antibiotic to “nip it in the bud.”
There is a growing concern about using antibiotics in situations when they are not necessary. We all are aware of the rise in antibiotic resistant organisms such as MRSA, wich is a staph bacteria that can cause serious skin infections and is no longer sensitive to the antibiotics that used to kill it.
Since there are very few new antibiotics being developed, this could be a huge problem in the not so distant future. In addition to the resistant organisms, antibiotic usage can cause a serious imbalance in the organisms that usually live in your intestines and possibly lead to an overgrowth of a nasty bacteria called C. Difficle.
When C. Diff overgrows, it can cause serious and even life-threatening diarrhea. There also is growing evidence that antibiotics can affect the other beneficial organisms in your intestines and possibly lead to the development of chronic diseases, such as diabetes.
Many people will develop a serious allergic reaction to the antibiotic used. Antibiotics, penicillin in particular, are the most common medication listed on allergy lists. Finally, if antibiotics are used for a viral infection, patients often will need a second round of antibiotics because the virus did not respond to the first. In this situation, the patient is exposed to two medications that they didn’t really need. If the antibiotic was not necessary in the first place, the risks of the medication is not acceptable.
Typically, the most common inappropriate usage of antibiotics occurs in the setting of a cold/sinusitis or bronchitis. I think this is in part because we – both providers and patients – have been using incorrect guidelines for when an antibiotic is appropriate.
For years we have thought that if the nasal mucous turned dark in color, it was a bacterial infection and an antibiotic was needed. There is also a widespread fear of bronchitis turning into pneumonia, so people understandably seek out antibiotics. The pediatricians have done a wonderful job of educating parents about the proper usage of antibiotics. It is heartening to see just how sparingly these medications are prescribed in the pediatric population. Hopefully, as we reeducate the adults, we will see a similar improvement.
The common cold symptoms of runny nose, sore throat, sneezing and cough can be caused by more than 200 different viruses. Typically, the virus infects the nose and sinuses first and causes the nose to make a clear mucous. In two to three days, the body’s immune system kicks in and the mucous changes to a white or yellow color. In the next few days, the normal bacteria that live in your nose will start to grow back and cause the mucous to be a greenish color. This is actually normal and does not mean you need an antibiotic.
People frequently will develop increasing pressure over the sinuses or tooth pain, which also does not necessarily indicate a bacterial infection. This is caused by the mucous backing up into the sinus cavities and can be relieved by opening the blockage. The CDC estimates that 98 percent of acute sinus infections in adults are actually caused by viruses. The signs that point to a bacterial infection are a severe infection that has lasted three to four days with a fever over 102 and purulent nasal drainage, an infection that persists greater than 10 days without improvement or an infection that was initially improving and then worsens or a fever that develops later in the course of the illness. If you don’t have any of these situations, using antibiotics for the infection will not help speed up the healing process and could actually hurt you.
For healthy individuals, treatment for a cold or viral sinusitis should include remedies that will help to open the sinus passages and also those that will support the immune system.
Saline rinses with the propellant-drive canisters three times a day can wash out the thick mucus, open the plugged sinuses and relieve congestion in the nasal passages. Decongestants also can be helpful to decrease the nasal congestion. You can get oral decongestants such as Sudafed behind the counter, phenylephrine OTC or nasal decongestant sprays.
Use care with the Sudafed if you have high blood pressure, and remember, it may make it hard to sleep at night. The nasal decongestants are safe for usage up to four days in order to prevent the rebound congestion that can occur with prolonged usage.
Nasal steroids also can decrease the swelling in the nasal passages. They are available over the counter now and should be started early in the illness since they take a day or so to be effective. Sleep and rest is actually one of the best remedies for these viral illness and probably one of the hardest for us to accept. You will heal faster if you just rest for a day or so.
Acute bronchitis is better described as a chest cold. In healthy people this is most often caused by a virus and will improve with rest and symptomatic treatments. When you have acute bronchitis, it is very important to avoid smoking or exposure to second hand smoke. You also need to get adequate rest to allow your body to fight the infection.
Coughing can be managed with honey and lemon or over the counter preparations with dextromethorpham. Try and pick cough suppressants with a single agent to limit side effects from the OTC medications. Prescription medications of albuterol or steroids can be used in stubborn cases. Typically, a cough from a viral bronchitis can last up to three weeks.
Signs that this might be something more serious include a fever over 101, shortness of breath or sputum that is purulent and thick or blood tinged. You should seek medical attention for these symptoms or if the cough lasts longer than three weeks. People with chronic lung or heart disease should discuss with their providers when to call for evaluation if they were to get an acute bronchitis.
Finally, the best way to treat a viral infection is to prevent it in the first place. Viruses are transmitted easily through the air and with contact on surfaces. Remember to cover your cough or sneeze to keep from sharing your virus. Stay home when you are sick so those around you are not exposed to your virus. Wash your hands frequently and nurture your immune system by getting adequate rest, hydration and nutrition.
By working together, we can limit the unnecessary usage of antibiotics so we will have them available when we need them. It is hard for all of us to change the way we have approached our common viral infections. And it will take time for patients and physician alike to gain confidence in a watchful waiting instead of the old fashion “nip it in the bud” approach. We all need to regard antibiotics like we would a strong chemotherapy that they are and use them judiciously. As we stop using antibiotics when they are unnecessary, I think we will see a wonderful improvement in all of our health.
If you are interested in finding out more information about safe antibiotic usage please visit http://www.cdcc.gov/getsmart or discuss it with your primary care provider.
Written by Dr. Valerie Scott, who is the Roper St. Francis wellness ambassador physician champion. Dr. Scott is board certified in family medicine and practices at Mt. Pleasant Family Practice.
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