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Cold and Flu Season: When Do You Need Antibiotics?

Health & Prevention

The cold and flu season is upon us.  Is there anything you can do to stay healthy? You bet!  Having a better understanding of the causes of the common cold can help to make sure you and your loved ones remain healthy and recover quickly.

These infections may be caused by common bacteria or viruses.  Symptoms of bacterial and viral infections often overlap, which can lead to confusion, misdiagnosis and mistreatment.  The most common mistake involves the use of antibiotics for a viral infection. Viruses do not respond to antibiotics, and sometimes require separate medications such as Oseltamivir (Tamiflu©).  Furthermore, antibiotic use can lead to new resistant bacterial infections, medication side effects, and disruptions of the normal “healthy” bacteria on our bodies. Taking an antibiotic during some viral illnesses can also cause a viral rash—which may be confused for antibiotic allergies or side effects and prevent use of the medication in the future.

It is important for patients and doctors to distinguish between viral causes of the cold and bacterial causes.  Here are several tips from Brian Hollenbeck, MD, Chief of Infectious Disease at NEBH to help you through the cold and flu season:

  • The influenza vaccine (“flu shot”), good hand washing, and good respiratory etiquette are the best first-line defenses to stay healthy this cold and flu season.
  • Do you have fever, sore throat, runny nose, cough, aches? If this has been going on for less than three days, the cause is most likely a virus. Most viruses will run their course with good hydration and rest. In more severe cases, the virus causing these symptoms may be influenza. If you suspect influenza, you should discuss with your doctor about getting tested and treated for this virus.  Treatment with Tamiflu will reduce severity and duration of symptoms and help stop the spread of the virus to others around you.
  • Do you have a severe sore throat, fever, swollen lymph nodes and no cough? If so, this may be strep throat, a bacterial infection, and you should talk to your doctor about getting tested and/or treated with antibiotics.
  • If you feel short of breath or chest pain you should always seek medical attention. This may be viral or bacterial pneumonia, or another cause and a doctor should help to guide your treatment.
  • Historically, it has been hard for physicians to know with certainty if a cold is caused by bacteria or viruses, but some testing is helpful:
    • Virus panels can help your doctor to identify common viruses, including influenza
    • Rapid strep tests and throat culture can help to identify strep throat
    • Procalcitonin is a test your doctor can order to help distinguish bacteria from viruses
    • A physical exam by a doctor can help to identify throat infections, sinusitis, ear infections, pneumonia and other illnesses that are more common in the winter months

Bottom line: Antibiotics are not always the best answer to the common cold.  The tips above can help to determine if you may need antibiotics or additional evaluation by a doctor.

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