Colds and flu

19 January 2016

Experts caution against antibiotics for colds and flu

According to the president of the American College of Physicians reducing the overuse of antibiotics for acute respiratory tract infections in adults is a clinical priority.

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Antibiotics are not needed for adults who have the common cold, bronchitis, sore throat or sinus infections.

Overuse of treatments

That's the advice from the American College of Physicians and the U.S. Centres for Disease Control and Prevention, which just issued guidelines for prescribing antibiotics for acute respiratory tract infections (ARTIs) in adults.

These types of infections are the most common reason for visits to the doctor and for outpatient antibiotic prescriptions for adults, the researchers said.

The advice, published on 18 January in Annals of Internal Medicine, is designed to combat what the two organisations see as overuse of such treatments.

Read: How to avoid overuse of antibiotics

According to an ACP news release, unpublished CDC data estimates "50 percent of antibiotic prescriptions may be unnecessary or inappropriate in the outpatient setting, which equates to over R 49 billion ($3 billion) in excess costs".

Preventing antibiotic resistance

"Inappropriate use of antibiotics for ARTIs is an important factor contributing to the spread of antibiotic-resistant infections, which is a public health threat," ACP President Dr Wayne Riley said in the news release.

"Reducing overuse of antibiotics for ARTIs in adults is a clinical priority and a High Value Care way to improve quality of care, lower health care costs, and slow and/or prevent the continued rise in antibiotic resistance," he added.

According to the guidelines:

  • Doctors should advise patients with the common cold that symptoms can last up to two weeks and they should follow up only if the symptoms worsen or exceed the expected time of recovery.
  • Antibiotics should also not be prescribed for uncomplicated bronchitis unless pneumonia is suspected: "Patients may benefit from symptomatic relief with cough suppressants, expectorants, antihistamines, decongestants and beta-agonists."
  • In most cases, antibiotics should be prescribed for a sore throat only if a strep test confirms streptococcal pharyngitis.
  • "Physicians should recommend analgesic therapy such as aspirin, acetaminophen, nonsteroidal anti-inflammatory drugs, and throat lozenges, which can help reduce pain."
  • Uncomplicated sinus infections typically clear up without antibiotics. Antibiotics should be prescribed only if there are persistent symptoms for more than 10 days, or if a patient develops severe symptoms or a high fever, has nasal discharge or facial pain for at least three days in a row, or "worsening symptoms following a typical viral illness that lasted five days, which was initially improving".

Read more:

Link between e-cigarettes and respiratory infections

Vaccinate pregnant moms to prevent whooping cough in babies

Antibiotics not worth risk in chest colds

Image: Antibiotics from iStock

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Ask the Expert

Flu expert

Dr Heidi van Deventer completed her MBChB (Bachelor of Medicine and Bachelor of Surgery) degree in 2004 at the University of Stellenbosch.
She has additional training in ACLS (Advanced Cardiac Life Support) and PALS (Paediatric Advanced Life Support) as well as biostatistics and epidemiology.

Dr Van Deventer is currently working as a researcher at the Desmond Tutu Tuberculosis Centre at the University of Stellenbosch.

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