Dr. Patricia Yarberry Allen is a collaborative physician. Her patients, she believes, will be her best partners in providing diagnostic information—as long as they are asked the right questions. She also believes in consulting with the best medical minds on issues that require specialization or unique clinical experience. As we head into the winter months, Dr. Pat consults with Dr. Jason Kendler, internist and infectious disease expert for Women’s Voices for Change, for answers to questions about upper respiratory infections, which are extremely common during this season.
Dear Dr. Pat:
I am 65 and in very good health. I haven’t had a cold or any illness for years. Suddenly everyone around me has had this throat/sinus/nasal infection, and many of these people then developed lung symptoms—not pain or fever, just constant coughing with green mucus production. Everyone took antibiotics. I don’t like drugs in general, and I feel strongly that antibiotics are just overprescribed. I now have the throat-on-fire symptoms along with constant runny nose, post-nasal drip, and tenderness over the sinus cavities. I don’t have any fever, chills, headache, or muscle symptoms that I had years ago when I had the flu. It is one week now and I don’t have the lung symptoms. Does someone with my history need to take an antibiotic? Should I wait to see if I get lucky and don’t get the lung symptoms? If I get the coughing with green mucus, should I take the antibiotics? I know you can’t diagnose me personally, but I would appreciate any general guidance you can give to lots of us who don’t know what to do about antibiotic use.
Your symptoms are so very common these days as fall moves into winter weather and people are traveling more for the holidays in virus-infected planes and are in stores with masses of people using poor cough and sneeze techniques. The simple remedies that I suggest for patients with your present symptoms are rest, hydration, chicken soup (no joke), and symptom management with an over-the-counter cold/sinus/throat pain remedy. Avoid alcohol. Stay away from other people, since you can spread the virus that has caused your symptoms to others by coughing and sneezing. Use proper cough and sneeze technique at all times. Avoid touching anyone unnecessarily and wash your hands frequently, since the respiratory virus does land on the hands when you use those tissues constantly.
I have asked the internist and infectious disease expert for Women’s Voices for Change, Dr. Jason Kendler, to answer your questions.
Dr. Jason Kendler, internist and infectious disease expert for Women’s Voices for Change, Responds:
Your excellent question brings up a number of important issues regarding the diagnosis and management of upper respiratory infections, which are extremely common, particularly during the winter months. In fact, about 30 million people suffer from sinus infection alone in this country each year. The overwhelming majority of these infections are caused by the respiratory viruses that cause the common cold. As such, 75 percent of these infections will resolve within one month without any treatment; most patients will get better in 7 to 10 days without antibiotics. Despite the fact that these infections generally get better without treatment, as many as 90 percent of patients with symptoms who contact a doctor will receive a prescription for an antibiotic.
Sarah, your hesitation to take antibiotics is appropriate, since using antibiotics that are not necessary can cause needless side effects and can contribute to antibiotic resistance in the community. On the other hand, up to 2 percent of patients with viral sinusitis will go on to develop bacterial sinusitis and would therefore benefit from treatment with antibiotics. It is the challenge of the physician to determine which patients need antibiotics (for bacterial infection) and which do not (for viral infection).
In general, for someone healthy like you who has been sick for a week or longer, a doctor will appropriately prescribe an antibiotic if there is fever, thick nasal discharge, tooth pain, facial pain, soreness to touch of the sinuses, or worsening symptoms. A sore throat could be caused by a viral infection, but a streptococcal infection (“strep throat”) would certainly warrant antibiotic treatment.
My advice to all patients who seem to be getting worse after a week would be to see a health practitioner who will take a thorough history and perform a careful physical examination to help distinguish viral from bacterial throat/sinus/lung infections. Regardless of the cause, a combination of rest, increased fluid intake, and over-the-counter medicines such as acetaminophen or ibuprofen can also be helpful. Antibiotics are not always the answer!
Jason S. Kendler, M.D.
Jason S. Kendler, M.D., is a Clinical Associate Professor of Medicine at the Weill Medical College of Cornell University. He is a graduate of Yale University and the University of Pennsylvania School of Medicine. He completed his postgraduate training at the New York Presbyterian Hospital–Weill Cornell Medical Center, where he served as Chief Medical Resident, including a Fellowship in Infectious Disease. Dr. Kendler is now Course Director for Medicine, Patients and Society 2, a course for second-year medical students at the Weill Cornell Medical College. He maintains an active practice in Internal Medicine in Manhattan and has a special interest in travel medicine.