Each week, OMRF Vice President of Research Dr. Rod McEver opens “Adam’s Journal” to answer a medical question from Adam Cohen, OMRF’s senior vice president & general counsel.
I recently had a respiratory tract infection. It seemed to be improving after five days, but then (sorry for the graphic detail), my phlegm grew thicker and greener. I was pretty sure this signaled that I’d developed a secondary bacterial infection requiring antibiotics. But a physician friend encouraged me to wait things out for a bit, and, sure enough, my symptoms cleared in a few days without treatment.
How can you know when to treat a respiratory illness with antibiotics?
Dr. McEver Prescribes
The vast majority of respiratory infections are viral in nature, caused by viruses such as influenza, SARS-CoV-2 or common cold viruses like the rhinovirus. Antibiotics will have no effect on these pathogens.
Nevertheless, the symptoms of these illnesses – cough, mucus, congestion, sore throat, fever, headache, muscle aches – are oftentimes indistinguishable from bacterial infections in your sinuses, throat, airways or lungs. However, antibiotics will bring relief for bacterial infections.
There are readily available quick tests for strep throat (bacterial) as well as Covid-19 (viral) and (flu). If you test positive for any of these, your doctor has a clear path: antibiotics to treat the bacteria that causes strep, but none for the others.
If your respiratory illness doesn’t fall into any of these buckets, so long as your symptoms remain manageable, the wisest approach is to rest and treat symptoms with over-the-counter medications, as your illness is almost certainly viral. That means it will resolve on its own over time. In these situations, antibiotics can be harmful, increasing your odds of becoming resistant to antibiotics and developing difficult-to-treat conditions like C. difficile diarrhea.
People often underestimate the time it takes to clear a respiratory virus, with symptoms commonly lasting as long as two weeks. As you did, they often confuse the natural course of illness – thickening of phlegm; deeper mucus coloration as your body continues fighting the same infection – with the onset of a second (bacterial) invader.
Generally, the safest course is to allow two weeks for a respiratory infection to clear. If symptoms remain acute at that point, it may be time for antibiotics.
Do you have a health query for Dr. McEver? Email firstname.lastname@example.org and your question may be answered in a future column!