By Dr. Amanda Green
Hospitalist at Paris Regional Medical Center

It’s the time of year when almost all noses start running, often leading to a cough. Going from hot to cold spaces, allergies, and colds and viruses will set off drainage from the nose to the throat, causing a cough. Sometimes called an upper respiratory infection (URI), acute bronchitis, or acute sinusitis, these are all forms of illnesses that do not get better with antibiotics. Many patients will go to their doctor, nurse practitioner (NP), or physician assistant (PA) saying that they get an antibiotic every year to kick whatever URI they have. Usually, the reason people seem to get better with 5-7 days of antibiotics is because they would have been better anyway as their body cleared up the issue on its own.

Why is it not OK to take antibiotics just in case there is a tiny percentage that the problem is bacterial? One of the biggest problems from unnecessary antibiotics is Clostridium difficile disease. Also known as C. diff, this disease causes abdominal pain and frequent watery diarrhea. It results from your good bacteria in your gut being killed by the antibiotic, leaving the C. diff to take over. Studies have shown that patients who stay in a hospital room where the patient before them was on an antibiotic are at higher risk of getting C. diff than other patients - showing how closely linked antibiotics are to this infection. C. diff colitis has to be treated by special antibiotics, and can lead to reoccurring infections.

Our microbiome (the bacteria that live on and inside of us) are being linked more and more to obesity, depression, our immune system and heart disease. We are learning more about when we alter our natural bacterial with antibacterial soaps or antibiotics, we leave ourselves more likely to have secondary problems.

Antibiotic resistance is another prominent reason to avoid unnecessary antibiotic exposure. When taking an antibiotic, most of the bacteria that it works on will die, but some may stay and, as they say, “what doesn’t kill you makes you stronger.” The remaining bacteria mutate and divide, and the next time they see the antibiotic, it does not kill any of them. Patients with frequent urinary tract infections are usually the victims of antibiotic resistance, but anyone who takes an antibiotic at any time is at risk to getting resistant to that antibiotic. The person can then share that resistant bacterial accidentally with another person, resulting in antibiotic resistance spreading in the community. At one point in Paris, Levaquin use was so high, our community developed a 50 percent resistance in tested bacteria to this drug. We need to save our exposures to antibiotics, so that they will work when really needed, such as in bacterial pneumonia, severe cellulitis (skin infection), or severe urinary tract infection. Even in diseases that need antibiotics, courses of three days for urine infections to five days for pneumonia have been shown to be effective rather than seven to 10 days.

Alternatives to antibiotics that work for URI-type illnesses include Dayquil and Nyquil-type over the counter medications, ibuprofen (make sure with your doctor that NSAID medicines are OK), Tylenol, and nasal steroids (like Flonase) for allergies and sinusitis. Rinsing out the nose with water or saline helps with the drainage and cough as well. If your doctor, NP or PA recommends these treatments for your symptoms, thank them for saving your good bacteria!

About the Author
Dr. Amanda Green is an Internal Medicine physician who has practiced in Paris for 16 years. She works as a hospitalist, Medical Director at the Paris Lamar County Health District, a Certified Hospice Medical Director, and in January 2020 became the Chief Medical Officer at Paris Regional Medical Center. She and Orthopedic Surgeon Dr. Greg Green have two children in Paris ISD and enjoy being an active part of the community.