Advice for cold and flu season

By: Guylène Thériault and Wendy Levinson

Cold and flu season for many Canadians means getting ready to have their lives and routines thrown off by painful and annoying symptoms. This can mean days off work or school dealing with sore throats, nasal congestion and fever. For parents, it can be challenging to try to comfort young kids with fever, coughing or ear pain.

As doctors, we know that both doctors and patients would love a quick fix — a magic bullet to deal with these symptoms. Patients want to get their lives back to normal as quickly as possible. Unfortunately, antibiotics are not usually the answer.

Antibiotics are commonly misused because people mistakenly believe they will treat the symptoms of colds and flus. In fact, fever, cough and ear pain are usually due a virus — and viruses are not affected by antibiotics.

More than half of all antibiotic prescriptions in Canada are estimated to be unnecessary – and ineffective.

Common conditions that are usually viral in nature but that are often prescribed antibiotics unnecessarily include sinus infections, ear infections and chest colds (or bronchitis). Antibiotics do not typically help for any of these conditions and the symptoms will get better with simple rest and time.

It’s hard for us as physicians not to be able to offer a cure, and hard sometimes for our patients, to accept that there isn’t much to be done aside from managing their symptoms and waiting it out.

A good first step is for doctors and patients to have a conversation about the downsides of unnecessary antibiotics.

What harm can taking unnecessary antibiotics do?  Plenty.

When trying to treat symptoms which are caused by viral infections, antibiotics don’t help and can actually make patients feel worse.  Antibiotics work by stopping illness-causing bacteria from growing and multiplying. When diseases are viral in origin, not bacterial, antibiotics have no impact.

Using an antibiotic when not needed also promotes the growth of bacteria that are resistant to commonly-used antibiotics. This makes patients, especially the elderly, more vulnerable to antibiotic-resistant infections and undermines the good that antibiotics can do for us and others when they are truly needed.

There are also side effects to taking antibiotics; about one in four people who take antibiotics experience stomach upset, dizziness or skin rashes.

There’s a new tool that you may notice in your doctor’s office to help have conversations about when antibiotics aren’t necessary – it’s called a “viral prescription pad.”  This is a tear off sheet similar to what you might receive for a prescription, except it contains information about symptom-relieving strategies for fevers, aches and pains. It also explains the risks of unnecessary antibiotics and offers examples of when you should go back to see the doctor should your symptoms worsen.

Receiving no antibiotics for a cold or flu does not mean no treatment. It just means a different approach.

One way to start the conversation about whether or not an antibiotic is really necessary is to use these three questions developed by Choosing Wisely Canada when talking with your doctor: Do I really need antibiotics? What are the risks? Are there simpler safer options?

Dr. Guylène Thériault is a family Physician who practices family medicine in Gatineau, Québec. She is the Assistant Dean, Distributed Medical Education, Department of Family Medicine, McGill University.

Dr. Wendy Levinson is the Chair of Choosing Wisely Canada, a Contributor with based at the University of Winnipeg and a Professor of Medicine at the University of Toronto.