Wednesday, October 12, 2016

Doc, I Need an Antibiotic!

We are nearing that time of year again where our phones ring off the hook and our waiting room overflows with sick patients. Our medical staff are fielding calls insisting for same day appointments or demanding antibiotics. So I just want to blog a little about what we see and treat this time of year. Let's start with sinusitis.


What are the common symptoms?
  • purulent nasal discharge ("gross yellow/green mucous")
  • nasal obstruction ("can't breathe")
  • facial pain, pressure, or fullness
  • can also get cough from the mucous and postnasal drip
What causes it?
  • viruses are most common (antibiotics don't help here)
  • bacteria 0.5-2% of cases
How do you know if you may need an antibiotic for treatment?  
See your doctor and let your doctor weigh your history and physical exam to determine. Usually these are the indicators:
  • symptoms are lasting for 7 or more days
  • symptoms are worsening, especially if after initial improvement
  • fever greater than 101
  • moderate to severe facial pain
Well, what happens if you take an antibiotic when really you did not need one?
  • you will get better no faster than if you did not take the antibiotic (you will never know)
  • you risk side effects of the antibiotics like diarrhea which may worsen your course
  • you are increasing the incidence of antibiotic resistant bacteria (like MRSA)
So what can you do if you don't need an antibiotic?
  • rest and drink lots of fluids
  • motrin or tylenol for pain
  • saline nasal spray to irrigate or use neti pot to irrigate
  • topical nasal steroids (like flonase) may help
  • topical atrovent (requires prescription)
  • guaifenesin (AKA Mucinex) can break up/thin out the mucous
What to avoid?
  • antihistamines (like benadryl, claritin, or zyrtec) may over dry and increase discomfort
  • zinc preparations show no benefit
How to prevent in the future?
So next time you get sick, you may want to try some of these remedies and give your body a fighting chance for a few days before you pick up the phone to call your doc. Now if you have been sick for 1 week and not improving, call your doc.

One more last pearl... coughs can linger and linger... according to one recent study the average duration of cough is 18 days!  However, if you are wheezing or short of breath with your cough... or it is just getting worse... go see your doctor.