Physicians are often put in quite a challenging position when trying to do best by their patients. One of the most difficult pieces is offering an appropriate treatment plan for upper respiratory infections (or common colds and acute bronchitis) - often which just tender loving care, rest, hydration and nutrition will support your body to fight of the infection on its own. We try our best to hold off on antibiotic treatment because there is inherent harm to the patient and the community from over-prescribing. Here is one of the most common disappointments I see on patient surveys:
"I went to see my doctor, and I had this miserable cold! She said I was going to be fine and sent me home! What a waste of my time and money! That doctor was useless!"
To help everyone understand, here's the Physician reasoning:
Your current infection is probably caused by a virus. Antibiotics cannot kill viruses. Viral infections can last about 2-3 weeks, but you will slowly begin to improve on a day-to-day basis, although it may feel like it’s slow and lingering.
Often times, most of your symptoms would have improved after 2-3 weeks, but you may even have a lingering cough that could last 4-8 weeks. This is part of the inflammation healing process, and it is not a type of bronchitis that can be healed by antibiotics.
Anti-viral medications for Influenza and COVID19 are available. These medications are very helpful to prevent severity of these specific viral infections (not other common cold viruses). You must test early for these diseases to make taking the medication effective and worth it --- another reason why we still recommend testing for COVID19 and the flu early in your symptoms as a helpful way of managing these diseases.
These are the reasons antibiotics can be a problem if it is prescribed too often (or reasons that it should be prescribed with caution):
- Antibiotics can cause side effects and allergic reactions – some people get nausea/vomiting, others diarrhea, and others end up at the hospital with swelling and rash.
- Antibiotics can destroy your good gut or intestinal bacteria. These good bacteria help with overall appropriate digestion and movement of your bowels. Good gut bacteria can also prevent deadly overgrowth of bad bacteria. One of the most common dangerous overgrowth is by Clostridium difficile (or C. Diff). This is a very serious condition that can cause inflammation in your bowels and can be very painful or simply very smelly. It also causes a severe diarrhea that would not go away, and this infection would then need more antibiotics for treatment. Antibiotic use can also lead to increased risk for fungal or yeast infections.
- Antibiotics overuse can lead to resistant bacteria – this may mean that one day, if you were in a situation which requires the use of antibiotics (for instance, in burn patients, transplant patients, cancer patients, and those with deadly infections), the antibiotic had stopped working on the bacteria because it was overused, then it is now a matter of life or death. There are already people in hospitals that struggle with this now. Unfortunately, we don’t have newer antibiotics to fight these infections at this time.
"Doctor, ok.... I understand you don't think it's necessary for antibiotics, but I'm miserable. Why aren't you doing anything for me?!"
Here is where I feel bringing this up with someone who is on your trusted health care team can make the difference (rather than going to a Big Box Store Clinic). You will feel much more comfortable telling a physician you've known for years how awful you feel and that you don't agree with that TLC-rest/hydrate plan (or your physician will notice how miserable you feel because they've seen you on your good days). Bring it up: Say - my cough is bad, can you please prescribe something for it?
This is again, part of the team approach to care. Please openly communicate how miserable you feel and what symptom(s) you need us to address the most right then and there. We might not be able to cure your viral infection right away, but we might be able to help ease the course.
"So what if my symptoms are getting worse even after a diagnosis of viral infection?"
Physicians don't have a magical scanner in our eyes and cannot predict if your currently benign infection is going to progress to pneumonia or a bacterial infection. We make risk assessments based on progression of a disease. I always say, what is occurring one day can change quickly in the following days.
We do not recommend antibiotics to “prevent” things getting worse or "getting ahead of the infection" for the above reasons written. However, there is always a chance of your symptoms getting worse and leading to such a complication, although this does not occur very commonly in every infection. Some people tend to have more complications than others. The most appropriate way to handle this situation is to keep your physician in-the-know (another good reason to seek out your primary care team to help, because they follow you all the way). Please understand that sometimes another office visit may be required to evaluate your symptom progression because certain diagnostic tests may need to be ordered or certain antibiotics only work for certain infections such as pneumonia, and we should see you to try to get the right diagnosis to give you the best prescription possible. It may seem inconvenient, but it is the best way for us to take care of you and get you feeling better sooner and stay out of the hospital with the least amount of side effects and harm as possible.
If it feels very miserable, then find us early so that we can test you for flu and COVID19 and check for pneumonia or other diseases as soon as possible. However, if it feels like a mild common cold and you test negative for COVID19 at home, then you might not need to come see us at the very early part of your cold each time. Check-in with your physician to see if they want to see you right away. You may save yourself a co-pay.
Surely if your symptoms are still not improving, and it's been more than 10-14 days or you notice worsening or scary symptoms, come find us - we're here to help rule out the bad diseases, provide treatment/therapies when indicated, and sometimes advise reassurance as well. It also puts you on our radar in case you call back saying... something's not quite right.