Last updated: Jan 15, 2009
How to know if you need an antibiotic
Doctors consider some guidelines when mulling this question, although it's still a gray area. "It's an inexact science," says Frank Esper, MD, a pediatric infectious diseases expert at Rainbow Babies & Children's Hospital, in Cleveland. Its difficult to distinguish a severe viral infection from a mild-to-moderate bacterial infection based on symptoms alone.
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- Fever. If you have fever, shakes, and chills, you could have a bacterial infection, but those are also common with a viral illness such as the flu, Dr. Esper says. Physicians will weigh your likelihood of having the fluIs it circulating in your area at the moment? How many patients has he or she seen with the flu that day?against the possibility of a bacterial infection. If you have a fever, and flu is circulating in your community, you'll probably leave the doctor's office without an antibiotic. Next year, get a flu shot.
- Length of time you've been sick. Viral infections that hang around for a while can sometimes morph into a bigger problem, such as a sinus infection, and bacteria may join the party. So if your symptoms have been lingering for weeks, your likelihood of getting an antibiotic goes up. However, most of the time, long-standing symptoms are due to a virus, not bacteria, says Dr. Campbell. Final verdict? Its still not the best way to determine your need for antibiotics.
- The color of your goo. Nasal secretions tend to be thin and clear during a viral infection, while green or yellow mucus can be a sign of bacteria. This one is tricky, though; most greenish discharges are viral. Overall, mucous color is considered an unreliable indicator of the need for an antibiotic.
- Your sore throat. Although it's red and looks terrible to you, your doctor may also look for white spots, which can be signs of bacteria, before considering an antibiotic. Most colds start with a sore throat, but a sore throat without other cold symptoms (such as a runny nose) can be strep throat, which does require antibiotics to halt the dangerous bacteria. To know for sure, you need a culture or rapid antigen test, which takes less than 20 minutes and can be done while you wait.
- Testing. A lab test is the only ironclad way to determine if you truly need an antibiotic. A physician can collect a sample of bodily gunk (whatever you can cough up or blow out of your nose), or take a throat swab. In general, a culture, in which bacteria are grown in the lab and tested, can take a day or two. Doctors often forgo the expense and time of a lab test if they think they can make a best-guess decision based on the above symptoms.