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When should I take antibiotics for a cold that’s not getting better?

Ear, Nose & Throat

I have been having a cold for the last 1 week. It doesn’t seem to get better. I try not to take antibiotics as I read in the news that it is not good. What should I do?

DOCTOR’S ANSWER (1)

The common cold is a viral infection of your upper respiratory tract (includes the nose, sinuses and throat). There are over 200 viruses that can cause a cold and an adult may on average experience a cold two to three times a year. Young children (especially those less than 6 years old) are most at risk of getting a cold.

Common symptoms of a cold include:

  • Sore throat
  • Blocked nose
  • Nasal congestion (mucous stuck in the nose or face)
  • Runny nose (may be clear initially but usually becomes thicker and yellow, brown or green in colour later)
  • Postnasal drip (mucous dripping down the back of the nose to the throat)
  • Fever
  • General feeling of unwell (malaise).

As the common cold is usually caused by a virus, your body will fight it off within 7-10 days. You do not need antibiotics for this. Antibiotics does not work against viruses. You can take medications to relieve the symptoms of your cold, e.g. antihistamines and decontestants, lozenges, cough medications etc. These medications however do not help you fight off the cold. You are much more lightly to get better with adequate rest, sleep and good hydration.

If your symptoms are worsening on day 5 of your cold or the duration of your cold last longer than 10 days, it is likely that you have developed a bacterial sinus infection (known medically as sinusitis). These figures were derived from numerous studies to determine which group of patients will best benefit from a course of oral antibiotics if they suffer from a “prolonged cold”.

A bacterial infection of the sinus is treated with a course of oral antibiotics, nasal douche (wash of the nose with salt solution) and nasal steroid sprays. It is sometimes difficult to differentiate a cold from a sinus infection as the symptoms can be very similar. Having said that, a patient with a sinus infection tend to have less fever, body aches and sore throat and more facial pain.

It is best to consult your general practitioner or an ENT Specialist for an assessment. An ENT Specialist will usually perform a nasoendoscopy (scope through the nose) under local anaesthesia to look for signs of sinusitis in a patient with “prolonged cold”. If you were given a course of oral antibiotics for sinusitis, it is important to complete it to ensure complete eradication of the bacteria (unless you have a side effect or allergic reaction from the antibiotics). Partial treatment of a bacterial infection with antibiotics may potentially lead to bacterial resistance (ie the surviving bacteria can “learn” how to become “immune” to the antibiotics) which can threaten the effectiveness of common antibiotics in the future.

Hope this helps.


Dr Gan Eng Cern
MBBS, MRCS, MMed, FAMS

38 Irrawaddy Road #08-45
Mount Elizabeth Novena Specialist Centre
Singapore 329563


936 views 25 Jan 2018
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