Internal Medicine
Acute Illness
"Do I need antibiotics?"
This is the most common question I have to answer in primary care. Most acute illnesses are viral, meaning there is no cure other than time. Our bodies are naturally good at healing. We only need antibiotics when bacteria becomes involved.
Viruses
Here are some general recommendations:
Examples
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Common cold
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Influenza (Flu)
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COVID
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RSV
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Adenovirus
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Parainfluenza virus (croup)
Supportive care
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Hydration
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Rest
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Saline nasal sprays and rinses
Recommendations:
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Stay away from others
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Wash hands frequently
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Cover your mouth when coughing or sneezing
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Avoid touching mucous membranes (eyes, mouth, nose, etc)
Over the counter medication
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Nasal steroid sprays for post nasal drip and congestion
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Guaifenesin (expectorant) for congestion
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Dextromethorphan (cough suppressant)
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Decongestants* for sinus pain
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Antipyretics (fever reducers) and pain meds such as Acetaminophen and NSAID's* such as Ibuprofen
*AVOID if you have high blood pressure or arterial disease/ blockage
Common bacterial illnesses
Strep throat
Strep throat is a specific bacterial infection of the throat with a bacteria called group A streptococcus.
Most common symptoms are fever, sore/painful throat with painful swallowing, pus on the tonsils, nausea, and lack of cough.
Gargling with warm salt water and taking NSAID's if allowed are supportive care options to help with symptom relief. Both reduce inflammation and swelling in the throat and therefore reduce pain. Gargling with warm salt water is a natural disinfectent as well.
Antibiotics are required if strep is confirmed. See below for our diagnostic tool.
Sinus Infections
Sinus infections may be viral, allergic, or bacterial.
Most common symptoms include nasal and sinus congestion, sinus pain and pressure, jaw or teeth pain, headache, swelling of the face, ear pain, sore throat due to post nasal drip.
Using saline nasal sprays and/or a rinsing system like the NetiPot Medi Bottle with saline packets and distilled water (purchased over the counter) can be very helpful in reducing nasal mucous, congestion, and post nasal drip which can lead to ear pain and sore throat.
If not on oral steroids, nasal steroid sprays can be helpful as well.
Cool compresses placed over the sinuses reduce swelling and help promote drainage.
Antibiotics and steroids may be required for treatment.
Azithromycin (Z-pack) antibiotic is no longer recommended as this antibiotic has increased resistance and does not penetrate into the sinuses well.
Pneumonia
Pneumonia can be primary (the initial source of infection) or may be secondary to a viral illness such as flu or COVID.
Most common symptoms include fever, cough, shortness of breath, wheezing, chest pain, and fatigue.
Pneumonia can cause serious fatigue that lasts much longer than the infection itself and most people say they do not feel back to their normal selves until 6-12 weeks later, especially when hospitalization is required.
Rest, cough medicine, and hydration are key!
Antibiotics are usually required.
Sometimes steroids and inhalers are prescribed to help with symptom management.
Cellulitis
Cellulitis is an infection of the skin. The most common bacterial causes are streptococcus and staphylococcus.
Staphylococcus usually causes an abscess at the site of infection which then requires incision and drainage.
Most common symptoms are redness, swelling, warmth, and sometimes streaking of the skin around the site of infection. If an abscess if present, is will feel fluctuant and tender to touch. Sometimes it has a head to it like a pimple. DO NOT POP THIS ON YOUR OWN!
Warm compresses can help if an abscess is present.
Antibiotics are usually required.
Centor's criteria is used to determine the likelihood of having strep throat and whether testing and treatment is required.
