In my practice, it is very common to see patients with the “common cold”. These patients may have a combination of symptoms such as fever, runny nose, blocked nose, cough, sore throat, headaches and body aches.

It is also very common for patients to request for antibiotics to treat these infections, most of which are actually caused by viruses. Here are some common questions and misconceptions that I encounter in my practice.

Are antibiotics are useful against viruses?

No, antibiotics only work against bacteria.

Are most upper respiratory tract infections caused by bacteria?

Most upper respiratory tract infections are caused by viruses, including Influenza, COVID-19 and other viruses.

Do I have a bacteria infection because I have green/yellow mucus/phlegm?

This is not true as both bacteria and viral infections can result in coloured mucus or phlegm.

How do you tell if I am having a virus or bacteria infection?

This is where it is important to see a doctor. The doctor will take into account your symptoms, the severity of the symptoms, the duration of the symptoms, as well as conduct a physical examination to check for signs of bacteria infections. If deemed necessary, the doctor can do a swab test to check for virus or bacteria infections. The doctor can then use all the information to arrive at a diagnosis.

What are some examples of symptoms and signs that can indicate a bacteria infection?

• Symptoms/signs suggestive of a bacteria nose/sinus infection:
  • High fever of more than 39°C at the onset of symptoms
  • Symptoms lasting more than 10 days
  • Symptoms with improvement initially then worsening
• Symptoms/signs suggestive of a bacteria throat infection:
  • Fever more than 38°C
  • Absence of cough
  • Enlarged tonsils with white spots
  • Enlarged painful lymph nodes on the neck

What are the harms of just taking antibiotics for a virus infection anyway?

• Unnecessary side effects
  • Antibiotics can cause side effects such as nausea, vomiting, bloatedness and diarrhoea. You may experience these side effects from taking antibiotics that are not required in the first place.
• Increase in antibiotic resistance
  • Taking antibiotics indiscriminately can lead to development of antibiotic-resistant bacteria.
  • This will result in difficulty in treating infections caused by antibiotic-resistant bacteria in the future.

Helpful tips:

• Keep track of your symptoms to report to the doctor to help the doctor make a more informed diagnosis:
  • Record down the list of your symptoms in chronological order.
  • Duration of symptoms.
  • Get a thermometer to check your temperature and record it down.
• Do not take antibiotics without instructions from your doctor.

Useful links:

• Health Hub: https://www.healthhub.sg/programmes/use-antibiotics-right
• CDC: https://www.cdc.gov/drugresistance/about/how-resistance-happens.html
• WHO: https://www.who.int/news-room/fact-sheets/detail/antimicrobial-resistance

References:

1. Altiner, A., Wilm, S., Däubener, W., Bormann, C., Pentzek, M., Abholz, H. H., & Scherer, M. (2009). Sputum colour for diagnosis of a bacterial infection in patients with acute cough. Scandinavian journal of primary health care, 27(2), 70–73. https://doi.org/10.1080/02813430902759663
2. Aring, A. M., & Chan, M. M. (2016). Current Concepts in Adult Acute Rhinosinusitis. American Family Physician, 94(2), 97-105.
3. Smith, K. L., Hughes, R., & Myrex, P. (2023). Tonsillitis and Tonsilloliths: Diagnosis and Management. American Family Physician, 107(1), 35-41.