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Taking Care of Your Upper Respiratory Infection

What you can do now:

A cold is one of the more unpleasant miseries we must face. Adults average three colds per year, six if we smoke. Here are suggestions for making this plague as tolerable as possible. With luck, you'll barely notice you have symptoms.

Upper respiratory infections are caused by more than two hundred different viruses, no two exactly alike. Symptoms can last from 24 hours to four weeks. You may have any variation of sore throat, runny or stuffy nose, cough, aches, pains, and a "fuzzy head."

One particularly nasty virus is the influenza virus, which causes the "flu": a severe cold that begins suddenly. Influenza causes a fever and severe aching. Otherwise, colds rarely cause fevers in adults.

Here's what to do to relieve your cold's symptoms.

In general:

  1. Dry air worsens cold viruses. Moist air helps your body kill them. Drink at least two quarts per day of water, tea, and/or soda. You should be drinking enough so you have to empty your bladder every hour during the day.
  2. Sleep with a vaporizer or humidifier at your bedside. Plain water is all you need in the vaporizer. Point the mist right at your face, so your pillow gets wet. Don't be dainty: get as much mist in your face as possible.
  3. Sucking on a zinc lozenge every two hours may reduce cold symptoms. (It's like a cough drop that says "zinc" right on the label.) The major side effect is a risk of nausea. Limit zinc intake to 100 mg per 24 hours, and don't use it for more than a week.
  4. In the past I recommended echinacea, an over-the-counter herb. However, a study in the NEJM in 2005 shows that echinacea may be of little use. A better choice may be andrographis, another herb you can get without a prescription. It can stop a cold in its tracks if you start it within 1-2 days of the onset of symptoms. Andrographis is an immune stimulant, so avoid it if you have an illness due to your immune system. Follow the directions on the bottle.
  5. Above all, if you smoke, stop smoking.

Aches, pains, headache, fever, feeling like you haven't slept for a week or were hit by a truck: Take two regular Tylenol or one Advil four times a day. Or an Aleve every eight hours.

Runny, congested nose: If you're otherwise healthy, take 30-60 mg. of pseudoephedrine four times per day as needed. Because pseudoephedrine is the raw ingredient in methamphetamine, you have to get it from the pharmacist (even though you don't need a prescription). Avoid any decongestant if you have severe high blood pressure or heart disease. Pseudoephedrine may dry out your throat or make you feel jumpy, like too much coffee. If you take it at bedtime, you may also need Benedryl (generic name diphenhydramine) to help you sleep. A better bedtime choice is a 12-hour spray decongestant like Afrin or Dristan Mist: put just enough in each nostril at bedtime so you can breathe through your nose. Spray decongestants can be addicting, so don't use them during the day or for more than 3-4 nights.

Sore throat: Gargle every 5 to 10 minutes with water, tea, or soda to rinse the irritating mucous from your throat. (Actually, this is more a "swish and swallow" to rinse off your throat.) When this doesn't do the trick, try Sucrets throat lozenges, available in any pharmacy.

Cough: Drinking lots of water and using the nighttime vaporizer helps most coughs. If you need more help, take 30 mg. of dextromethorphan every eight hours. This is a common ingredient in many over-the-counter cough remedies, but unfortunately most brands have way too little. Delsym syrup is the major brand with enough dextromethorphan. NyQuill and Comtrex have enough dextromethorphan but are too loaded with grogginess-inducing antihistamines to be useful during the day. There are many other brands; read labels.

Contact my office if you develop any of the following symptoms:

  1. Fever over 101 degrees for more than one or two days.
  2. If you feel really sick, not just miserable or achy all over.
  3. If you can see dots of white pus on your tonsils or throat.
  4. If you have chest pain that feels like someone stuck a knife into your back or side (not due to coughing and not just in the center of your chest).
  5. If you become short of breath, not just because of a stuffy nose.
  6. If you've been exposed to person with a known strep throat within the past two weeks or had a physician-diagnosed strep throat yourself in the last year.
  7. If you have pain in your sinuses -- in the bones surrounding your eyes and nose -- and have rotten-tasting mucus running down the back of your throat.

I can't be sick! You have to give me antibiotics!

It's amazing how often people ask to "get rid of this thing," meaning they have an important engagement or they're don't want to get sicker. They're mega-frustrated, and they want something to get rid of these symptoms immediately!

You may feel that if we took you seriously -- if we really understood how bad you feel -- you'd get a prescription for antibiotics. At least we'd be "doing something!"

Most of my patients come to the office after 7-10 days of being sick. Because everyone knows colds only last a few days, patients believe that after a week you have to get antibiotics or it will never go away.

Here's the catch: no antibiotic in the world can kill a cold virus. There is no cure for the common cold. The complete lack of benefit from antibiotics for colds is the best proved scientific fact in medicine. Why is this so certain? Doctors kept prescribing antibiotics needlessly, so scientists kept testing whether they were effective. The studies always came up empty. The truth is a cold can last for up to three weeks.

Until a few years ago, I routinely prescribed antibiotics for people who had cold symptoms for more than two weeks. Then a scientific study specifically tested whether this strategy helped. Giving half the people with prolonged colds antibiotics and half identical-looking placebos showed no difference at all.

Most people aren't really sure about the difference between bacteria and viruses. They're all "bugs," and antibiotics kill bugs. But viruses and bacteria are completely different. Viruses aren't even really alive: they're collections of DNA and protein that take over the cell machinery in your body to make copies of themselves. Bacteria are like microscopic plants that can live on their own in many different situations. It's easy to kill bacteria with antibiotics; it's much harder to kill something like a virus that was never alive in the first place.

(In the same way, you'd never spray insect killer into your PC to kill a computer virus. Wouldn't work!)

Getting sick was not your fault. Cold viruses are incredibly good at getting spread around. You catch the virus by touching a surface someone has sneezed or coughed on and then touching your nose or eyes.

No matter what anyone does, you'll almost certainly get over your cold within a few days or 2-3 weeks. Meanwhile, it would be easy to make you worse in the heroic effort to "do something." For example, an allergic reaction to penicillin shots kills 1 out of 10,000 people who receive them. I know of a child who wound up in the hospital for a week because of a needless prescription for a cold.

Antibiotics have been proven to be useless for colds in study after study. Why do so many people demand them? Maybe Doctor Oldtimer always gave everyone a shot. Maybe you received antibiotics just before your cold was going to go away anyway, but you attributed the result to the medication. Perhaps you once had pneumonia or a sinus infection or stubborn bronchitis for which antibiotics were necessary, and now you "just want to make sure" that the previous complication does not recur. But antibiotics are proven not to prevent later bacterial infections. You are just as likely to get sick, but you will become infected with antibiotic-resistant bacteria. Finally, prescribing unneeded antibiotics has led to an epidemic of highly resistant "super bugs."

It's true that cold viruses may make you more susceptible to subsequent bacterial infections. So if you get a cold, begin to get better, and then become sick again, antibiotics may be necessary for the new, secondary bacterial infection. (Of course, you may simply have caught a new viral infection. If you're not sure, we're happy to help you figure this out.)

Here are the main reasons people need antibiotics:

  1. A strep throat, caused by strep bacteria and thus susceptible to treatment. You may have a strep throat if you have a fever of 100 degrees or more, if there is white pus on your tonsils or throat, or if there are enlarged and tender lymph nodes ("glands") under the angle of your jaw. Suspect a strep throat if you know you've been exposed to strep in the last two weeks or if a doctor said you had a strep throat within the past year.
  2. If you have emphysema or certain other lung diseases you should receive antibiotics -- even for virus infections -- because they are of proven value. We may treat very elderly patients or those with chronic illnesses like diabetes or heart disease with antibiotics sooner than other patients, because their immune systems may not be as strong as we'd like.
  3. Upper respiratory infections lasting for more than a month and which are not simply post-cold allergies.
  4. Sinus infections or "sinusitis": pain in the bones surrounding your nose and eyes, plus rotten-tasting mucous draining down the back of your throat.
  5. On rare occasion people just feel bad for days on end. This may be due to a bacterial infection, or something else may be going on unrelated to a cold. Helping you sort this out is our job. Please feel free to call or come in if you're not sure.

Despite all the above excellent reasons you may need antibiotics, more and more scientific medical studies show that antibiotics are of little use in simple bronchitis, sinus infections, and ear infections. I still prescribe them if you've been ill for weeks or have more than a minor bacterial infection.


Last updated Sun, Nov 1, 2009

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©2011, James Gagné, MD