Fact And Fiction About Colds, Flus, And Antibiotics

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When cold and flu season rolls around there is always a lot of misinformation about when antibiotics are needed, the risks and benefits of flu shots, the differences between a cold and the flu, etc.  

Below are common cold and flu questions and comments doctors often hear from patients – and answers to go with them.

“I don’t get flu shots.  I got one once and it gave me the flu.”  

That's false.

The flu vaccine is made from killed virus. It is physically impossible to get the flu from the flu shot. However, you may feel ill for a few days. This is a general reaction to the vaccine, but not the flu itself. These symptoms are usually mild and last one to three days before resolving without treatment. Also, the flu vaccine does not become effective for about two weeks after receiving it. So it is possible to catch a bad cold or even the flu in the two weeks following your shot Thus, this is still not a result of the vaccine itself.  

“I’ve had a cough and a sore throat for two days.  I need an antibiotic to nip it in the bud before it turns into pneumonia.”  

Research has proven that more than 95 percent of upper respiratory illnesses are due to viruses, which do not respond to antibiotics (antibiotics kill bacteria, not viruses). Trying to “nip” a viral infection by treating it with antibiotics is like trying to prevent your car from running out of gas by refilling the engine oil. It won't work. Inappropriate use of antibiotics can cause problems such as infectious diarrhea or resistance to antibiotics. That is, when antibiotics are used improperly they may lose their effectiveness or may stop working entirely against certain bacteria.

“But, I’m worried that I have bronchitis.”  

Bronchitis is a term that means, literally, inflammation of the airways.  This is most often due to a viral infection and often does not require antibiotics.  Many times, an upper respiratory infection that starts in the sinuses does end up settling in the chest, which causes productive cough and chest congestion.  You can thank gravity for this. Everything gets pulled downward, from the sinuses to the lungs. This is when bronchitis occurs.  However, this does not necessarily require antibiotics.  It does not mean that pneumonia is coming next.  With proper medication to alleviate congestion and help with the cough, even bronchitis will go away on its own.  

“But I’ve always gotten a Z-pack in the past….”

Sometimes, antibiotics, like Z-packs (azithromycin), are warranted.  However, this is often not the case if symptoms have been present for only a few days. And if the illness is caused by a virus.

“I need a refill on the Z-pack.  It usually takes two courses to make my symptoms go away.” 

Antibiotic are designed to work in one course of treatment.  The natural course of most upper respiratory illnesses is that they often resolve in about seven to ten days. Z-pack are designed to be taken in five days, so, by the time you finish two courses, the 10-day course of the illness is over and you probably would have felt better anyway, without the medicine.

“It is so confusing to find the right over-the-counter medication at the pharmacy. How do I know which medication will help with my symptoms?”

Even your health care provider may get confused in the cold/flu aisle at the pharmacy. There are seemingly endless options and it is mind-boggling trying to figure out which ones may help the most – and whether it is worth paying the extra money for name-brand medications (almost never worth it). Below is a very basic guide to the types of OTC medications and other treatments that may help, based on your symptoms:

  • Sinus congestion: Decongestant (such as Sudafed), saline nasal spray, netti-pot
  • Sinus drainage: Antihistamine (like generic Claritin, Allegra, or Zyrtec)
  • Chest congestion: Mucinex, drinking lots of water to keep mucous thin
  • Cough: Robitussin, cough drops, Mucinex, honey (for patients over 1 year old)
  • Sore throat: Ibuprofen, throat lozenges, warm/cold liquids

“I’ve had a runny nose and a cough for a few days.  I’m pretty sure I have the flu.”  

Symptoms like this are much more likely caused by the common cold. Influenza (flu) causes more severe symptoms such as body aches, fever, and exhaustion – and fewer sinus-type symptoms.  Patients with the flu can often pinpoint exactly when symptoms began as opposed to a cold, which comes on more gradually. A swab can be done in the office to determine if you really do have the flu. Treatment can be given if diagnosed within threedays of symptom onset.  Treatment can decrease the duration of symptoms by about a day and make symptoms less severe.  

“I’m so congested.  I’ve been using Afrin every day for the last few weeks but it doesn’t seem to be helping anymore.”  

Avoid over-the-counter nasal sprays, except for saline spray, which is safe to use as often as needed.  Afrin and its generic equivalents provide almost-immediate relief when used.  However, if you use these for more than three to four days, your symptoms will return with a vengeance when you stop.  Instead, try using saline spray, or ask your doctor for a prescription spray such as Flonase or Nasonex, which are much safer to use long-term and will often give you the same relief.

A special note if you haveasthma, emphysema/COPD, or are a heavy smoker: Because your lungs are likely more fragile and more susceptible to infection, it is important for you to be seen by your doctor if you develop cough, fever, or other concerning respiratory symptoms.  Your doctor will likely treat you more aggressively because of your condition.

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