Research Summary: Colds & Antibiotics

BACKGROUND: Inappropriate antibiotic prescribing refers to physicians writing prescriptions for antibiotics when they're not needed. According to Steven Goldberg, M.D., most patient cases of colds don't require an antibiotic, but doctors write prescriptions for more than 40 percent of patients who come in with a cold.

REASONS: Inappropriate prescribing happens because of both doctor and patient factors. Dr. Goldberg says, "Patients, are very, very busy with family and work. They really need to get better fast, and for many of them, they think that an antibiotic will help get them over their cold faster -- when for the overwhelming majority, the antibiotic won't help at all." Dr. Goldberg says physicians are under pressure to see many patients and provide specific solutions to patients' problems. He explains, "It's oftentimes easier for [doctors] to quickly write an antibiotic prescription than it is to have a conversation about the causes of a cold, and then talk about things to make you feel more comfortable as you're getting better, like over-the- counter remedies."

DANGERS: There are several reasons why antibiotics should not be prescribed for colds or upper respiratory tract infections. Dr. Goldberg says the first is resistance. If you take antibiotics when you don't need them, you make it more likely that you're going to develop a serious bacterial infection. The second reason is side effects. Antibiotics are associated with a range of potential side effects, such as stomach upset, diarrhea, and even more serious reactions. Finally, there is the cost factor. Dr. Goldberg says, "Inappropriate antibiotic prescribing costs several hundred million dollars every year -- of unnecessary expense."

TAKE AN ANTIBIOTIC WHEN ... There are some instances when people have an upper respiratory tract infection, and they actually do need an antibiotic to get better. These are typically people who have been ill for an extended period of time (more than seven to 10 days) and are getting much sicker and having difficulty breathing or have a high fever. If they also have related medical problems, such as underlying heart or lung disease or diabetes and are then prescribed an antibiotic, it's very important to take it every day and for the full course. That's because taking it for just part of the course will reduce the number of bacteria in the infected area but potentially not kill the infection.

ALTERNATIVES: Dr. Goldberg says for most people who have a cold, giving it time is the best thing. Over-the-counter medicines can also make patients feel more comfortable. For body aches or low- grade fever, acetaminophen or ibuprofen can help. For coughs or stuffy nose, Dr. Goldberg recommends any cough suppressant and decongestant combination and a hot, steamy shower. New research also shows people who walk at a brisk pace for 40 to 45 minutes on a nearly daily basis have half the sick days with the common cold than people who don't walk at all. And another study shows people taking the herbal remedy ginseng were significantly less likely to have two colds during cold season than their counterparts taking a placebo pill. Those taking ginseng also had milder symptoms when they did catch a cold.

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