It’s a Virus

Ahhh…cold and flu season is officially upon us and I can attest that I think it is going to be a particularly rough season this year. Personally, I am now just getting back to my normal after my viral respiratory infection spiraled into a full on sinus infection after about 3 weeks of illness. The key here is I waited 3 weeks before finally admitting that I needed an antibiotic. As a provider, I am often faced with those patients who have a day or 2 of cough and sniffles and they think they automatically need an antibiotic, specifically the almighty Zpack. This has to be one of the hardest things new providers face is telling patients, “No, you do not need an antibiotic for your viral infection,” because many times patients have been led to believe that the antibiotic is the cureall. As providers, we need to work on educating the public as to what requires an antibiotic and what does not. Ironically, when I initially started this post late last week, I did not realize this week was National Antibiotic Stewardship Week.  What better time to discuss the difference between viral and bacterial infections and when antibiotics are needed than the week dedicated to properly utilizing antibiotics?

Viral respiratory infections are so tricky because there are so many viruses out there that can cause infections and very limited treatments other than supportive care. This causes frustration for patients as everyone wants an immediate fix and no one wants to hear that they may be sick for 10-14 days because honestly, we all live terribly busy lives. Symptoms of a viral upper respiratory tract infection are rather nonspecific and often do feel like symptoms that may be seen in other infections. These symptoms can include sore throat, headache, cough, congestion, low grade fever, and general malaise. Some of these symptoms persist, but they gradually improve. Acetaminophen or ibuprofen are helpful in managing the headaches, low grade fevers, and body aches associated with the illness and antihistamines and decongestants are good for relieving nasal congestion and sneezing. Most adults will have between 2-4 colds every year and very few turn bacterial. 

Things to look for with persistent respiratory infections are new and worsening symptoms. Patients who present with a few weeks of cold symptoms with new onset high fever and persistent facial pain may be presenting with bacterial sinusitis. This only affects about 2% of all incidents of rhinosinusitis, however if watchful waiting with supportive care has not caused symptoms to improve or if new symptoms develop, treating with an antibiotic is the likely next step. Other symptoms such as difficulty breathing and wheezing may point towards lower respiratory infections, bronchitis vs pneumonia. The key to remember is that bronchitis is not routinely treated with an antibiotic whereas pneumonia is. This can cause frustration for patients because many providers still treat bronchitis with antibiotics despite the fact that the majority of bronchitis is viral, so this is where we are finding those patients who insist that every little cough and chest congestion needs a Zpack. I experienced one such frustrated patient last week who was a middle aged man with 2 days of congestion and cough. The patient had no fever, sore throat, or other symptoms. On interviewing him, he told me “I get this once a year and I get a Zpack and then I am fine.” Upon exam, his lungs were clear, he had mild nasal congestion and post nasal drip and I explained to him that his symptoms were viral and that a Zpack would not help his symptoms. He was unhappy, and likely didn’t believe me seeing as he’s “always been treated with a Zpack”, however I explained to him supportive care and why we don’t utilize antibiotics for colds and I’d like to believe he understood my rationale. That, or he went to another provider who would give him what he wanted. I really hope that is not the case, but unfortunately it wouldn’t surprise me.

As providers, we really do need to be good antibiotic stewards so that antibiotics can work to fight the bacteria they need to fight and not just throw antibiotics at every little sniffle or sore throat. The more providers who practice this way, the less patients we have coming in for unnecessary antibiotics in the future.

xoxo, Tara