Understanding the Need for Antibiotics

A very small percentage of sinusitis and bronchitis are caused by bacteria and will need antibiotics.  The rest (and all flu and colds) are caused by viruses, which are very, very biologically different from bacteria and therefore antibiotics will do nothing to them.

Think about it like this: A virus is like a tree and a bacterium (singular for bacteria) is like a dog (but actually, they are even more biologically different from one another than a tree and a dog are!).  Trees and dogs sometimes interact, but if you try to give your dog plant food, it’s not going to go well.  Dogs’ systems can’t do anything with plant food and viruses can’t do anything with antibiotics.  In recent years, antiVIRALS have been developed for influenza (and other illnesses caused by viruses, like herpes), but again, these are very different medications than what we think of as antibiotics.

How Do You Know When You Might Need Antibiotics?

Well, if you have a chronic lung disease like COPD or are immunosuppressed from rheumatologic medication, cancer or HIV, you may need them sooner rather than later (because dangerous bacteria can quickly hop on the trail of viruses in these folks).  BUT, if you have a healthy, functioning immune system and nice, pink lungs, you should probably just follow your grandmother’s advice and have a big bowl of chicken soup and stay in bed (if you can).  You will be better in 1-3 weeks.  If things do not seem to be steadily improving after the first 5 days or if there are fevers >100.5 for more than 3 days or return after they initially break, it’s time to come in.  Green and yellow nasal discharge and/or phlegm DO NOT mean you have a bacterial infection (old wives’ tale alert!).  Green or yellow discharge means your body is doing a great job fighting off the viral infection!

Helpful Tips to Treating the Common Cold

Tips to treat the common cold: Stay hydrated and get lots of rest.  Medication like Sudafed (you have to ask the pharmacist for and cannot take if you have high blood pressure), taken every 4-6 hours (but not after 5 p.m. as it can bring on sleeplessness) can help to decongest you.  Mucinex, steam and saline nasal sprays may be helpful as well.  Stay away from any nasal spray that is not plain saline! Zinc lozenges, taken every 3 hours, have also been shown to reduce the time you are sick.

Helpful Tips to Treating Sinusitis

Tips to treat sinusitis: see the above recommendations.  Many people also find a neti pot helpful in treatment and prevention.  If you have bloody or pus-like nasal discharge, persistent fevers, redness on your face or severe pain in one area of your face, it’s time to get checked out in the office for a bacterial sinusitis.

Helpful Tips to Treating Bronchitis

Tips to treat bronchitis:  This is usually just a bad cough if you don’t have lung disease.  It is caused by a virus and antibiotics don’t help it.  Along with standard cough suppressants and lozenges, you may also consider something called Pelargonium syrup (found in a health food store), which has been shown in a well-done study to help with a cough.  If you have fevers lasting more than 3 days or start to get better and then get worse, it’s time to get checked out for pneumonia (which is helped by antibiotics).  And remember, the average VIRAL cough lasts 18 days!

Helpful Tips to Treat the Flu

Tips to treat the flu:  Flu and pneumonia, which can be hot on its trail, is actually the eighth leading cause of death in the United States.  Getting your flu shot is the best chance you have at not getting the flu!  It is not a cold (it is caused by a different family of viruses than the colds are).  The fevers are much higher than with a cold or the other infections just listed.  Typically higher than 102o!  This usually comes on quite suddenly and is accompanied by bone-crushing aches.  It is hard to get out of bed.  There can be a cough, sore throat and nasal discharge, but usually not much.  You don’t have to do anything to treat the flu (except rest and stay hydrated), but if treated within 48 hours of the onset of symptoms, medication like Tamiflu (which can cause GI to upset and sometimes psychosis in small numbers of people) can help you get better a day or two earlier.  It may also help people who live with someone who has the flu, not get it.  If you have the flu, don’t spread it to others!  Stay home until 7 days have gone by or 24 hours after the fevers go away (whichever is longer).  If you have to go out in public, please wear a surgical mask.  If you start to get better and then take a turn for the worse, CALL IMMEDIATELY.  This could be pneumonia that hops on the trail of the flu and can be very dangerous.

Zpack May Not Always Be a Solution

Why can’t I just take the darn antibiotic (Zpak!)?
You may or may not have heard about bacterial resistance.  Microbiologists and infectious disease specialists have been worrying about it for a long time and now, it’s here.  Heard of MRSA?  It is the aggressive bacteria that few antibiotics can treat!  It is a man-made problem from the overuse of antibiotics.  There are other bacteria that are being created from the overuse of antibiotics that if you haven’t heard about yet, you will—VRE, pan-resistant gram negative bacteria, etc.
http://www.nytimes.com/2010/02/27/business/27germ.html

Taking antibiotics can also make you more susceptible to a nasty diarrheal infection called Clostridium dificile (c.dif). 
http://www.nytimes.com/2009/04/14/health/14well.html?em

It may even make you fat (remember, livestock are given antibiotics in their feed to fatten them up—that’s a big problem for another discussion)!