Saturday, October 18, 2008

Please Stop Asking Me For Antibiotics For A Cold!

It is the start of the flu season and we have had a large number of patients coming in the a sore throat, sinus pressure, hacking cough, and stuffy ears. This is usually a cold or allergy flare. IT DOES NOT REQUIRE AN ANTIBIOTIC FOLKS. I try so hard not to give antibiotics for upper respiratory symptoms, but most patients get upset when they pay for your evaluation and don’t walk out with an RX.

Most patients come in the very first day of symptoms. I cannot tell whether it is bacterial or viral ESPECIALLY this early in the game. Most say that they have not had a fever (which doesn’t mean it’s a bacterial as well) and don’t appear to be toxic feeling. I know it sucks that have a stuffy nose, scratchy throat, stuffy ears and a cough. This shall pass if you just hang in there. Most virals wrap up in 7–10 days though some still leave a residual cough from reactive airway response.

Most say “I’m going somewhere and I don’t want this to get out of hand”, or it’s Friday and I know you are closed for the weekend and I don’t want to not be able to feel better, and such.

I live in a hotbed of allergy triggers with almost no airflow. We are surrounded by oaks, pines, hay fields, and ragweed. 90% of you are allergic to these things. Do I tell you to take your allergy meds on a DAILY basis and you do not? YES. Do you take your nasal sprays? Most do not. If you don’t block these triggers, they will start the symptoms that MAY develop into bacterial infections if left too long.

Symptoms that do not require antibiotics:

Fever (low grade < 102.5)

Dry or “rattling if not productive” cough

Stuffy or runny nose (even if it’s green)

Ear pressure or muffling or facial pressure

Headache that is relieved with OTC Tylenol or Motrin

Symptoms that do require antibotics:

High fever (>102) on a consistent basis (more than one day)

Productive cough with shortness of breath or extreme chest pain

Facial pain on palpation that is intense (means that you almost jump back when touched)

Ear pain with bulging, red tympanics or exudate

Sore throat that is so bad that you cannot swallow regular foods or swollen with white pustules (you need to be tested for Strep)

Plan of action will be to test for the flu in the season if you are appearing appropriately ill. Strep testing as needed for sore throat. Otherwise, watch, wait, take the over the counter meds for comfort, drink lots of fluids and get plenty of rest. Take your allergy meds as prescribed. I will call in an antibiotic if these symptoms don’t resolve in 10 days or you get worse enough to miss school or work and can’t get out of bed.

I have written a post over at one of my other sites regarding how I treat MRSA infections. It is a monetized post so if you would like you can read it here.


  1. Amen! And it is the same story in peds...

  2. I know that moms and dads hate when their children are sick but I hate it worse when they become resistant to antibiotics.

  3. Absolutely! But good luck convincing them that this is a risk, even with MRSA running rampant...

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