When you have a “cold” or upper respiratory infection (URI), you are going to feel under the weather, of course. You may have a sore or irritated throat, cough, congestion in the sinuses, runny or stuffy nose, easy fatigue, and sometimes even a fever. However, most URIs are caused by a virus, and after 5-7 days, the symptoms are usually significantly improved.
Unfortunately, most of us are very impatient, and after 2-3 days of symptoms, too many of us go to the doctor specifically to get a prescription for an antibiotic. Because antibiotics are specifically meant to kill bacteria, they have absolutely no effect on viruses. When people start improving after taking an antibiotic, they assume that it is the effect of the antibiotic. However, by the time they start taking the antibiotic, from about day 2-4 of illness, the viral infection is just starting to get better.
Interestingly, the antibiotic azithromycin (Zpak), is one of the mostly commonly prescribed antibiotics for URIs. It so happens that this antibiotic has an anti-inflammatory effect, in addition to it’s antibacterial quality. Therefore, it reduces inflammation related to an infection, and symptoms improve as a result, independent of the antibacterial activity. This anti-inflammatory effect misleads the patient to believe that the antibiotic has sped up the resolution of their illness. A pure anti-inflammatory drug such as Aleve may have done the same thing, without killing good bacteria in the body, like the antibiotic does.
There are times when URIs are a bit more sinister. Occasionally, the cause of the infection is bacterial to begin with. More commonly however, the infection started out viral, but then after several days, there is superimposed bacterial infection. This is because the inflamed tissues from the viral infection, are more susceptible to bacterial invasion and infection.
Below are 6 clues that bacteria may be causing your URI and you may need antibiotics:
1 – Symptoms are starting to get worst after 7 days of being ill, PLUS there is thick, cloudy mucous coming from the nostril(s).
2 – You are still ill after 10 days (not worst, but there have been no signs of improvement), PLUS there is thick cloudy mucous from the nostril(s).
3 – It is painful to swallow PLUS there is fever >100.4‘F PLUS there are tender nodes/glands in the neck. This usually indicates a bacterial pharyngitis (such as “strep throat”). Usually there is no cough in this situation.
4 – There is facial pain and/or redness, especially if it is on one side. This may indicate bacterial infection of one of the sinuses (cheek pain from maxillary sinusitis, or forehead pain from frontal sinusitis).
5 – Swelling of any part of the face may indicate serious infection of deep structures. For example swelling around the eye suggests spread of bacterial infection from the sinus to the tissues around the eye socket. Swelling at the jaw may be a sign of spread of bacterial infection from the throat or tonsils, to the deeper tissues, extending to the neck.
6 – Confusion may indicate that a person is seriously ill, probably septic from severe infection. Alternatively, confusion may arise if someone had a sinus infection that spread to the brain. This is a serious complication requiring urgent medical attention.
Most healthy persons will experience no problems with a viral URI. The elderly, and people known to have a weakened immune system should be more vigilant when it comes to managing a URI. When in doubt, you should always contact your primary health care provider, who will be able to evaluate your individual risk and treat accordingly.
What do you think? Do you tend to get anxious after being ill for only 2-3 days? Do you frequently take antibiotics for URIs? Please comment below!