Why doctors shouldn’t prescribe antibiotics for colds

July 20, 2015

Mark L. Friedman, MD, FACEP, FACP

 No one wants to be sick. Physicians are supposed to help us feel better. So why won’t your doctor prescribe antibiotics when you have the same cold that turns into a sinus infection? Won’t taking antibiotics prevent the illness form getting worse?

The short answer is taking antibiotics is not preventive medicine. In fact, it’s the wrong thing to do.

The longer answer is that these conditions usually start out as viral infections and viruses are not susceptible to antibiotics (which are only active against bacterial infections).

Sometimes colds do progress into secondary bacterial infections that require medical attention (and possibly antibiotics). How can you tell? If your symptoms persist for more than seven days, you have a temperature of more than 102.5 degrees Fahrenheit, you have a severe headache, stiff neck, persistent sore throat, earache, difficulty breathing or swallowing, chest pain or other significant symptoms, you might have a secondary bacterial infection.

“But,” you say, “the last time I had a cold my doctor gave me antibiotics and I got better.” The (unfortunate) fact is that some physicians do prescribe antibiotics for a cold because it is easier and faster than having to explain the dangers of overuse or incorrect use of antibiotics to their patients. They also think that this makes patients happier and more satisfied with their care (and some doctors are employed by organizations that rate them on patient satisfaction). As I explain in this video, the bottom line is that even though you got better, it’s not because of the antibiotic! You would have gotten better just as fast without it.

But if it makes the patient happier, what’s the harm in prescribing unneeded antibiotics? Read about the potential side effects of Zithromax (Z-Pak) here, one of the most commonly overprescribed and abused antibiotics that doctors prescribe for colds. As many as 12% of people given this drug experience side effects, including diarrhea, abdominal pain, jaundice, palpitations and allergic reaction. A study published in the May 2012 New England Journal of Medicine documented an increased incidence of fatal cardiac events in patients taking this medicine. Nonetheless, Zithromax is a beneficial and highly effective drug when used for the appropriate illnesses, such as bacterial pneumonia.

Every time I prescribe any drug, I do a risk/benefit analysis. Is it worth the associated risks (every drug has risks) in order to gain the benefits (cure or improvement of disease, relief of pain, etc.)? Why should I expose my patient to any risk at all (even less than 1% risk) if the chance of benefit is zero? When a doctor prescribes an antibiotic for a common cold, there is increased risk to the patient with no real benefit.

If I did prescribe Zithromax for 1,000 patients who have only the common cold and 120 of those patients (12%) get sicker from the drug and perhaps one of them dies, am I practicing good medicine?

As a patient, you are a sample of one. You do not see the low frequency but serious risks that become apparent with larger sample sizes.  As a physician, I do.

There is a reason prescriptions are required for many drugs: patient safety. Otherwise why not just make them all available "over the counter" without a prescription? At First Stop Health we believe in doing what is best for our patients and we encourage our physicians to prescribe appropriately. If the symptoms persist or worsen, patients can always call us back for re-evaluation.

Originally published Jul 20, 2015 3:33:00 AM.