Top 5 common infections that usually do not need antibiotics

In observance of the Centers for Disease Control and Prevention's "Get Smart about Antibiotics" week, Le Bonheur Chief of Infectious Disease Sandra Arnold, MD, shares some important information regarding the importance of appropriate antibiotic prescription and use.

Even though it’s still warm outside, cold and flu season has already begun. Most of the illnesses that make us sick this time of year are caused by viruses. Infections caused by viruses will not get better with antibiotics because antibiotics only work for bacteria. It’s very important that we only use antibiotics when we really need them because overuse of antibiotics can lead to antibiotic resistant bacteria in your body, in our community and in our hospitals.

Here are the top 5 common infections that usually do not need antibiotics.

1. Common cold – the common cold is caused by different viruses depending on the time of year. Symptoms of the common cold include low-grade fever, runny nose and congestion, cough and sore throat. There are no antiviral medicines to treat these viruses. Colds can take a long time to go away and can yield yellow or green discharge from the nose. This does not mean that you have a bacterial sinus infection that needs antibiotics. Most colds will be improving or be substantially better within 7 to 10 days. If you are not getting better after 10 days or you have a fever that will not go away with bad pain over your sinuses, you may have a bacterial sinus infection, for which it is reasonable to take antibiotics. Congestion and runny nose that turns green but then goes back to yellow or clear and is getting better after 10 days is a cold, not a sinus infection, and you do not need antibiotics.
2. The flu – the flu is caused by influenza virus, which only circulates in the winter. It causes symptoms of a cold but has higher fever and also muscle aches and pains that can be pretty unpleasant. There is a vaccine to prevent the flu and there are antiviral medicines that work against the flu. These work best if taken soon after the symptoms start. Antibiotics do not help the flu unless you get an ear infection or pneumonia as a complication of the flu.
3. Bronchiolitis or bronchitis – these are viral infections where the infection is lower down in the respiratory tract than in the common cold and the flu. The same viruses which cause colds can cause bronchiolitis (which only occurs in young children under the age of 2) or bronchitis. These infections may be associated with more severe cough and people with these often have wheezing or other abnormal sounds when the doctor listens with a stethoscope. Even though there may be infection lower down in the respiratory tract, antibiotics will not help you feel better faster as antibiotics do not work for viruses. Again, if your illness is caused by the flu (you have fever and body aches with your cough, runny nose and sore throat), you might get better faster if you take an antiviral medicine for the flu.
4. Ear infection (otitis media) – ear infections are frequently caused by bacteria but many are caused by viruses. Ear infections often occur in young children as a complication of a viral respiratory infection. A doctor cannot always know which ear infections are caused by viruses and which by bacteria just by looking in the ear. For milder infections, it is reasonable to wait and see if the infection gets better on its own. If not improving in 48 hours or the infection is severe, antibiotics should be used to help it get better more quickly.
5. Sore throat – most sore throats are caused by the viruses that cause colds and the flu. Strep throat (a bacterial throat infection cause by the bacteria Group A Streptococcus) is a bacterial infection of the throat associated with fever, sore throat, swollen glands in the neck and sometimes stomach pain and vomiting. Strep throat does not cause runny nose, congestion or cough. If you have cough and runny nose with your sore throat, you should not be tested or treated for strep throat. You should only be treated for strep throat if your doctor does a throat swab and it tests positive for strep. Strep throat will get better faster with antibiotics but antibiotics are not required for you to get better.

Remember, antibiotics are very useful medications when you really need them; however, they are medicines just like blood pressure or cholesterol medications and can have side effects including diarrhea, rash, yeast infections or allergic reactions. When an antibiotic is necessary, these risks are acceptable as the benefit outweighs the potential harm. In viral respiratory infections, the harms outweigh the benefits as antibiotics do not speed recovery or prevent serious complications. Because everyone carries bacteria that can cause disease as a part their normal healthy bacteria, when you take antibiotics, all these bacteria are exposed to the antibiotic and this can lead to antibiotic resistance in these bacteria. We all share our bacteria with each other, especially children, and this can lead to the spread of antibiotic resistant bacteria in our communities. We must always balance the benefits of antibiotics (when they are necessary) against the harms they cause and should not use them unless they are really needed.