Posts Tagged ‘antibiotics’


Acute bronchitis is an infection causing inflammation of the lung’s airways and is one of the most common of human ailments.

It usually begins with head cold symptoms such as a runny nose, sinus congestion, or a sore throat. It is almost always caused by a virus and rarely by bacteria. If a cough is not due to pneumonia, influenza, or asthma, it is most likely what we call bronchitis.

Most people actually feel fairly well with bronchitis, except for having a persistent, nagging cough. Fever is rare and mucus production may or may not be present.

A very common misperception is that colored mucus — especially green — indicates a bacterial infection and therefore the need for antibiotics. Recent scientific evidence supports that virus infections also produce green mucus.

Those who smoke are much more susceptible to bronchitis because of the damage done by the smoke to the lining of the breathing tubes of the lungs. This allows germs to enter the lungs more easily, causing an infection.

Many patients request antibiotics in hopes of quickly ridding themselves of the cough and therefore visit their doctor as soon as symptoms begin so that they may “nip it in the bud.”

Some think that antibiotics helped them on previous occasions, but there is no proven benefit for these drugs in the treatment of bronchitis.

Inappropriate antibiotic use can cause unnecessary side effects — diarrhea and yeast infections to mention a few — increase the cost of medical care, and lead to the development of resistant germs.

This means that many of our commonly used antibiotics are no longer effective against many germs and there are very few new and extremely expensive antibiotics being developed. That’s a scary situation.

Treatment for bronchitis is directed towards relieving the symptoms. For the head cold symptoms that come with bronchitis, an oral decongestant pill such as Sudafed (pseudoephedrine) as well as a decongestant nasal spray, such as Afrin (oxymetazoline hydrochloride), can be used to combat nasal and sinus congestion.

Afrin spray works well to open up clogged nasal passages but should not be used for more than one week to avoid rebound (worsening) congestion. Tylenol (acetaminophen) or Advil (ibuprofen) can be used for the relief of aches and pains. Drinking plenty of liquids has proven to loosen mucus.

For cough symptoms, over-the-counter cough medicines with dextromethorphan, such as Robitussin DM or Vicks 44 may be helpful.

A recent study has recommended the use of a natural cough remedy using a mixture of 5 parts honey and one part instant coffee crystals. Take one tablespoon of the mixture in about 6 ounces of water every 6 hours for cough.

Also, for a cough that makes the lungs feel tight or wheezy, a doctor may prescribe a brief course of an inhaled medication commonly used for asthmatics.

In summary, most coughs that we call bronchitis can last at least 3 weeks, are almost always caused by a virus, and antibiotic treatment is not helpful. However, if at any time you have a cough with a fever, you should see your doctor.

Read Full Post »

In a recent column, I said that antibiotics are usually not necessary to treat most upper-respiratory infections. I have been asked to discuss antibiotics in more detail.

An antibiotic is a type of medication that kills bacteria, or at least inhibits growth, thus curing an infectious disease.

The first antibiotic to be discovered was penicillin, which was produced from a common mold and was discovered accidentally by Alexander Fleming in 1928. It wasn’t used to treat disease until 1941, but it became extremely helpful when it was found to cure the myriad infections of the soldiers in World War II.

Today, there are more than 100 different antibiotics on the market, treating bacterial infections ranging from the minor, such as strep throat, to the life-threatening, such as meningitis.

As of yet, we have very few antibiotics that can treat viral infections. There are none to treat the common cold and only a few that can help treat influenza. However, bacterial infections — the cause of such common diseases as strep throat, bladder infections, skin infections and many ear infections, for example — can be cured by the use of antibiotics.

If an antibiotic is used, your physician will choose the one most likely to be effective against the type of germ causing your infection. Other factors in the choice of an antibiotic include medication cost, dosing schedule and potential side effects.

Antibiotics have been over-prescribed for a number of reasons, including patients’ expectations or insistence on use of antibiotics; physicians prescribing them because they don’t have the time or willingness to explain why they are not necessary; and medical legal reasons.

The consequences of over-prescribing antibiotics are twofold.

First is the possibility of a bad reaction to the antibiotic. This might span from minor conditions — a bothersome rash, diarrhea or a yeast infection — to a life-threatening allergic reaction called anaphylactic shock.

The bigger problem, as I see it, is the emergence of resistant germs. This happens when the overuse of antibiotics allows the development of germs that are no longer killed by most of the common antibiotics.

As opposed to the post-World War II decades, when drug companies were pumping out new antibiotics faster than germs could become resistant, we are now in a situation in which, for various reasons, drug companies are not putting in the resources to develop new antibiotics. This will become a serious crisis when we reach a time when many infections will not be treatable with existing antibiotics.

As I have emphasized previously, when seeing your physician for an illness, it is best not to have expectations of being treated with antibiotics. Rather, let your physician decide whether antibiotics are needed, and expect an explanation from him or her as to the reasoning behind that decision. You should also be given suggestions as to what you can do to make yourself feel better during the course of your illness.

Read Full Post »

There are many misperceptions about the appropriate use of antibiotics for the treatment of upper-respiratory infections.

As we come to the end of another year and find ourselves in the midst of the cold and flu season, I want to talk about the diagnosis and treatment of the common upper-respiratory infections. These infections include sinus infections (sinusitis), sore throats (pharyngitis), ear infections (otitis) and coughs (bronchitis).

These are the most common illnesses seen in my practice in urgent care, as well as in most acute-care practices. We physicians are constantly receiving information from current medical literature indicating that almost all of these infections are caused by viruses, which are completely unaffected by the use of antibiotics. These viral infections will usually improve with time. The big question here is how much time.

At what point does the simple viral infection become a secondary bacterial infection that can be cured with an antibiotic? That is the critical issue, and one that I’m sorry to say is difficult to determine.

We physicians have various means to confidently diagnosis such problems as appendicitis, heart attacks, ulcer disease, diabetes and others. But we have no easy, fast, or accurate method of determining at what point in time the upper-respiratory infection changes from a viral infection to a bacterial infection.

I want to say emphatically that antibiotics will not shorten the duration of an upper-respiratory infection.

Why not just give an antibiotic and hope for the best?

Simply put, antibiotics can cause problems from annoying to life-threatening allergic reactions, diarrhea and yeast infections. Just recently, overuse of antibiotics has been linked to obesity by Dr. Martin Blaser, a professor of microbiology at New York University Langone Medical Center. Antibiotics are also very costly and drive up the cost of health care when prescribed needlessly.

The most important issue is that the inappropriate use of antibiotics causes the development of “super germs” that resist treatment by almost all antibiotics. Unfortunately, unlike in past years, very few new antibiotics are being developed. The situation worries me.

What I would ask of patients with symptoms of the abovementioned respiratory illnesses is to give as much time as possible for the illness to run its course. If you have a fever or increasing pain, if you feel so sick that you can’t perform your usual routine or if you develop any other symptom that worries you, an immediate trip to your physician is justified.

Once you decide to see your doctor, you should expect the doctor to listen to your explanation of symptoms, examine you, give you a diagnosis and offer an estimate as to when you should feel better. Then let him or her advise you of the proper treatment to help you feel better.

When it comes to the common upper-respiratory infection, let us do for you what will ultimately help you, in the safest and best way, feel better.

Read Full Post »

Pneumonia is a potentially serious infection of the lungs, usually caused by viruses or bacteria.

As opposed to bronchitis, which is a relatively nonserious infection of the lungs’ airways, pneumonia infects the tissue of the lungs, filling the tiny air sacs with pus and other liquid. This reduces the amount of oxygen reaching the bloodstream.

Germs have the potential of spreading from the infected lung tissue into the rest of the body, causing septic shock and possibly death. Although this is not the common outcome, it still accounts for 60,000 Americans dying of pneumonia every year.

Pneumonia symptoms can vary significantly, depending on underlying health problems and the type of organism causing the infection.

More than half of pneumonias are caused by a variety of viruses. These are usually not serious and often last a relatively short time. Because a person with viral pneumonia tends not to be as sick as someone with bacterial pneumonia, such a person is usually “up and about” and therefore is often referred to as having “walking pneumonia.”

Symptoms of viral pneumonia include cough, fever, muscle pain and fatigue. Signs which often occur with bacterial pneumonia include shaking chills, high fever, chest pain and cough. Mucus may be present with either type of pneumonia but is more likely with the bacterial variety.

Pneumonia is not usually contagious.

One of the most common symptoms I see in patients with any form of pneumonia is the extreme fatigue, which can last many weeks after all other symptoms have cleared.

Risk factors for pneumonia are as follows:

  • Age — Adults 65 and older and very young children
  • Chronic disease, such as emphysema, diabetes and heart disease
  • Smoking
  • Recent hospitalization,  surgery or traumatic injury

Pneumonia treatments vary on the type and severity of the illness. Bacterial pneumonia will be treated with antibiotics. The entire course of antibiotics must be taken to prevent relapse and to prevent resistant strains of bacteria from forming. Viral pneumonia technically doesn’t need antibiotics, but because of the difficulty of distinguishing between the two, a health care provider will usually choose to err on the side of treatment, especially because viral pneumonia can sometimes turn into a bacterial infection.

In all cases of pneumonia, one also needs to control fever, drink lots of liquids and get plenty of rest.

Prevention of pneumonia is possible. Because pneumonia is a common complication of influenza, getting a flu shot every year is a good idea.

There is a false assumption held by many that getting a pneumonia shot will prevent one from getting any type of pneumonia. Not so. A pneumonia vaccine is available, but it is only effective for the pneumococcal pneumonia germ. It might not prevent one from getting this form of pneumonia, but having the vaccine can decrease the infection’s potentially fatal side effects. The vaccine is usually recommended for those who fall into the previously mentioned “risk factor” categories and can be administered any time after 2 years of age or at least once to anyone after age 65.

It’s a good idea to seek medical care if a person has a cough with shortness of breath, chest pain, chills and fever or feels much worse after a bout of cold or flu. Pneumonia is a serious infection, but for the average person, if it’s caught in time and treated properly, it should cause no lasting harm.

Read Full Post »

Over-the-counter cough and cold medications to alleviate cold symptoms in young children are being withdrawn from pharmacy shelves. This is because of unintentional misuse or of overdose of these medications, causing harm and, rarely, death, especially in children younger than 2.

These medications are frequently used in good faith, even though there is no scientific proof that these drugs are actually effective. This is a case where the risks outweigh the benefits.

Health care providers are now asked to advise not using these drugs for children younger than 6. Some of the most commonly used drugs in this category are PediaCare, Triaminic and Dimetapp.

I know this may sound discouraging when caring for a sick child, but there are very useful non-drug treatments for cold and cough symptoms:

  • Encourage the child to drink plenty of fluids to prevent dehydration and to help thin out mucus. Contrary to popular opinion, milk has not been proven to increase mucus. The fat in milk does combine with saliva in the mouth, causing a slimy sensation, but that’s not harmful.
  • Fever or pain can be controlled using either acetaminophen (Tylenol) or ibuprofen (Advil), giving accurate and consistent doses every six hours.
  • Saline irrigations: For infants, use rubber bulb suction with saline nose drops to remove mucus. A saline nose spray can be used for older children.
  • Use a cool-mist humidifier or vaporizer in the child’s room. To prevent contamination, the water should be replaced daily and the machine cleansed regularly according to the manufacturer’s recommendations. Keep indoor relative humidity at about 40 percent to 50 percent
  • If a medication such as Tylenol or Advil is given, I do not advise the use of household silverware spoons to measure doses of medication. Common teaspoons can vary, holding anywhere from 2 to 10 milliliters (mLs) of liquid, which could cause either an under- or overdose of a medication. Proper measuring devices using units of milliliters usually come with the medicine or can be obtained from the pharmacist.
  • Honey can relieve coughs by increasing saliva, which coats the throat and relieves irritation. Suggested doses are half a teaspoon for children between 1 and 5 years, 1 teaspoon for children 6 to 11 years, and 2 teaspoons for children 12 years and older. Do not give honey to a child younger than 1 year old.

See your health care provider immediately for any of the following cases:

  • A child younger than 2 months of age with any fever
  • A child younger than 2 years with a fever that lasts longer than two or three days
  • A child who complains of an earache or a severe sore throat
  • A child who has thick green nasal discharge for more than 2 weeks
  • Mild symptoms that fail to improve after 10 to 14 days
  • Any child who seems very ill to you

By the way, for children who have been appropriately prescribed antibiotics, I am frequently asked whether the drug needs to be refrigerated. The two most commonly prescribed antibiotics, Amoxicillin (which tastes like bubblegum or occasionally is fruit-flavored) and Zithromax (which has a cherry-vanilla-banana taste), can be kept at room temperature for as long as 10 days. Refrigeration may improve the taste, but it isn’t needed to maintain potency.

Read Full Post »