Antibiotics for Colds, Bronchitis, and Sinusitis

From the January 2004 edition of Dr. Fuhrman's Healthy Times:

Antibiotic use has skyrocketed in recent years, but the misuse of antibiotics isn't a new problem. Since the 1970s, medical studies have concluded that as much as 80 percent of all outpatient prescriptions are prescribed inappropriately.

Antibiotic sales are soaring, but—in direct response—so are drug-resistant infections. As more and more antibiotics are used inappropriately, more and more strains of bacteria are mutating and becoming resistant to antibiotics. As a result, many patients who have infections that in the past could have been appropriately and effectively treated with antibiotics will die because the antibiotics will no longer work.

Drug companies are a big part of this problem. They promote the use of their products through widespread advertising and the practice of giving free samples of the more potent, broad-spectrum antibiotics to doctors. The more widely these newer (and often ten times more expensive) antibiotics are used, the greater the chances that the bacteria will develop resistance.

Demanding patients
Many patients don't think a doctor is doing his job if he doesn't prescribe antibiotics or other medication. If he doesn't prescribe the medication they want, some patients actually will look for another doctor who will. For example, Robert Dristan is an emergency room physician well aware of the dangerous and inappropriate overuse of antibiotics. He told me that he sees a steady stream of patients with colds, bronchitis, or the flu. He always patiently describes the viral nature of these ailments, explains that no antibiotic can kill a virus, and informs patients that inappropriate use of antibiotics for these conditions could only harm them. He said that on more than one occasion, patients for whom he did not prescribe antibiotics returned, waving bottles of pills in his face, triumphantly stating, "My doctor said I almost had pneumonia." Patients can easily find a doctor willing to fabricate a diagnosis to justify coming to the rescue with a treatment.

Once a patient called me screaming on the telephone that her husband came to me for an antibiotic for his terrible cold, and all he got was a lecture. She wanted her money back and said she and her husband would never be coming again. Numerous patients have made similar demands. Most doctors perpetuate this problem because they give in to the pressure to prescribe antibiotics. They like to appear that they are offering an important and necessary service by writing prescriptions.

Powerful medicine
Antibiotics are not harmless. Their use should not be undertaken without a convincing prognosis that serious harm will result if the antibiotic is not used. Antibiotics kill the normal bacteria that inhabit the intestines. These healthy bacteria serve an important function in digestion and production of fatty acids and nutrients. The use of antibiotics, and the change in flora that results, reduces vitamin absorption (for example, of vitamin K) and can lead to nutritional deficiency.

Furthermore, the use of antibiotics results in yeast overgrowth. It can cause severe allergic reaction, as well as food and environmental allergies to develop more readily.
Overuse of antibiotics also can result in future infections with more serious (and resistant) bacterial organisms. Side effects can range from mild diarrhea and stomach upset to severe bone marrow suppression and serum sickness.

When to use antibiotics
Antibiotics are the appropriate treatment for severe bacterial infections. These infections include cellulitis, Lyme disease, pneumonia, joint infections, cat bites, meningitis, and bronchitis in a long-term smoker. Bronchitis in a non-smoker is just a bad cold. Almost every viral syndrome involves the bronchial tree and sinuses. The presence of yellow, brown, or green mucus does not indicate the need for an antibiotic. Likewise, sinusitis is not an appropriate diagnosis for the routine use of an antibiotic. Antibiotics should be reserved for the more serious sinus infections that show evidence of persistent symptoms lasting more than a week, such as continual fever and headache that accompanies facial pain and facial tenderness.

Childhood ear infections, a multi-billion dollar industry
Ear infections (otitis media) are the most common medical problem in children under seven years of age in the United States. Not only do nine out of ten children develop at least one ear infection each year, almost one-third of them develop chronic congestion with fluid in the middle ear that can lead to hearing loss and make the child a candidate for myringotomy or tube placement. Children who are breast fed for over a year have been shown to have many fewer infections than those weaned earlier.1 Studies also point to the fact that most ear infections early in life are viral, not bacterial.2 The vast majority of ear infections resolve nicely on their own, whether bacterial or viral, without an antibiotic. An international study following 3,660 children treated by general practitioners in nine countries showed that antibiotics did not improve the rate of recovery from ear infections.

It is common practice in this country to treat all ear infections with an antibiotic. Whether bacterial or not, our children get a routine prescription for an antibiotic at every minor illness. This cycle often is repeated many times, which may beget other medical problems in adulthood. This use of antibiotics early in life is likely a contributor to the increasing incidence of allergies and asthma and other problems later in life. Medical studies have linked a significant increased incidence of asthma, hay fever, and eczema to those who received multiple antibiotic prescriptions early in childhood, especially in the first year of life.3

Conservative treatment
In Europe, antibiotics are used for ear infections only when there is persistent drainage or persistent pain because these infections resolve on their own, without treatment, over 85 percent of the time.4 Studies show that the majority of ear infections are of viral etiology. For example, a microbiologic survey found that 75 percent of pediatric ear infections were caused by common respiratory viruses.5 Generally speaking, the use of antibiotics should be reserved for serious infections, not conditions the body is well equipped to resolve on its own. More and more physicians and authorities are recommending only treating ear infections with antibiotics when symptoms are not improving after three days and they are accompanied by drainage, fever, or persistent pain. Instead, ear drops for pain relief and other pain relievers can be used if the child is too uncomfortable to sleep.

A British study reported on 168 children treated in this manner. Antibiotics only were used if the illness followed an unusual course with high fever or profound weakness, or if the child had a history of purulent meningitis or a concurrent documented bacterial infection. They followed up on any child ho did not recover in the typical time frame. s a result of this well-designed protocol, antibiotics were recommended by the physicians in only 10 children—fewer than 6 percent of all children presenting with acute ear infections. No serious complications, such as mastoiditis, meningitis, or permanent hearing loss, were observed.6

This is similar to the way I treat childhood ear infections, except I also incorporate nutritional excellence, which I find reduces even further the likelihood of needing an antibiotic. The children of families who adopt my dietary recommendations simply stop getting ear infections.

1. Betran AP, de Onis M, Lauer JA, Villar J. Ecological study of effect of breast feeding on infant mortality in Latin America. BMJ 2001; 323(7308):303-306. Abdulmoneim I, Al-Ghamdi SA. Relationship between breast-feeding duration and acute respiratory infection in infants. Saudi Med J 2001; 22(4):347-350.

2. Pitkaranta A, Virolainen A, Jero J, et al. Detection of rhinovirus, respiratory syncytial virus, and coronavirus infections in acute otitis media by reverse transcriptase polymerase chain reaction. Pediatrics 1998;102(2 Pt 1):291-295. Heikkinen T, Thint M, Chonmaitree T. Prevalence of various respiratory viruses in the middle ear during acute otitis media. N Engl J Med 1999;340(4):260-264. Heikkinen T, Chonmaitree T. Importance of respiratory viruses in acute otitis media. Clin Microbiol Rev 2003;16(2):230-241.

3. McKeever TM, Lewis SA, Smith C, et al. Early exposure to infections and antibiotics and the incidence of allergic disease: a birth cohort study with the West Midlands General Practice Research Database. J Allergy Clin Immunol 2002; 109(1):43-50. Wickens K, Pearce N, Crane J, Beasley R. Antibiotic use in early childhood and the development of asthma. Clin Exp Allergy 1999; 29(6):766-771. Droste JH, Wieringa MH, Weyler JJ, et al. Does the use of antibiotics in early childhood increase the risk of asthma and allergic disease? Clin Exp Allergy 2000;30(11):1547-1553. Nelen VJ, Vermeire PA, Van Bever HP. Puzzling associations between childhood infections and the later occurrence of asthma and atopy. Ann Med 2000;32(6):397-400.

4. Tucker ME. When to use antibiotics–and when to resist. Family Practice News Dec 15, 1997;27.

5. Heikkinen T, Chonmaitree T. Importance of respiratory viruses in acute otitis media. Clin Microbiol Rev 2003;16(2):230-241. Heikkinen T, Chonmaitree T. Increasing importance of viruses in acute otitis media. Ann Med 2000;32(3):157-163. Heikkinen T, Thint M, Chonmaitree T. Prevalence of various respiratory viruses in the middle ear during acute otitis media. N Engl J Med 1999;340(4):260-264. Pitkaranta A, Virolainen A, Jero J, et al. Detection of rhinovirus, respiratory syncytial virus, and coronavirus infections in acute otitis media by reverse transcriptase polymerase chain reaction. Pediatrics 1998;102(2 Pt 1):291-295.

6, Bollag U, Bollag-Albrecht E. Recommendations derived from practice audit for the treatment of acute otitis media. Lancet 1991;38 (8759):96-99.
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Comments (3) Read through and enter the discussion with the form at the end
Toby - February 2, 2007 3:27 PM

What do you think of supplements that boost the immune system, like Cold-fX? I'm curious for a professional's opinion. My coworkers use it and have recommended it to me quite enthusiastically.

Lori_m - May 12, 2007 2:32 PM

Dr Fuhrman would probably tell you to boost your immune system naturally through a diet of nutritional excellence, then you would not have any need for pills and potions.

I don't know of that particular supplement but Dr Fuhrman does not usually promote the usage of prophylactic herbal supplements. If its a whole food extract or non-toxic gentle vitamin formula, maybe and even then only if actually addressing the issue first by eating a nutrient dense diet.

Nisreen - April 16, 2011 5:18 PM

Does the Thalasems patients need antibotic when they have dental treatment

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