Antibiotic Use in Upper Respiratory Infections

Rosalind Kaplan, MD, FACP

Health care providers in the United States are working to correct a long-standing problem in caring for patients with respiratory infections, including ear infections, sinus infections, sore throats, bronchitis, and ‘the common cold.’ It is apparent that, for years, antibiotics have been frequently prescribed for these ailments, and more frequently than not, they are unnecessary. Patients now suffer the consequences of over-prescribed antibiotics as antibiotic-resistant bacteria and antibiotic side-effects, including allergic reactions and gastrointestinal problems, have become serious public health issues.

The majority of upper respiratory symptoms are caused by viral illnesses, which, as most people are aware, are most common during the winter months. Viruses are not susceptible to antibiotic treatment and most upper respiratory infections do not require antibiotics, as they will resolve themselves over time. The discomfort associated with such viral infections can be managed with symptomatic treatment, such as fever-reducers, anti-inflammatory medication, over-the-counter cough medications, fluids, and rest.

For patients with influenza, which is also a virus, there are anti-viral medications that can decrease the length of symptoms and lessen the severity if started in the first two days of the illness. This is the exception to the rule for viral illness. In addition, vaccination for influenza, while not perfect, is safe and effective, and is the best way to prevent the flu.

The best way to prevent other viral illnesses is through frequent, thorough hand washing, and covering the mouth and nose when coughing and sneezing.

The Centers for Disease Control has excellent information on treatment of upper respiratory infections. The following list corrects common misconceptions, as it summarizes cases in which antibiotics are necessary and when they are not.

Middle Ear Infection (Otitis Media) – May require antibiotics depending on severity and the age and health of the patient.

Sinus Infection (Sinusitis) – May require antibiotics, depending on severity and length of time the patient has had symptoms.

Sore throat (Pharyngitis) – Requires antibiotics only if the cause is Streptococcus A (strep throat), which can be determined by rapid antibody testing or throat culture. Antibiotic treatment for strep throat prevents sequelae, such as rheumatic fever, but does not significantly shorten symptoms, and can take up to 9 days to take effect after onset.

Bronchitis (cough and irritation) – Rarely requires antibiotics except in patients with airway obstruction or signs of severe underlying disease like pneumonia found in exam and/or x-ray.

The ‘Common Cold’ – Does not require antibiotic treatment. Most upper respiratory infections with multiple symptoms, such as nasal congestion, cough, and sore throat, especially if there is no fever, are in this category.

To maintain proper antibiotic use, healthcare providers should reserve prescriptions for patients who are likely to have bacterial illnesses, rather than for those with self-limiting viral illnesses. This will reduce bacterial resistance to antibiotics and eliminate many potential side effects, especially allergic reactions, stomach upset, and diarrhea.

Education on topics like proper antibiotic use is essential to patient safety!

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