First you suffered through a head cold and now you have a hacking cough that just won’t go away. Your throat feels raw, and your coughing is keeping everyone awake at night.
Your family is yelling at you to “get to the doctor and get some antibiotics,” but you know there is no easy answer for what ails you.

It’s easy to forget from one winter to the next how miserable you can feel after a week or two of sneezing and coughing, and you want something to ease your pain as soon as possible. Studies show that as many as 60 percent of patients suffering from cold, cough or sore throat symptoms go to the doctor and come home with a prescription for antibiotics. The evidence, though not widely known, is clearly to the contrary:

• Colds and most coughs and sore throats are caused by viruses not bacteria.
• Antibiotics are useless against viral infections.
• Using antibiotics when you don’t need them is not only a waste of time and money but can be risky to your own health and that of others.

A Real Problem
Each year, doctors report increasing numbers of infections that are difficult to treat with antibiotics. Last summer, a woman in Michigan developed the first U.S. staph infection resistant to vancomycin–a powerful antibiotic normally given only to hospitalized patients. Fortunately, her infection responded to other types of antibiotics, and the disease did not spread.

Infectious disease experts have long warned about the dangers of antibiotic resistance, and recently their efforts have begun to show some results. A study published in the Journal of the American Medical Association [June 19, 2002] found that antibiotic prescriptions written for children and adolescents in 1999-2000 were 40 percent lower than in 1989-1990. Figures compiled by the National Center for Health Statistics revealed a 27 percent drop in antibiotic prescriptions for all patients in ambulatory care settings from 1992-1999.

Doctors know that antibiotics are useless against viral infections, but there are a number of reasons they might prescribe an antibiotic to a person presenting with a persistent cough, sore throat or nasal congestion.

In a worse case scenario, the lingering illness might develop into a severe bacterial infection such as pneumonia or bacterial meningitis. Pneumonia is difficult to diagnose and can be deadly if not treated early. However, pneumonia is much more likely to occur in a person over age 60 or one with other medical conditions such as congestive heart failure or emphysema. Persistent coughing, in fact, helps protect against pneumonia by getting rid of secretions rather than allowing them to settle in the lower lungs.

A sore throat could be a strep infection, but strep throat usually occurs in the absence of a cough and with symptoms such as fever and enlarged lymph nodes in the neck. To rule out strep throat, many doctors take a throat culture, even though it may take several days for the result to come back.

Even a child with an inner ear infection probably does not require antibiotics unless she has fever, cough and vomiting as well as an ear ache lasting at least three or four days.

Patient Pressure
In the majority of cases, a prescription for antibiotics is written because the patient expects one, and the doctor doesn’t have time to explain fully why one is unwise or unnecessary. Faced with anxious parents who have been awake several nights in a row with a suffering child, a doctor may feel that a prescription is the path of least resistance.

In such a context, antibiotic resistance seems like a distant social issue, and the physician may theorize that the antibiotic will bring some peace of mind and do little harm. Recent studies suggest, to the contrary, that persons who take antibiotics frequently may increase their own risk of encountering an antibiotic-resistant infection.

While patients and perhaps even some doctors believe that antibiotics may hasten recovery, there’s little evidence to support this view. Upper respiratory tract infections can cause distress for surprisingly long periods. In one study, the majority of patients still had symptoms 10 days after seeing a doctor–even if they received a prescription.
In most cases, what the patient really wants is reassurance and help with managing symptoms. In response, some doctors “prescribe” plenty of fluids, cold packs for swelling and a pain reliever such as ibuprofen (Advil, Motrin).

Other strategies used successfully to lower the number of antibiotic prescriptions include 1) giving a brief explanation and an informational leaflet about why antibiotics should not be prescribed and 2) writing a delayed prescription–one that is to be filled several days later but only if the symptoms do not improve.

An ad campaign started recently by the Centers for Disease Control is aimed at educating the public about antibiotics and letting them know why it’s a bad idea to ask for or use antibiotics when they’re not needed.

When a prescription is necessary, it’s important to take all of the medication even after symptoms improve. Those half-full vials of antibiotic in your medicine cabinet are evidence of the role we all play in antibiotic resistance.

Antibiotics are major weapons in the fight against infection; one writer referred to them as a “national treasure.” Development of new antibiotics has slowed over the past 30 years while resistant bacterial strains have multiplied rapidly. Doctors fear that the time may come when a life-threatening infection emerges that is untreatable with the medications available.

By having a little patience with the stuffy nose and cough that are driving you crazy this winter, you are doing your part to ensure that there is help available should you suffer a life-threatening infection at some time in the future.