Adam’s Journal
Ten days ago, I came down with some sort of respiratory illness. (I tested, but it was neither Covid nor the flu.) As of this writing, to put it indelicately, I’m still coughing up phlegm (sorry), and it’s still green (again, sorry).
Does this mean I’ve developed some sort of secondary infection? Do I need antibiotics to get better?
Dr. Scofield Prescribes
Probably not. Coughing green mucus at day 10 does not signal a bacterial infection or a need for antibiotics. Unless accompanied by additional worsening symptoms, this is likely the natural tail of what was presumably a respiratory virus.
People tend to underestimate how long respiratory viruses last. A cough from viral infection – what most of us would call colds – typically persists for three to four weeks. So, you’re well within that window.
It’s also important to stress that green – or yellow – mucus doesn’t necessarily mean a bacterial infection. The color comes largely from the inflammatory response to the infection, regardless of whether it’s bacterial or viral.
In other words, your symptoms are typical of a person experiencing a normal recovery from a respiratory virus.
It is possible to experience a secondary bacterial infection following a respiratory virus, but for that to be the case, I’d look for you to take a U-turn. Specifically, I’m talking about symptoms like: a new or persistent fever; shortness of breath; rapid breathing; chest pain; or a worsening cough.
Those kinds of symptoms don’t prove a bacterial infection – which can lead to pneumonia – but they significantly change the picture. If you are experiencing them, you should see your healthcare provider, who may prescribe antibiotics.
Still, many patients will seek antibiotics even when evidence of a bacterial infection is thin to non-existent. They figure, hey, why not? Better safe than sorry, right?
Actually, no. In these situations, taking antibiotics may, in fact, open the door to future infections.
Research in both humans and mice suggests that a course of antibiotics in this situation leaves people more prone to subsequent bacterial infections. It appears that antibiotics disturb the microbiome – the microscopic organisms living in your digestive tract – in ways that impair the body’s defenses against harmful bacteria.
I know it’s no fun to have a cold, but be patient. So long as your symptoms are getting better, even if it’s happening more slowly than you’d prefer, you’re likely on the road to recovery. No antibiotics needed.
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Dr. Hal Scofield is a physician-scientist at the Oklahoma Medical Research Foundation, and he also serves as Associate Chief of Staff for Research at the Oklahoma City VA Medical Center. Adam Cohen is OMRF’s senior vice president and general counsel. Send your health questions to contact@omrf.org.
