I know, I know, don't use antibiotics for virus caused illnesses. However, I have a recent observation...

I have come down with the ick - whatever is going around these days in the San Antonio/Austin coridor. I don't get sick often, but when I do, it tends to either cause bronchitis or sinusitis. With the bronchitis, it can take over a month for me to get over it.

Never had a fever that I know of - checked a couple of times. I had some antibiotics that I bought last time I was in Mexico. I was feeling so bad on Sunday and could feel the bronchitis starting. I figured it wouldn't hurt to start antibiotics. So I did.

I felt bad yesterday. I feel so much better today. Chest congestion is almost gone. Head congestion let loose this morning. Am I on to something with starting the antibiotics when I know I'm getting sick, is it a placebo effect, am I flirting with antibiotic resistant strains?

Right now, I'm at the point where I say eff it and next time I start feeling bad, start the antibiotics. I'm shocked because normally, 4 days in I'm no where close even to be getting better. Am I still better off being sick for a month or so?

Unfortunately, there's no way of knowing. Unless you get tested for viruses and get a chest xray to evaluate for pneumonia, or other bacterial illness, we can't say for certain if you would've just gotten better on your own, or the antibiotics did anything.

Viruses are the most common cause of bronchitis, if that's what you have. I think less than 10% of bronchitis is from bacteria.

Also, there is no one antibiotic to rule them all. There are a couple that come close, but they're super expensive and require special approval from infectious disease doctors because they're kind of our last line of defense against multi-drug resistant organisms. Amoxicillin, azithromycin, and a few others are slowly becoming borderline useless because every doc-in-a-box prescribes them anytime anyone comes in with the sniffles.

Even bronchitis does not routinely benefit from the use of antibiotics, unless caused by bacterial etiology. There are some antibiotics that do have an anti-inflammatory effect, which is what you may be benefitting from more so than their anti-microbial effect (assuming you didn't have a bacterial source of your symptoms).

And again, there are dozens of potential viral causes. Some will have a shorter duration of symptoms than others. Your symptoms likely would have improved on their own. But the only way to know for sure is to do large scale clinical trials where the patient is blinded to whether they're getting antibiotics or placebo. Which have been done.

I have a screen shot of a urinary tract infection that is resistant to every antibiotic that's normally used against this bacteria. It's actually quite scary.

Edit to see if this pic will post:


Carbepenem based antibiotics are actually one of the bigger guns we have. Yet this is resistant to it.

All that makes sense logically. I just can't make it make sense based on my history of taking forever to get over colds and my propensity to have them progress into my chest. I get you want to use antibiotics sparingly, but with this experience, this five day crap I've had sure does seem to be going away very quickly for me.

Thanks bigtruck for the info.

I know the adult literature is big on bronchitis is viral but in kids it is almost always mycoplasma and benefits from azithromycin. Mycoplasma in kids has a distinctive course and sound to it vs viral bronchiolitis or wheezing. It is the only thing I use azithromycin for (aside from campylobacter colitis). Recently there has been a big uptick in mycoplasma in USA.

Mycoplasma Pneumoniae Infections Have Been Increasing | NCIRD | CDC

Typically it is preceded by parainfluenza that gives a croup/laryngitis picture. Most patients get over that in 3-5 days, roughly 30% end up with secondary mycoplasma. Starting antibiotics early does not seem to help.

KidDoc said:

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I know the adult literature is big on bronchitis is viral but in kids it is almost always mycoplasma and benefits from azithromycin. Mycoplasma in kids has a distinctive course and sound to it vs viral bronchiolitis or wheezing. It is the only thing I use azithromycin for (aside from campylobacter colitis). Recently there has been a big uptick in mycoplasma in USA.

Mycoplasma Pneumoniae Infections Have Been Increasing | NCIRD | CDC

Typically it is preceded by parainfluenza that gives a croup/laryngitis picture. Most patients get over that in 3-5 days, roughly 30% end up with secondary mycoplasma. Starting antibiotics early does not seem to help.

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You do outpatient peds right? What prompts treatment in those kids? Do you do PCR for mycoplasma? Or chest X-ray? Or the clinical picture with a second sickening?

bigtruckguy3500 said:

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KidDoc said:

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I know the adult literature is big on bronchitis is viral but in kids it is almost always mycoplasma and benefits from azithromycin. Mycoplasma in kids has a distinctive course and sound to it vs viral bronchiolitis or wheezing. It is the only thing I use azithromycin for (aside from campylobacter colitis). Recently there has been a big uptick in mycoplasma in USA.

Mycoplasma Pneumoniae Infections Have Been Increasing | NCIRD | CDC

Typically it is preceded by parainfluenza that gives a croup/laryngitis picture. Most patients get over that in 3-5 days, roughly 30% end up with secondary mycoplasma. Starting antibiotics early does not seem to help.

---

You do outpatient peds right? What prompts treatment in those kids? Do you do PCR for mycoplasma? Or chest X-ray? Or the clinical picture with a second sickening?

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Yup outpatient peds.

Exam + preceding viral picture. The local urgent cares have mycoplasma on their PCR but St Jo still doesn't include it so we have no real way to test rapidly. The x ray always shows increased peribronchial markings so not helpful.

Makes sense. Your post actually made me double think a kid early this morning. Asthmatic 4 y/o. Cough started a month ago, and they went to yellow on their asthma action plan, and then to red tonight with extra albuterol and flovent. Kid actually had great air movement without wheezing. But I almost didn't get a respiratory panel. There was no mycoplasma, but she had rhino/entero + RSV. CXR negative. Just gave a dex and a duo neb. Lungs sounded the same, but she said she felt better.

Thanks for the CME. Will be on my mind more now.

This happens with my husband. The kids or I will bring home a normal cold. If he gets it, it will go to his chest immediately and he will do antibiotics just to get it to go away. Otherwise it's weeks of being sick and coughing up junk.