Addicted to Penicillin

With warmer weather right around the corner, cold and flu season is finally wrapping up. One of the most interesting things I noticed this past winter has been the persistent request by some patients for antibiotics. The typical sore throat or stuffy nose seems to prompt some people to see their healthcare provider, not for a diagnosis but for antibiotics. Often times they have already diagnosed themselves with a qualifying condition and just need someone to hand over the penicillin.  

The simple truth is that most upper respiratory infections are not caused by bacteria, the microscopic bugs targeted by common antibiotics such as amoxicillin and azithromycin, but rather by viruses. The common cold for example, which causes sore throat, stuffy nose and sneezing, is caused by more than 200 different viruses—not one of which is treatable with antibiotics! Viruses are also responsible for most cases of laryngitis and pharyngitis (sore throat) as well as sinusitis (inflammation in the sinuses surrounding the nose and eyes). 

The word antibiotic literally means anti-life. These drugs are only affective against certain living organisms. While there is some debate in the scientific world, viruses are generally considered to be nonliving. Rather than being responsible for their own reproduction, viruses invade living cells and reproduce solely by taking over existing cellular machinery. 

Another worrisome trend is the emergence of antibiotic-resistant bugs. There are many reasons for this, including failure to complete a prescribed course of antibiotics for a legitimate bacterial infection. Another totally preventable factor is the treatment of common viral syndromes with antibiotics. Most clinicians know better but often give in to patient pressure. When the symptoms begin to resolve within a few days, the patient attributes this to the treatment where in all actuality they would have improved without them. 

Despite the fact that viruses are responsible for the majority of upper respiratory infections, there are times when bacteria do become involved (And by the way, cold weather itself does not cause one to get sick… viruses and bacteria do. It’s believed that such illnesses are more common during colder months due to the fact that we spend more time indoors).

Here are some characteristics of true bacterial infections and when it’s appropriate to treat them with antibiotics:

• Strep throat
• Presence of a sore throat with pain along the front of the neck
• Fever greater than 100.4 degrees
• Inflamed tonsils with or without pus
• Note, a diagnosis cannot be made by appearance alone!
• Absence of a cough, runny nose and nasal congestion which would suggest a viral infection
• The presence of 2 or more of these criteria may warrant a rapid strep test or a throat culture to confirm the diagnosis
• Sinusitis
• Presence of headache with pressure or pain about the face
• Fever greater than 100.4 degrees
• Symptoms lasting greater than 10 days or any worsening after having first improved
• Thick nasal discharge with or without pus
• Again, a diagnosis cannot be made by appearance alone!
• Nasal congestion or obstruction

Following these generally accepted guidelines will not only ensure that you’re not wasting money on ineffective treatments but they will also help prevent future complications such as antibacterial resistance! If you have any doubts however, please visit with your family doctor or PA and let them give you an opinion. After all, we are here to help! 

---