By Katie E. Golden, MD


It’s almost fall, which promises the glorious return of cooler temperatures, football season, and children in school. This also means the return of cold and flu season, and there is nothing like a sore throat and stuffy nose to spoil the enjoyment of your pumpkin-spice latte. 


We will certainly see an increase in the number of patients presenting with respiratory infections in the colder months when people are more likely to crowd indoors and sneeze or cough on one another. Patients often come to us with the hope for a quick solution to their symptoms with an antibiotic, and we never enjoy having to disappoint them with a simple prescription of time instead. I thus wanted to take some time to explain why, in the majority of respiratory symptoms and infections, antibiotics are not indicated, and even harmful.


The symptoms of an upper respiratory infection (URI), or ‘the common cold’, can vary from patient to patient, and also depend on the specific virus causing the infection (of which there are many). They often include some combination of sinus or nasal congestion, sore throat, and cough. Patients also can experience symptoms that typically accompany any type of infection including fever, headache, nausea or loss of appetite, fatigue, and generalized body aches. 


The most important fact about URIs is that they are most often caused by viruses, not bacteria. Viruses and bacteria are fundamentally distinct organisms, and therefore the treatment is very different. Bacteria are living organisms, capable of complicated metabolic and survival mechanisms, and often cause more serious infections. Viruses, in contrast, are not considered living and are better understood as proteins that are reliant on a living host to thrive and replicate. While bacteria often require antibiotics for treatment, viral illnesses typically resolve on their own (and there are only a few specific viral infections for which we even have prescription medications). For this reason, identifying the source of infectious symptoms is crucial to recommending the appropriate treatment.


Healthy individuals who develop typical cold-like symptoms are almost invariably infected by a virus. This means that antibiotics will not alter the course of their illness, and instead will only invite all the unwanted side effects and potential complications that come with antibiotic medications. After decades of unnecessary over-prescription of antibiotics, we now have a solid understanding of the negative impact of these drugs. First, along with killing potentially harmful bacteria, antibiotics also kill all the friendly, supportive bacteria that live in our intestine and help us stay healthy. This can translate to significant gastrointestinal symptoms (nausea and loss of appetite, food intolerances, acid reflux, vomiting, abdominal pain, painful bloating and indigestion, constipation or diarrhea). This augmentation of our natural intestinal microbiome can lead to more chronic changes in our immune system, and in some cases, can predispose us to severe, even life-threatening bacterial infections or chronic autoimmune conditions such as Inflammatory Bowel Disease. Second, antibiotics are some of the most common medicines to cause severe and life-threatening allergic reactions, which can develop at any stage in a person’s life. They can also dangerously interfere with other drugs, leading to both decreased efficacy as well as dangerous toxicity of other daily medications. Finally, there is a more population-wide, serious concern about growing antibiotic resistance that has led to the evolution of bacteria that are resistant to all antibiotics. While this concern is less immediately relevant to an individual patient (and we are primarily concerned with the health of the person in front of us), it is important to recognize that our overprescription of antibiotics is contributing to a serious public health threat with highly concerning consequences.


Rest assured that your emergency department doctor is attuned to the symptoms and physical exam findings that point towards a bacterial infection of the sinuses, throat, or lungs, and will sometimes obtain further testing to investigate the possibility of an infection requiring antibiotics. We also hope our patients trust that we will never run unnecessary tests or prescribe unnecessary antibiotics that we do not believe serve the best interest of our patient. 


As a final note, it is important to note that our better understanding of the potential harm of antibiotics means that there is a newly evolved practice change in prescribing these medications, which can be confusing for patients who are accustomed to a Z-pack when they have had a cold in the past. This means that if you were formerly prescribed medication for a cold, it was possibly unnecessary and you recovered from your illness just the same as if you didn’t have the antibiotic in your system.   So when you develop an inevitable URI this season, rest assured the little virus monsters in your body are self-limited and will die eventually, and those old antibiotics in the medicine cabinet will not shorten the course of your symptoms. But they might give you diarrhea, a life-threatening reaction, or contribute to the development of the superbug that is going to take over the world and kill us all. (Just kidding, you’ll probably just get diarrhea).