Say you have a bad cold. It’s gone to your chest and now you’re coughing up green gunk. It’s also starting to hurt when you cough and you’re a little short of breath.
Can you answer these questions:
1. How long should you use an antibiotic?
2. How do you decide how long is long enough?
If you plan on treating yourself or others when no doctor is available, you definitely need an answer to this question. Bronchitis is a condition where, if you treat until the cough is gone, you could well use up a month’s supply of antibiotics – most likely unnecessarily.
In an uncomplicated situation (an otherwise healthy individual who has no more than the above symptoms), the correct answer is zero days. No antibiotic is needed. The cough may last three weeks, and this period is not reduced by the use of antibiotics.
Yes, I know, your doctor probably has given you antibiotics for this same condition. Doctors are often too chicken not to. But it’s the truth! And if antibiotics are prescribed, patients often call back when the first course of treatment is completed reporting that they are not yet well (naturally), and thus they request a second round of antibiotics, after which they usually have recovered (naturally). Chest colds are usually caused by viruses, and as you’ve heard a hundred times, antibiotics don’t cure a virus.
The answer is somewhat different for complicated patients, i.e. those with smoking-related COPD, asthma, congestive heart failure, cystic fibrosis, and other serious underlying diseases. These patients should usually be treated for 5 days, occasionally longer. However, you can’t really use cessation of cough as a criterion for discontinuing the antibiotic. The cough may linger for weeks. Look at the whole picture: if the patient seems to have turned the corner, the antibiotics may be safely discontinued.
Pneumonia is another question yet. Fever, rapid breathing, a “toxic” (very sick) appearance, and rapid heart rate make pneumonia more likely (which usually does require antibiotics). This is where diagnostic skills are essential, as discussed at length in the textbook, Armageddon Medicine.
So if not antibiotics, then what?
Treatment is largely symptomatic, aimed at decreasing the cough, especially if it disrupts sleep. Dextromethorphan and narcotics are effective (in patients 6 years and older). Inhalers such as albuterol (or Primatene Mist) help those who are wheezing, as may caffeine, inhaled corticosteroids, and sometimes oral steroids.
As for herbal treatments, dark honey, echinacea, and pelargonium (kalwerbossie, South African geranium, rabassam) offer modest benefit (which, therefore, would be as good or better than antibiotic treatment in the otherwise healthy patient with bronchitis).
Stocking antibiotics is essential, but use them wisely, preferably for life-threatening conditions.
Image above depicts a child with pertussis. Adults may be susceptible, so update your immunity with a Tdap vaccine (updated tetanus shot) today.
For a good review on the treatment of bronchitis, read Diagnosis and Treatment of Bronchitis, by CLICKING HERE.
Copyright © 2012 Cynthia J. Koelker, MD