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The Answer Doc

But Doc, don’t I need an antibiotic?

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Posted: December 5, 2007 10:23 a.m.
Updated: December 20, 2007 5:00 a.m.
    As we enter cold and flu season, primary care offices become inundated with patients with cold. Many of these patients complain of symptoms such as nasal congestion, sore throat, mild cough and low-grade fever. Many of these patients are children. Often they show up in the office after one or two days of symptoms.
    Ninety percent of all the “colds” we see in the office are usually just that, common colds caused by viruses.  The most common symptoms of acute upper respiratory infections caused by viruses include:
    1.  Nasal congestion, sore throat (often caused by excessive swallowing of mucus)
    2.  Cough (mucus trapped in the upper windpipe, not in the lungs)
    3.  Fever (usually low grade, although children can have high fever with a cold)
    4.  Headache/sinus pressure (due to mucus in the sinuses)
    5.  Nausea (especially in children as swallowed mucus is very irritating to stomach)
    There is no effective treatment for the viruses that cause upper respiratory infections, aka the common cold. The human body simply needs time to fight off the infection. Antibiotics do nothing to treat a virus. In the case of the common cold, symptomatic treatment is what helps the most. Controlling symptoms while the body fights off the virus is the best course of action.  As physicians, we have been guilty of over prescribing antibiotics, often when they are not needed. This has created three problems. One, patients think that having a cold means they need an antibiotic. Two, we have created an enormous amount of resistant bacteria, often in children. Three, these resistant bacteria are getting harder and harder to treat and we are running out of good antibiotic choices.
    If you do have a “cold,” before visiting your doctor, you may wish to try the following symptom relief measures for a couple of days and see if you improve. More often than not, you will.
    1. Decongestants. If you don’t have blood pressure problems, decongestants such as pseudoephedrine and phenylephrine do a very good job of drying up nasal congestion.
    2. Cough medication.  There has been a lot in the news lately about cough medication. Any cough medication for children under 6 should be prescribed by a doctor. That being said, current data support that there are no truly good cough suppressants. Dextromethorphan, often known as DM, does seem to have a mild benefit.  Most cough medicines have guafenesin in them. Guafenesin is a mucolytic, meaning it breaks up congestion and helps you get it up more easily.
    3. Pain relievers/Fever reducers. The old adage of letting a fever run its course is garbage. Using ibuprofen (i.e. Advil, Motrin) and acetaminophen (i.e. Tylenol) to control fever and reduce body aches is a good idea.  I often ask my patients to alternate doses of ibuprofen and acetaminophen every four hours for the first several days of a cold, especially in children. Ibuprofen is not only a pain reliever, but is an anti-inflammatory that really helps reduce the inflammation in swollen nasal passages and inflamed throats.
    4. Fluids. Pushing fluids is important. It helps thin out mucus to help you clear it easier and keeps you from getting dehydrated, which can occur when someone has a fever. A great way to keep hydrated is to mix Gatorade/Powerade half and half with water. It forms a solution that is very similar to normal saline, which is what doctors commonly use in IV fluids for people that are dehydrated. Sip from this mixture every 5-10 minutes.
When should I seek a doctor’s care?
    There are definitely reasons to seek a doctor’s care in the first one to two days of “cold” symptoms. If you fit into one of these categories, you should seek care sooner than later:
    1. You have been exposed to the “flu.” Treatment in the first 48 hours significantly improves how fast a patient with the flu gets better.
    2. You have had direct exposure to strep throat.
    3. You have chronic asthma or COPD.
    4. You have a compromised immune system from medications such as steroids, cancer treatment, organ transplant or have HIV/AIDS.
    5. You were recently sick, seemed to get better, but then the symptoms returned.
    6. You have had cold symptoms for longer than a week and you don’t seem to be getting any better.
    A cold can make you or your child feel rotten. Treating the symptoms will make you feel better. Time, not antibiotics, is what is most often needed to make it go away.
      Dr. Christopher Munger’s column appears every other Sunday. Dr. Munger is board-certified in family practice. He is a member of the Family Health Care Center in Statesboro and admits patients to East Georgia Regional Medical Center. He is originally from California. He received his bachelors’ degree from UCLA, his medical degree from Columbia University in New York City and completed his training in family practice at the University of Virginia. He lives in Statesboro with his wife and two dogs.
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