Antibiotics And Respiratory Infections

First, we determine the type of infection or condition. Antibiotics are reserved for bacterial infections. Common respiratory infections that may require antibiotics are:

1. Bacterial Sinus Infections – Sinus symptoms can be caused by bacteria, viruses, or allergies. Most sinus symptoms are due to viruses or allergies and do NOT require antibiotics. The most bothersome symptoms tend to be specific to the sinuses, with nasal congestion, facial pain, postnasal drainage, and headaches. Symptoms of viral and bacterial sinusitis overlap, and it may not be easy to tell the difference early on. But most people with viral sinusitis will improve within 7-10 days of symptoms. Those with bacterial sinusitis may improve temporarily, but symptoms tend to return and may worsen. Still, 70-80% of people with bacterial sinusitis with a healthy immune system will improve without antibiotics! Treating with other medications that are much less harmful for about one week before starting antibiotics (if symptoms continue) reduces the risk of harm caused by antibiotics.
2. Strep Throat – Symptoms mainly affect the throat with a painful or sore throat, painful swallowing, swelling, redness, and pus on tonsils. Some may have mild nasal congestion, many have a headache but typically no cough. Strep throat is treated with antibiotics to prevent complications. 
3. Pneumonia – Symptoms mainly affect the lungs with a productive cough, shortness of breath, low oxygenation, and fast breathing. Bacterial pneumonia is treated with antibiotics.

1. Viral Infections.  Many viral infections affect several organs. We see this with covid-19, influenza, and even the common cold. Many will have sinus symptoms (nasal congestion, sneezing, runny nose, sometimes sinus pain), throat symptoms (sore throat typically at the beginning), lung symptoms (cough and at times shortness of breath). They may also have ear symptoms (fullness, mild discomfort), eye symptoms (redness, discharge), and skin symptoms (rashes mainly in children). Symptoms of viral infections typically peak between days 3 and 6 and then get better after that. Antibiotics do not work for viral infections.
2. Allergic Rhinitis.  Can cause sinus symptoms (nasal congestion, sneezing, runny nose, sometimes sinus pain, postnasal drainage), throat symptoms (from drainage), lung symptoms (cough), ear symptoms (fullness itching, mild discomfort), and eye symptoms (itchy, watery, red). People with allergies do not have a fever and overall feel fine other than their symptoms. Antibiotics do not work for allergic rhinitis.

Viral or bacterial infections can cause mucus to be yellow or green. Therefore, having yellow or green mucus does not mean an antibiotic is required. 

It is unlikely for a healthy individual to have a bacterial infection requiring antibiotics once or twice a year around the same time every year.  The seasonal nature of symptoms is consistent with an allergy or viral infection, as viruses spread easily in cold weather. 

While it is possible to start with allergy or cold symptoms, and then because immunity is weakened from being sick, bacteria grow over time; this should not occur every time one is sick, year after year except there is another abnormality that predisposes to a bacterial infection.

• For example, people with chronically weakened immunity are more likely to get a bacterial infection and are more likely to be severely ill. In these cases, it is better to have one consistent doctor to treat symptoms appropriately and monitor closely.
• Also, people with anatomical abnormalities like nasal polyps or nasal septum deviation may be predisposed to bacterial infections as the mucus can get trapped in the nose. Seeing a doctor for further management of the underlying condition is recommended.