December 2017

Happy holidays! ‘Tis the season for family and friends…and coughs and colds, almost all of which are caused by viruses. Unfortunately, the latest research shows too many patients are still receiving antibiotics for treatment of these annoying, but mostly benign, conditions.

Is there anyone on the planet who by now does not realize that antibiotics do not help viral illnesses? I think not, so the problems must lie elsewhere. Let’s explore some myths and facts.


  1. People know colds/ coughs are caused by viruses, but they think they have a bacterial illness because:

-their mucus is colorful

-their symptoms have lasted too long

-they feel too sick foar a virus

  1. People ask for/ demand antibiotics because they:

-erroneously think the illness is bacterial based on one of the above reasons

-know it’s probably viral, but they “can’t afford to be sick right now.” (As though there is special antibiotic effectiveness for those too busy to be sick.)

-know that antibiotics have always worked for them before

-don’t realize the harms of unnecessary antibiotic use

  1. Providers give antibiotics because:

– patients demand them

– they think the illness possibly might be bacterial

– they don’t know that mucus color is not indicative of bacterial illness

– they don’t know how long the average viral bronchitis lasts

– they want to make the patient happy

– they are unaware of the extent of antibiotic harms

– it’s faster to order the drug than to explain why the patient doesn’t need it


98% of respiratory illnesses (sore throat, cough, cold, ear infections) in otherwise healthy people are due to viruses.

While certain bacteria impart certain colors to colony growth, viral infection regularly causes colorful excretions too. For common colds and coughs, mucus color mostly has to do with how long the goo has been sitting in your body—the longer, the more colorful. First-thing-in-the-morning junk is likely to be green, yellow, brown or even blood-streaked. As you clear out last night’s goo, the color gets paler to clearer as the day goes on. What you are seeing is a heap of your infection-fighting white blood cells clouding the mucus to rid you of the germs.

The average length of bronchitis—that is a cold with a cough—is 3 weeks. Three! That’s the average! Some viral coughs last up to 6 weeks—and I’ve had my share. A typical cold lasts 7-14 days.

According to surveys, most providers who give antibiotics for coughs, colds, non-strep sore throats, and ear infections, do so because the patient demands them.

98% of coughs and colds get better without antibiotics.


How to tell if you are in the 2% who may need additional treatment:

–the presence of any chronic disease, like diabetes or COPD, severe heart failure, dementia, kidney failure, or cancer places patient at higher risk for bacterial complications of viral illness—you should see your doctor for advice if you are feeling sick

–temperature > 100 degrees occurring anytime after the first 2-3 days of illness

–feeling suddenly a lot worse after experiencing steady improvement

–sudden pain over one sinus (pressure in all the sinuses is normal with a cold)

–symptoms lasting longer than 2 weeks for a cold, or 3-6 weeks for a cough


Of course it doesn’t hurt to see your provider when you’re sick, but be clear you are looking for their opinion on your illness, not demanding an antibiotic. Watch your provider’s jaw drop in surprise and respect when you say, “I don’t want an antibiotic unless I need it.”


Potential harms of antibiotics—even when used appropriately:


–tendon rupture

–kidney compromise

–allergic reactions

–heart electrical disturbances

–increased resistance of germs in current and future infections, both for individual patient and society

–some of the approximately 8 pounds of “good” bacteria we all carry inside and outside are killed by the antibiotic (we are only just beginning to realize the importance of our 8 pounds of good bacteria to maintaining health—including asthma, obesity, immune system malfunction, mental health)

–higher risk of intestinal infection with C. difficile—currently the most common health-care related infection in the US—and some forms are now resistant to all antibiotics


I can’t remember the last time I used an antibiotic. And it’s not because I don’t get sick. Antibiotics are life-saving for serious bacterial conditions. I’d like to keep them that way, just in case you or I really need one.



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