GET SMART: COUGHS AND COLDS, WHY NO ANTIBIOTICS This handout addresses the common management & misconceptions of treating these infections and handy tips to help you manage. Most of us will get a cough & cold, sore throats, sore ears and sinus infections at least once a year. Majority of these are caused by viral infections. What causes these infections? Infections of the sinus (sinusitis), throat (pharyngitis), tonsils (tonsillitis), ears (otitis media), airways (bronchitis or bronchiolitis) are caused commonly by viral infections. Doctors generally use the term viral URTI (Upper Respiratory Tract Infection, pronounced ur-ti) to describe most of these infections. What is a virus and why do I get them? A Virus is a “bug” that is present in the environment and are passed through infected people by sneezing, coughing, direct contact or indirect contact with contaminated surfaces (ie door handles, computer keyboards, shopping trolleys). Our immune system (the part of the body that fights infections) kills virus 24hrs a day. It also kills most bugs that enter our system including bacteria too. However when our immune system is down or if the infection is too much for our immune system to handle we get viral infections. What are the symptoms of Viral URTIs? Generally feeling unwell, tired & run down, reduced appetite, body aches, fever, coughs and cold are the common symptoms. Symptoms peak about day 2 - day 5. At this stage there may be green or yellow sputum (phlem), and this is the time majority of the patient present to their GP. Then symptoms slowly resolves (the stronger your immune system the quicker this occurs). However you may have a lingering cough for about 2 - 3 weeks. This is common and it is because the infected airways takes time to reduce the swelling and irritation. The important thing to remember is that during this period you are coping and not suddenly deteriorated. So in total it can last from 7 - 21 days. How can I treat viral URTIs? There is no magic cure. It’s symptomatic and just allow your strong immune system to fight it. The most useful treatments are     Rest Paracetamol, Iburpofen or Aspirin - this helps the aches and pains, headaches and fever (Children aged under 16 should not take aspirin.) Drink plenty of fluids - Keep hydrated to give energy to your immune system Stop smoking What about over the counter medications? There is little evidence they work (this does not apply to paracetamol and ibuprofen) 1 In 2009 WHO (World Health Orgainsation) & MHRA (Medicines and Healthcare products Regulatory Agency) recommend against the use of these medications. MHRA wrote 2 "The new advice is that parents and carers should no longer use over-the-counter (OTC) cough and cold medicines in children under 6. There is no evidence that they work and can cause side effects, such as allergic reactions, effects on sleep or hallucinations. For 6 to 12 year olds these medicines will continue to be available but will only be sold in pharmacies, with clearer advice on the packaging and from the pharmacist. This is because the risks of side effects is reduced in older children because they weigh more, get fewer colds and can say if the medicine is doing any good. More research is being done by industry on how well these medicines work in children aged 6-12 years." Get Smart, why not antibiotics? Antibiotics do not kill viral infections. Antibiotics (as their name implies) kill bacterial infections. To kill viral infections you needs an anti-viral not an antibacterial. The reason is they differ in shape (imagine a virus is a circle and a bacteria a triangle), so antibiotics will only target anything that resemble the shape of bacteria (ie a triangle). Also we do not have specific anti-viral medications as there are so many types of viruses (over 100) that not one medication can be manufactured. Using antibiotics in viral infections will cause side effects like nausea, vomiting and diarrhoea (since it will kill all the good bacteria in your intestines and reduce your immunity). It may also cause fungal infections (thrush), rash and worse build up resistance to antibiotics (when antibiotics can no longer kill bacterial infections). A recent studies showed using antibiotics children (under 3 months or ≥ 7 courses) increased their risk of getting Irritable 3 Bowel Disease (Ulcerative colitis and Crohn’s disease) when older Why do some doctors prescribe antibiotics? Your doctor is here to genuinely help you feel and become better. Frequently, doctors prescribe antibiotics even when they don't believe they're medically necessary. It feels better to do something instead of nothing. Remember it won't cure the infection, it won't keep other people from catching it, it won't relieve your symptoms and it can cause side effects. Antibiotics worked last time I had similar symptoms Most people present to their GP at the peak of their illness (usually day 3 - day 5, even day 7) and this is usually when antibiotics are prescribed. This is also the time when their immune system is going to make them feel better anyway, yet they think the antibiotic worked and forgot who really did the hard work, their own immune system. What to look out for - The Red Flags Most viral URTI do not cause complications. Complications are common but not frequent in patients who have underlying lung conditions like asthma or COPD. Contact your doctor if you have any of the following symptoms      If a sudden deterioration in your condition Fevers not resolving despite paracetamol and ibuprofen Headaches become worse or severe Fast breathing, wheeze, shortness of breath, or chest pains. Coughing up blood or if your sputum (phlegm) becomes dark or rusty coloured      Disorientation or confusion If a cough persists for longer than 3-4 weeks Rash Neck stiffness or if light hurts your eyes If any other symptom that you are concerned about References 1. WHO Pharmaceuticals Newsletter No. 2, 2009, http://www.who.int/medicines/publications/newsletter/2009pharmnews2.pdf 2. Safety information, MHRA, 28 February 2009, http://www.mhra.gov.uk/NewsCentre/Pressreleases/CON038902 3. GUT doi;10.1136/gut.2010.219683 http://gut.bmj.com/content/60/1/49.abstract This material is prepared by Dr Rasika Amarasekera for Moorhouse Medical Centre, Christchurch, NZ