Why I hold off on antibiotics for my cough

For as long as I can remember I have tended to develop a bad cough nearly every time I get sick in the cold and flu season. I’m not sure if I have a minor tendency to bronchospasm or if my years of passive smoke exposure as a child somehow damaged my lungs. Who knows, but I seem to have the tendency for every URI become a lingering brohchitic cough.

In addition as a family physician I have lots of opportunity to contract these illnesses.   I have always believed that these are primarily viral illnesses, but for many years I treated myself much as I tried to treat others, and when after a week or so of cold symptoms when I developed the inevitable productive cough with discolored sputum I started on an antibiotic.  Not surprisingly I always got better, and often it seemed like the antibiotic turned the tide.  For the last 3-4 years I’ve stopped treating this scenario with antibiotics. I still get better, and although it sometimes seems like maybe it takes a bit longer, I am no longer tempted to treat this with antibiotics.

Why not? I’d like to say that the data showing that most of these illnesses are viral anyway, and that antibiotics are largely ineffective was the major factor.  It should have been enough. The altruistic argument that overuse of antibiotics is leading to increasing antibiotic resistance should also have been a strong factor.  Like many of my patients though these were not enough to keep me from starting an antibiotic hoping that they would shorten the illness, keep it from getting worse, and anyway, “I always needed the antibiotic.”

No, the real reason I now avoid antibiotics is that I’ve come to believe that the risk of taking antibiotics is too high to justify taking them in this scenario.  If I take an antibiotic for bronchitis I put myself at risk for serious and life-threatening illness.  Clostridium difficile used to be a fairly uncommon and almost exclusively hospital acquired infection. Now we commonly see C. diff in the outpatient setting in previously healthy patients.  Almost inevitably the patient has been recently treated with an antibiotic, often for an indication that is questionable.  C. diff is also becoming increasingly antibiotic resistant itself, and serious cases and even death are being seen.  Fecal transplant, something that 10 years ago would have sounded like someone’s idea of a bad joke, is now actually being used to treat refractory cases of C. diff colitis.  Is the potential to shave a few days off an annoying cough really worth putting myself at risk of C. diff?  Not for me.

MRSA, methicillin resistant Staphlococcus aureus, strikes me as yet another good reason I should avoid antibiotics if they are not definitely needed. Though the evidence that MRSA is more common in individuals who have used antibiotics for other illnesses is lacking, I am concerned that since I regularly in close proximity to MRSA at the office that if I am use an antibiotic and alter my normal bacterial flora I may seem an inviting host for this virulent pathogen.  I like my normal commensal bacterial microflora, and don’t want to kill off these good bugs and thereby  expose a niche for MRSA to colonize.

So there you have it.  For entirely self-serving reasons I now take my chances of coughing for a while longer when I get bronchitis, and allow my sinus infections to resolve with sinus rinse instead of on antibiotics. A recent review showed that our expectations and reality about cough with viral illness are out of synch anyway, expectations of a week but in reality the cough averages about 17 days.   Think through your reasons to present to your doctor’s office requesting antibiotic therapy for your respiratory illness if you don’t have significant underlying lung disease or a strong reason to take the drugs.

Edward Pullen is a family physician who blogs at DrPullen.com.

View 5 Comments >

Most Popular

Get KevinMD's 5 most popular stories.