Disease Season: Viral Vs. Bacterial infections

We’ve all been there … cold winter weather hits and brings with it coughing, sneezing and sniffling as well as sinus and ear infections, upset stomach and fever.

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If you have been suffering this season, you are not alone – not for a long shot.

According to Dr. Stanley Martin, Director of Infectious Diseases at Geisinger Health System, a recent survey showed that there are 500 million upper respiratory infections in the United States each year.

“That’s huge,” Martin said. “The economic impact is equally great because people lose work or school,” he said. “The average adult has approximately two to three colds per year and the average child has at least two or more.”

Almost all of those colds, Martin explained, are caused by viruses.

“There are a lot of different viruses that cause them (upper respiratory infections),” he said.

Infections of the upper airways, particularly the sinus, are “extraordinarily common” at this time of year. Symptoms range from facial pressure, low grade fever, headache, nausea, diarrhea and inflammation of the nasal passages and may be enough to send you running to the doctor.

So what do you do if you find yourself feeling under the weather? You might think that a trip to the doctor’s office is your first step. Unfortunately for most, there is not much that a doctor can do to help.

“Sinusitis, ear infections, laryngitis and sore throat – all these things are clustered in upper respiratory tract infections and are extremely common in patients this time of year,” Martin said. “And of course, the common cold is the most common form of illness at this time.”

The problem is that most of these diseases are viral non-bacterial, so doctors can only advise patients to treat their symptoms with over-the-counter medications, liquids and plenty of rest.

“Ninety-seven to 98 percent of sinus infections begin as a virus,” said Jennifer Rager, DO, Sunbury Community Hospital and the Outpatient Center. “That means the treatment is conservative – antibiotics will not work.”

Antibiotics are only good when treating bacterial infections, Rager explained, and giving a patient a prescription too soon can do more harm than good.

“Since most breast infections are viral, if you are treated with an antibiotic, a patient will begin to develop a defense immune to the medication and then will not function effectively in the future,” he explained.

Too often doctors are quick to prescribe antibiotics, however, Martin said, because patients insist.

“Many times prescriptions are patient-driven,” he admitted. “Some patients put a lot of pressure on their doctor to get an antibiotic believing it will help them better.”

That simply is not the case, he said.

“From my point of view as a doctor of infectious diseases, the biggest riddle is the over-prescription of antibiotics – there are no effective antibiotic treatments for a viral infection,” he said.

In fact, prescribing an antibiotic when it is not needed will do more harm than good because when a patient then gets a bacterial infection, he said, antibiotics will not work as well.

Like Rager, Martin agreed that a very low percentage of cases of sinusitis is related to a real bacterial infection and most should be treated with over-the-counter medications such as Tylenol and nasal saline.

“People tend to go to the Z-pack (Zithromax Z-Pak – an antibiotic that fights infections) a little too fast,” he said. “It’s a huge problem. There’s an average of about 700 antibiotic prescriptions per 1,000 people in this country and so few of them are actually related to bacteria.”

Despite the numbers, there are cases where bacterial infections are diagnosed and need to be treated. But how do you know the difference and when is it time to call the doctor?

“Give him at least a week and a half,” Rager said. “I know it’s not easy to hear when you feel sick, but really your best defense is to treat the symptoms until you feel better. They do not speed up the healing process, but getting an antibiotic will simply end its purpose.”

Martin noted that if at any point in the disease a lower respiratory disease develops in the lungs, experiencing a high fever (102 or more) or shortness of breath (particularly in elderly patients or those with underlying lung problems), a visit to a family doctor.

There is no simple test to determine if an infection is viral or bacterial, so your best defense against infections and colds at this time of year is to avoid catching one in the first place.

“Infections, including paranasal sinuses, are contagious,” Rager said, “and anyone can pass them through dirty hands, sneezing or coughing.”

“Hand hygiene is very important to try to prevent these infections from spreading,” Martin said. “When a patient who is infected is touched and then touches it, a doorknob can be transferred.”

As it turns out, Mom was right. Be sure to wash your hands, cover your nose and mouth when coughing and sneezing and using hand sanitizer are essential to stay healthy this winter season.