Cold and flu season is here — but doctors say antibiotics won't help you get better faster

The Dose24:00What do I need to know about using antibiotics correctly?

As the season for coughs and colds returns, medical experts have a reminder: antibiotics aren't a go-to treatment for common viral respiratory infections. 

"I think that a lot of people are in the habit of still seeking antibiotics if they're finding that their illness is prolonged or more severe, just in case," said Dr. Lynora Saxinger, an infectious diseases specialist at the University of Alberta Hospital in Edmonton.

Overprescribing — including at a patient's request — and misuse of antibiotics is fuelling antibiotic resistance, a global health threat, giving rise to superbugs that can't be treated by first-line antibiotics. 

Saxinger says patients who are prescribed an antibiotic for an illness the drugs don't treat can be given a false perception of their effectiveness.

"They get a prescription, it's for a virus, but they start to get better shortly after because they've just peaked in their illness while this whole process was going on," she told Dr. Brian Goldman, host of The Dose podcast.

"So there's also a learned behaviour where people associate getting better with having had an antibiotic prescription."

Growing concern

The risk of antibiotic resistance is increasing year over year and affecting patients in hospital on a daily basis, according to infectious diseases physician Dr. Jerome Leis.

"We have, for example, patients who have an infection that, because of resistance, now requires an intravenous course of antibiotics rather than pills, or now requires a second-line antibiotic that not only is less effective, but has increased risks to the patient," said Leis, medical director of infection prevention and control at Sunnybrook Health Sciences in Toronto. 

In certain cases where antibiotics are no longer an option, doctors are turning to surgical methods to control infections, he added.

In 2018, one-quarter of bacterial infections were resistant to a first-line antibiotic used to treat them, and nearly 15 people died due to resistant infections, according to a 2019 report by the Council of Canadian Academies. The same report predicts resistance rates will rise to 40 per cent by 2050. 

Meanwhile, the U.S. Centers for Disease Control says at least 28 per cent of the antibiotics prescribed by doctors are considered unnecessary and contribute to superbugs.

But proper stewardship of the potentially life-saving drugs — using them only when prescribed, for the bacterial infections they treat — can help ensure they remain effective. In June, the Public Health Agency of Canada released a five-year, pan-Canadian plan to combat antibiotic resistance.

Wait-and-see for common infections

Dr. Daniel Flanders, a pediatrician in Toronto, says he works hard to prescribe antibiotics only when necessary, but acknowledges that there's a balance between practising antibiotic stewardship and providing good service to patients.

"I think we need to get better and better at communicating reasons why we might choose not to treat someone's child or someone's infection with antibiotics," he said.

Best practices have shifted rapidly, even in the last two decades, Flanders explained. For example, when a child came into a clinic with a middle-ear infection (otitis media) 15 years ago, an antibiotic would almost always be prescribed.

Now, doctors are more likely to take a wait-and-see approach and allow the infection to resolve on its own. 

"Lo and behold, the majority of ear infections don't need antibiotics to get better," Flanders said. 

The "watchful waiting" method can apply to a number of other common conditions. Many "above the neck" infections — sinus and ear, throat and chest — typically resolve on their own, Saxinger explained.

Urinary tract infections and diarrheal illnesses, unless complicated with symptoms like whole body infections or blood in the stool, can also be resolved without antibiotics, she added.

"There should always be some ability to kind of touch base [with a doctor] in a day or two to make sure things aren't going off the rails, and the patient should always be counselled about what to look out for," Saxinger said.

What to ask a doctor about antibiotics

The World Health Organization says individuals can help reduce the spread of antibiotic resistance by using antibiotics as directed and, crucially, only when prescribed. The organization adds that patients should never demand antibiotics from a health-care provider.

Leftover antibiotics should never be used, and they should be disposed of properly at a pharmacy. Practising good hygiene is also recommended.

If antibiotics are prescribed, Leis says patients should ask their doctor three questions:

• Do I really need antibiotics and what is the reason they're being prescribed?

• What are the risks and side effects of this course of treatment?

• Are there any simpler or safer options or any alternatives?

Ultimately, Flanders says it's not about discouraging people from visiting their doctor — it's about building trust.

"It makes much more sense to make the mistake of going there and overreacting so that you can kind of learn better and better each time when to come and when not to come," he said.

"Then, let the doctor worry about whether antibiotics are necessary."