The common cold is a viral infection that affects the nose and throat with associated sneezing, headaches, and cough. The rhinovirus is the most common type of virus that causes colds; however, there are more than 200 viruses that may cause the common cold. Antibiotics are not effective against viruses and are used to treat bacterial infections.
One of the largest misconceptions is that the color of the mucus suggests a bacterial infection. A patient can have yellow or green mucus and still have the common cold. The most important sign that would indicate a bacterial infection is present is the duration of symptoms. The American Academy of Otolaryngology guidelines for acute sinusitis require the presence of symptoms for greater than 7 to 10 days before being considered a bacterial infection. In addition, symptoms of the common cold may last for up to two weeks with cough and post nasal drip being the last symptoms to go away.
The exception to the 7 to 10 day rule is if someone has what he or she believes to be the common cold and start to improve, but then develop symptoms again. This is called a ‘double worsening sign’ and if it occurs before 7 days, it is still considered a sign of bacterial infection and antibiotics should be initiated.
In general, there is no role for antibiotics in the setting of the common cold. The Center for Disease Control (CDC) discourages the use of antibiotics for the common cold as it will promote something called ‘bacterial resistance,’ where bacteria will develop immunity to certain antibiotics and will not be as effective. Antibiotics can also kill the good bacteria that live in our body, causing symptoms of diarrhea or even a yeast infection in women.
Caring for the Common Cold
In general, for the common cold, one should hydrate, rest, and consider adjunctive treatments, such as Mucinex, decongestants, nasal irrigations, anti-inflammatory medications, or zinc lozenges. Before starting any of these medications, patients should consult their physician. Although often overlooked, rest and hydration are critical in the first few days of a cold since the body is using its own immune system to fight the virus. Without adequate rest and hydration, the body’s defenses can weaken and not only lead to a bacterial infection, but the symptoms of the cold may last longer or be more severe.
In summary, the use of antibiotics to treat the common cold is not necessary. Since the common cold is caused by a virus, antibiotics will not be helpful. Certain exceptions apply to patients who may have a weak immune system or a known history of severe bacterial infections where early antibiotic use may be indicated and worth the risk of antibiotic resistance. However, this is not generally the case. The next time you receive a prescription of antibiotics for the common cold, check with your primary care or otolaryngology (ear, nose and throat) physician to see if he or she thinks this is necessary.
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Dr. Satish Govindaraj is Vice Chairman of Clinical Affairs in the Department of Otolaryngology and Chief of the Division of Rhinology and Skull Base Surgery for the Mount Sinai Health System. For more information, visit www.mountsinai.org/sinuses or call 212-241-9410 to schedule an appointment.