Should I Ask My Doctor for An Antibiotic for an Upper Respiratory Illness?


Should I Ask My Doctor for An Antibiotic for an Upper Respiratory Illness? 
Healthy Living - October 14, 2014
Joan Pellegrini, MD

The vast majority of upper respiratory illnesses are “colds” which are viral infections that are self-limiting. Antibiotics do not treat viral infections. However, doctors still sometimes prescribe antibiotics for upper respiratory viral infections. There are several reasons for this.
One: it can sometimes be difficult to tell the difference between a viral infection and a bacterial infection. A clinician will ask several questions about how the patient feels and then may add on some lab work or x-rays in order to differentiate between a viral and a bacterial infection. If there is still uncertainty and the patient has been ill for longer than expected, a clinician may try an antibiotic to see if it helps (if it does, then it was a bacterial infection).

Second: sometimes a viral infection can cause enough immune weakening that a secondary bacterial infection then occurs. In that case an antibiotic will help.
Third: a patient may request an antibiotic and the clinician is too busy to argue.

This last point is important. A recent JAMA (1) article was a study of healthcare professionals and their tendency to prescribe antibiotics increased as the day went on. The theory is that they had the time and energy in the morning to have a detailed discussion with the patient about why an antibiotic was not needed but then had less time/energy as the day progressed. Doctors know that patients rarely get upset if an antibiotic is prescribed but they sometimes do get upset when one is not given. The problem is that antibiotics can cause problems such as rashes, diarrhea, resistance, nausea, etc. Therefore, it is best if the patient does not go to the doctor to get antibiotics but rather go to the doctor to see if anything else needs to be done. I would offer this same advice for sinusitis, ear infections, and “flu” symptoms. The best thing a patient can do is be very detailed about the symptoms and timing and other questions that the doctor will ask. 

1) Linder, et al. JAMA Internal Medicine published online October 6, 2014.