Now that Christmas is over, tis the season for coughin’ and sneezin’.  This is the time of year when legions of folks dealing with some kind of upper respiratory symptoms try to decide whether or not to make the trek into their doctor’s office.  Let’s see if we can help sift through some of the factors involved and maybe save a few trips.

Upper respiratory infections (URI’s) include the common viral illnesses (where antibiotics are useless and just add cost, side effects and resistance) such as colds, flu, viral sore throats, bronchitis, laryngitis, croup, mono, and viral sinusitis.  As well, there are the much less common bacterial URI’s (where antibiotics may be appropriate):

  • Bacterial sinusitis – about 2% of viral URI’s progress on to this
  • Bacterial bronchitis – again, far less common than its viral cousin
  • Whooping cough – still very common and deadly in poorly immunized countries and raising its ugly head in pockets of this country having poorer immunization rates
  • Strep throat – comprising less than 10% of sore throats and rarely occurring in children less than 2-3 years old.

Overall, URI’s are the most common acute illness seen in medical offices.  In the U.S. we have about a billion URI’s per year. Children have about 3-8 viral URI’s per year, adolescents and adults have approximately 2-4 annually, while people older than 60 have fewer than 1 cold per year.  With the average URI lasting a few days to nearly two weeks start to finish, that’s a lot of days with symptoms.  The flu affects 5-20% of the US population during each flu season.

So which symptoms are worth a trip to a doctor, and which ones are just viruses that need to run their course?  Your typical cold, viral bronchitis or sinusitis rarely benefits from a trip to the doctor.  This would include your typical runny nose, cough, sore throat, headache type of illness and it is the vast majority of URI’s.  As stated above, antibiotics are worse than useless for these.  Drink lots of water, take acetaminophen or ibuprofen for higher fevers (101 and up as a rule of thumb) and general pain, and consider something like Mucinex DM if you want to further thin out the mucous and quiet a cough.  Take a long shower in the morning and blow and cough out everything you can from the night before.  Of course try not to pass it on to your family, friends and co-workers.

So when should you come see the doctor with URI symptoms?:

  • If the symptoms worsen after initially improving for a time
  • If the symptoms are more severe (shortness of breath, wheezing, dehydration)
  • If the symptoms are not gone or nearly gone within 10-14 days
  • Go in as soon as possible if moderate or severe flu symptoms hit (cough, congestion, fever, body aches) during flu season (fall to spring) as prescription flu medications only help if started within the first 48-72 hours of illness.
  • If you have a bad sore throat, possibly with headache and nausea but without runny nose or congestion as this kind of symptom combination is more often strep throat (or mono if you are in your teens or 20’s).  An antibiotic is then appropriate if a strep test confirms strep throat.
  • If you or the person with symptoms is frail and in poor overall health, including the very young and the very old.
  • If URI symptoms have led to severe ear pain.
  • As far as sinusitis, the recommendations say “Uncomplicated sinus infections typically clear up without antibiotics. Antibiotics should be prescribed only if there are persistent symptoms for more than 10 days, or if a patient develops severe symptoms or a high fever, has nasal discharge or facial pain for at least three days in a row, or ‘worsening symptoms following a typical viral illness that lasted five days, which was initially improving.’”

One final thought: I cringe at the idea of telephone or internet medical care where a person pays to call a doctor, have a phone diagnosis, and get a prescription called in.  The likelihood of overprescribing antibiotics for viruses will be even higher as well as missing more serious infections such as early pneumonias.

I hope that helps give some idea of when it’s more worth coming in and when it may not be.  Certainly, when in doubt, check it out.