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Antibiotics a Later Resort for Respiratory Infections

Posted on: Thursday, 10 November 2005, 12:00 CST

By DR. PETER GOTT, M.D. Newspaper Enterprise Association

Dear Dr. Gott: Once or twice a year I have severe upper- respiratory infections and bronchitis, lasting for up to a month. Prior to moving to Montana, I was given a quick knockout punch with a shot of penicillin.

For the last several years, I have been, and continue to be, treated with useless decongestants, cough syrups, etc., and it takes me about the same time to get well as if I took nothing at all.

I have questioned several doctors here about penicillin, and I have yet to get an answer or explanation. Could you give me and other sufferers of this condition an explanation regarding this matter?

Dear Reader: In most people, upper-respiratory infections are caused by viruses that lead to symptoms that last for about one or two weeks. By then, the body's immune system kills the viruses and symptoms disappear. Because viruses are immune to antibiotics, such drugs are not helpful or appropriate for acute respiratory ailments. (Also, they are expensive and can be associated with adverse reactions.) Doctors treat the symptoms at this point. In some patients, the viral infections reduce the body's immunity, allowing bacteria to invade the respiratory tract and set up shop, a turn of events with predictable consequences: continuing cough and sore throat, progressive fatigue and malaise, a feeling of being unwell.

Bacterial infections in the upper-respiratory tract (throat and trachea) will often spread downward to cause bronchitis and pneumonia.

Fortunately, most bacteria are susceptible to antibiotics. Therefore, if a patient's upper-respiratory symptoms last more than a couple of weeks, or if the patient grows sicker or if symptoms change (harsher coughing, for instance), most physicians will choose to prescribe antibiotics. If we can obtain a sputum or throat culture before starting treatment, fine. But in most instances, this information is not vital.

Giving a shot of penicillin early in the course of an upper- respiratory infection is bad medicine. The drug is not particularly effective against many modern bacteria, and there is always the possibility of a severe allergic reaction. Thus, the risks far outweigh the benefits.

I agree with your Montana doctors, who correctly treat the symptoms of a viral infection. This therapy will not speed up recovery; it simply makes patients more comfortable.

If your infection fails to clear up in a couple of weeks, I am sure that your doctors would be willing to prescribe an antibiotic.

You and I grew up in a past culture in which penicillin was viewed as a cure-all. Things have changed. There are now many more antibiotics and, experts caution, we have to be careful about over- prescribing because of the serious reality of bacterial resistance to the drugs.

Write to Dr. Gott c/o United Media, 200 Madison Ave., 4th floor, New York, NY 10016.

Source: Tulsa World

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