Mrs. Langevin (a fictitious name) comes to the clinic without an appointment with a sore throat lasting for 3 days. She asks for an antibiotic to feel better quickly. The last time she consulted for the same reason, the nurse practitioner prescribed her an antibiotic, and she felt much better after a few days. Was it really the antibiotic that made the difference?

I took antibiotics and I got better!

If you have ever taken an antibiotic for an infection and felt better after a few days, there are two possible options: either it was a bacterial infection that responds well to treatment, or it was a viral infection and it was simply your immune system doing its job, not the antibiotic. For example, tonsillitis can be viral or bacterial. Conversely, laryngitis is always viral. Symptoms caused by viruses are not necessarily less severe than those caused by bacteria. Some viruses can be treated with antivirals, such as oral or genital herpes and shingles.

Virus or bacteria?

Both viruses and bacteria are microorganisms that attack the body. Each microorganism causes its own symptoms with varying intensity. Without going into cellular biology details, it is important to note that bacteria are larger than viruses and generally require antibiotics to be eliminated. So, within a few hours, antibiotics begin to act by eliminating the bacteria, which helps reduce debilitating symptoms. Viruses, on the other hand, do not respond to antibiotics. They are eventually stopped by the immune system. Of course, people with weakened immune systems will have more difficulty overcoming infections, which can lead to complications.

There are symptoms that don’t lie!

False. Some signs can be misleading. For example, colored nasal discharge does not necessarily mean the infection is bacterial. The same goes for fever. However, a fever lasting more than 5 days is generally bacterial in origin. It is recommended to wait at least 48 hours of fever before consulting, as it is more difficult to distinguish between viral and bacterial causes during this time.

Back to Mrs. Langevin

The throat culture test performed on Mrs. Langevin ruled out the presence of bacteria. It remains to be explained to Mrs. Langevin that the only treatment available for viral tonsillitis is symptom relief with over-the-counter products under the guidance of her pharmacist. Patience will also be required!

Why are we cautious about prescribing antibiotics?

Allergic reactions, C. difficile infections, drug interactions, and antibiotic resistance are some examples highlighted by Dr. Vadeboncoeur to justify reluctance in prescribing antibiotics. He points out an interesting fact in his article in L’actualité: people who fear vaccines should be more afraid of antibiotics!

Some examples of infections that can be viral and/or bacterial

Common reasons for consultation

• Laryngitis: virus
• Otitis: virus or bacteria
• Pharyngitis: virus or bacteria
• Tonsillitis: virus or bacteria
• Sinusitis: virus in most cases, can complicate into bacterial infection
• Common cold: virus
• Flu: virus
• Gastroenteritis: virus
• Bronchitis: 90% viral origin
• Pneumonia: virus or bacteria
• Conjunctivitis: bilateral usually viral; unilateral without other upper respiratory infections more likely bacterial
• Urinary tract infection: bacteria

Common childhood illnesses

• Scarlet fever: bacteria
• Roseola: virus
• Fifth disease: virus
• Hand-foot-and-mouth disease: virus
• Impetigo: bacteria
• Meningitis: virus or bacteria
• Measles: virus
• Rubella: virus
• Chickenpox: virus

Sexually transmitted infections

• Chlamydia and gonorrhea: bacteria
• Genital warts: virus (HPV)
• Herpes: virus
• Syphilis: bacteria
• Hepatitis: virus

What can be done to prevent these invaders?

Hygiene measures and infection prevention remain the first line of defense. For viruses, vaccination remains the preferred method to prevent many infectious diseases.

Mrs. Marie-Ève Denis, IPSPL PRAXIS Family Health Clinic

References consulted

• INESS Guide. National Institute of Excellence in Health and Social Services. Viewed January 2018. Retrieved from: http://www.inesss.qc.ca/publications/guides-de-linesss.html
• Exanthematous diseases, purpuras, and dermatitis in children. Jean-Bernard Girodias. 2010. CHU Ste-Justine. Retrieved from: http://www.urgencehsj.ca/wp-content/uploads/maladie-eruptives.pdf
• Vadeboncoeur, Alain. (2016). Antibiotics: Use only when necessary. L’actualité Review.