Do I Need Antibiotics For My Cough?

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At this time of year more than any other, I tend to find my waiting room packed from wall to wall with people who are coughing and spluttering over each other – and me – with cold or flu like symptoms. As you would expect, most of them are children, along with a great number of people with asthma or diabetes, or some other medical condition which means that ‘the cough always goes to my chest’ – however, large numbers of normally healthy adults do find their way to my door eventually if their irritating cough does not go away.

Essentially, when people come to see me with a cough or cold, the question they generally want answered is ‘Do I need antibiotics?’, but I find that attitudes split neatly into three camps. The first are the ‘I don’t want antibiotics but I understand that they may be necessary so I’ll take them if that’s what you suggest’ group, alongside the (more challenging!) ‘I must have antibiotics at any cost otherwise I’m going to be very unhappy with you’ lot, and last but not least, the ‘Just tell me what I need and I’ll take it’ people. I have discovered that finding out which category any given patient falls into is critical to how well things will pan out – in terms of the consultation and my sanity at least – and as such I tend to make it one of the first questions I ask when faced with yet another poor soul suffering with the dreaded cold.

But as with so many other questions when it comes to health and wellbeing, the answer to the ‘antibiotics for a cough’ dilemma is – well, it depends!

If you have a cough, sore throat, high temperature and blocked/runny nose with clear mucus then it is extremely likely that what you are suffering with has been caused by one of the common cold viruses and it is essentially exactly that – a cold. As most people know by now, antibiotics are a treatment for infections caused by bacteria, not viruses, and as such will be useless in terms of curing a cold caused by a virus, as all colds are. If you have all or most of these symptoms, a high fever (greater than 38.5C) rather than just a mild fever and joint/muscle pains, then you are most likely to be suffering with flu rather than a cold. Flu is also caused by a virus and while, if you fit into one of a number of health categories, you could have a flu vaccine at the beginning of the flu season (GP surgeries generally start offering them in October or November), which would significantly reduce your chances of developing full blown flu, if you are unfortunate enough to become ill with it there is no cure – the treatment for most people is rest, plenty of drinks to remain well hydrated, plenty of painkillers, and most of all patience while you wait for the nightmare to pass. Again, antibiotics are useless against flu; they are far more likely to give you an upset stomach to deal with as well as all your other aches and pains than they are to actually help.

Official guidance given to doctors advises that it is very difficult to distinguish a cold from flu; unofficially the £50 note test works pretty well for me – if someone places a £50 note at the entrance to your home and tells you that all you have to do to claim it as your own is to get out of bed, walk to your front door and collect it, if you would go and collect it then you probably don’t have flu. If you would groan, turn over in bed, and frankly not care even if it was more like £50,000, it is likely that you have flu! This is not particularly scientific (or that reliable!) but is a fun way to look at it as a rough guide, and the distinction is not really necessary anyway as the treatment for colds and flu is essentially the same.

So when would most doctors prescribe antibiotics for a cough/cold/flu type illness? I can think of three main ones:

Sinusitis

Basically like a cold, but lasting for too long and people complain bitterly about a blocked nose and pain across the front of their face, and anything they do manage to blow out of their nose is generally green or bloodstained. There is some evidence to suggest that antibiotics may help to reduce the length of time that sinusitis will make a person miserable, so if things have been dragging on for several days and the poor individual concerned is really debilitated by their illness then antibiotics may help.

Chest Infection

Otherwise known as a lower respiratory tract infection, or an infective exacerbation of asthma or chronic obstructive pulmonary disease (that’s COPD or chronic bronchitis), chest infections usually result in people having a high temperature and a cough that produces green, red or brown mucus from the chest. For most people it is very difficult to tell the difference between sinusitis or a cold dripping down the back of their throat from their nose to their chest and then being coughed back up and therefore looking like a chest infection, and an actual chest infection.

I have long since learned that I also struggle; the most reliable way is to listen to the chest with a stethoscope and my own children have caught me out a number of times by sounding absolutely awful from across the room, but a quick check with my trusty stethoscope has revealed that their chest has been completely clear.

Essentially, if you have a fever and a cough that is producing unpleasant mucus then it is well worth a visit to your doctor as you may well benefit from some antibiotics, but please don’t be too surprised or alarmed if they advise you that your chest is clear and don’t prescribe anything other than cold remedies. And if that is what they do, please don’t think that you have wasted their time…

Tonsillitis

If you have a high temperature and a sore throat then this can be a sign of tonsillitis, and it is important to be checked by a doctor in case you have developed an abscess at the back of your throat, known as a quinsy – this is generally considered to be an emergency and cold remedies are not what is needed if you have a quinsy, you need expert help! If you have simple tonsillitis without a quinsy then antibiotics are often a good idea.

So when should you sit tight and just assume things will get better on their own? If:

  • You do not have a high temperature
  • You have a mild fever (less than 38.5C) and it is easily treated with over the counter cold and flu remedies that contain paracetamol or ibuprofen
  • Your cough is either dry or produces clear mucus
  • You are otherwise generally healthy, even if you feel pretty rotten currently.

If this describes you then over the counter remedies, rest and fluids are usually all that is needed, your local pharmacist will be happy to help. You could also try some Echinacea or zinc capsules from an alternative medicine perspective – these are generally safe and may reduce the length and severity of your suffering. And be kind to your loved ones by trying not to spread your virus! Wash your hands frequently, use disinfectant sprays around the home and cough/sneeze into tissues that you then put in the bin. That said, you are most infectious in the 48 hours before you develop symptoms yourself, so by the time your misery ensues it is probably already too late!

So when should you go to the GP? Basically:

  • If you have a fever greater than 38.5C, particularly if it does not reduce with medication
  • If you have a cough that is producing unpleasant mucus
  • If you have any other illnesses that make a chest infection more likely, such as COPD, asthma, diabetes, immune system problems
  • If you are very young or in the ‘getting a bit older’ group!
  • If your cough has dragged on for more than a week or two and shows no signs of resolving by itself. This could be a chest infection, or pneumonia and you may need a chest xray.
  • If you have a long history of infections like this and you know that in your case your GP usually recommends antibiotics
  • If you think you have tonsillitis

So what do you do if you are not sure? You could call NHS Direct for advice (number 08454647), or most surgeries will be happy for a nurse or GP to give brief advice over the telephone and make an appointment for you if appropriate. If in doubt, talk to someone – a health professional will not think you are wasting their time and they may be able to give you valuable advice.

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