It’s booger season.
And that means that urgent care centers, emergency departments and primary care offices everywhere are being inundated with people seeking antibiotics.
So in the spirit of community wellness, I am offering you these friendly public service announcements.
PSA #1: Green mucous doesn’t mean you need antibiotics.
The color of your sputum doesn’t matter very much.
So why do doctors ask about it?
Well, congestive heart failure is more likely to produce frothy white sputum. Pneumonia caused by streptococcus pneumoniae classically produces “rusty” colored sputum. But people with allergic rhinitis are totally capable of “hocking up” lovely yellow/green mucous in the morning. The color can be a clue, but it’s not the crux.
But people like to look at the things that come out of their bodies. So go ahead and keep checking the tissue every time you spit or blow. Everyone does it.
PSA #2: The seven day cold is a myth.
You can have a cough from viral bronchitis for weeks. Symptoms of sinusitis are supposed to be present for a full 10 days before you even consider prescribing antibiotics.
If you don’t have a fever and are better than when you first got sick. Stick it out. It takes way longer than a week to get over some of this stuff.
PSA #3: A fever is 100.4°F or greater. Period.
People say, “But my temperature is usually low, so 98.6°F is a fever for me!”
That is false. Please save your nurse the eye roll.
PSA #4: “Itis” does not equal antibiotics.
Bronchitis and all other itises are just fancy words for inflammation/irritation. Viruses can cause sinusitis and pharyngitis and bronchitis (see diagram).
But people have come to expect antibiotics for many of these afflictions (bronchitis in particular).
According to Uptodate, more than 90% of bronchitis is caused by a virus, but more than 60% of patients who seek care for “bronchitis” will get a prescription for an antibiotic!
Guidelines from the American College of Physicans and the CDC clearly state that antibiotics should only be prescribed for bronchitis if it’s caused by pertussis. But physicians bend these guidelines because patients have come to expect antibiotics and patient satisfaction is a mighty powerful motivator these days.
PSA #5: You can get multiple “colds” in a year.
There are HUNDREDS of viruses that cause cold symptoms – too many to create a useful vaccine. So in a lifetime, it’s not surprising we get way more than we’d like. It doesn’t matter if you had a cold a month ago. You can get another one. It’s sad, but true.
PSA #6: Antibiotics are not a harmless ‘it can’t hurt and might help’ kind of thing.
I have seen life-threatening Stevens-Johnson syndrome from antibiotics several times. It is sickening to think that some of those ICU admissions could have been prevented by avoiding unnecessary antibiotics.
Allergic reactions can be serious and unpredictable.
And opportunistic infections are real. Your body is literally crawling with bacteria. They live on your skin, in your mouth, intestines and nether regions and they’re happy there. If you have a virus and you take an antibiotic – while that virus is singing MC Hammer’s “Can’t Touch This” – all of those resident friendly bacteria emit death screams and fade to black to REM’s “It’s the End of the World as We Know It.”
When you kill off friendly resident bacteria – you make room for “opportunistic infections” like c.diff colitis and yeast infections.
PSA #7: Antibiotic resistance is a real thing and we should all be worried about it.
Regardless of whether or not you believe in evolution, ‘survival of the fittest’ is a real thing and it’s true for bacteria. Every time we put people on antibiotics they don’t need, we are “showing our hand” to our opponent.
Bacteria aren’t smart, but if one of them has a mutation that makes it resistant to the antibiotic (just by chance), it will continue to thrive and divide while the antibiotic kills the susceptible strains. The result is a new resistant bacteria that can be spread.
In the 1990’s ciprofloxacin was a recommended treatment for gonorrhea. Now it’s not. Consider this quote from the CDC:
“In the late 1990s and early 2000s, ciprofloxacin resistance was detected in Hawaii and the West Coast…By 2006, 13.8% of isolates exhibited resistance to ciprofloxacin, and ciprofloxacin resistance was present in all regions of the country…On April 13, 2007, CDC stopped recommending fluoroquinolones as empiric treatment for gonococcal infections for all persons in the United States.”
PSA #8: Wash your hands.
Kids totally pick their boogers. (Adults, too, if we’re being honest.) And people touch stuff. So that stair railing probably has some boogers on it. And the drinking fountain handle too. Inanimate objects that transmit germs are called, “fomites.”
Use hand sanitizer or wash your hands. Not obsessively, but a lot. It’s good for you. It’s good for everyone. Enough said.
PS – Hand sanitizer has a high alcohol content. The fruity smelling kinds have tempted a few kids to eat them and there have been case reports of little kids presenting to emergency departments heavily intoxicated by hand sanitizer!
PPS – Stay Healthy, friends!