Do antibiotics help with cough and cold?

Antibiotics Do NOT Help Cough and Cold

Antibiotics are rarely effective for acute cough and are not indicated for the common cold, acute bronchitis, or uncomplicated upper respiratory infections. 1

The Evidence Against Antibiotics for Cough and Cold

Why Antibiotics Don't Work

• Viruses cause more than 90% of common colds and acute bronchitis, making antibiotics completely ineffective since antibiotics only target bacteria 2, 3
• The ACCP (American College of Chest Physicians) evidence-based guidelines explicitly state that antibiotics have no benefit for acute cough from the common cold 1
• Multiple high-quality guidelines confirm antibiotics should not be used for common cold, influenza, or acute bronchitis 3

The Harm of Inappropriate Antibiotic Use

• Antibiotics are associated with significant adverse effects including diarrhea, allergic reactions, and gastrointestinal symptoms without providing any symptom relief 4, 3
• Inappropriate antibiotic prescribing directly contributes to antimicrobial resistance, making future bacterial infections harder to treat 5, 6, 3
• Using antibiotics when not indicated adds unnecessary costs and exposes patients to risks without any benefit 3

What Actually Works for Cough and Cold

First-Line Effective Treatments

• Combination antihistamine-decongestant products (first-generation like brompheniramine with pseudoephedrine) provide significant relief, with approximately 1 in 4 patients experiencing meaningful improvement 1, 7, 4
• NSAIDs (naproxen or ibuprofen) effectively relieve headache, ear pain, muscle/joint pain, malaise, and improve sneezing 1, 7, 4
• Ipratropium bromide nasal spray is highly effective for reducing runny nose (rhinorrhea), though it doesn't help congestion 7, 4

Additional Helpful Options

• Zinc lozenges (≥75 mg/day) started within 24 hours of symptom onset significantly reduce cold duration 7, 4
• Nasal saline irrigation provides modest symptom relief without side effects 7, 4
• Oral or topical decongestants (pseudoephedrine or oxymetazoline) have small positive effects on nasal congestion, but limit use to short-term (3 days maximum) to avoid rebound congestion 7, 4

When to Consider Antibiotics (The Exceptions)

Specific Bacterial Complications Only

Antibiotics are only appropriate when a bacterial complication develops, not for the viral cold itself:

• Bacterial sinusitis - but NOT during the first week of symptoms, as viral infections cause identical sinus imaging abnormalities that resolve without antibiotics 1
• Pneumonia - confirmed by clinical findings and/or imaging 1
• Pertussis (whooping cough) - if given early in illness 1
• Severe COPD exacerbations in current/former smokers with severe airflow obstruction 1

Red Flags Requiring Reassessment

• Symptoms that worsen after initial improvement (biphasic course) suggest possible bacterial superinfection 1, 7
• Symptoms persisting beyond 10 days without ANY improvement may warrant consideration of bacterial sinusitis 7
• Development of high fever after initial cold symptoms 7

Natural Course of the Common Cold

• Cough is worst during the first few days and gradually improves over 1-2 weeks 1
• Approximately 25% of patients still have symptoms at day 14, which is completely normal and does NOT indicate bacterial infection 1, 7
• Only 0.5-2% of viral upper respiratory infections develop bacterial complications 7

Common Pitfalls to Avoid

• Don't prescribe antibiotics based on symptom duration alone - colored (green) sputum does NOT reliably indicate bacterial infection 2
• Don't prescribe antibiotics due to patient/family pressure - use effective communication strategies to explain why antibiotics cause harm without benefit 2, 3
• Don't diagnose bacterial sinusitis in the first week - viral infections cause identical sinus inflammation that resolves spontaneously 1
• Don't assume antibiotics will prevent complications - they don't reduce the 0.5-2% bacterial complication rate 7

What Patients Should Be Told

• Antibiotics do not treat viral infections like the common cold 5, 6
• Taking antibiotics when not needed increases future antibiotic resistance and makes bacteria harder to treat later 5, 6
• The common cold is self-limited and typically resolves in 7-10 days with symptomatic treatment only 7, 4
• Effective symptom relief comes from antihistamine-decongestant combinations, NSAIDs, and supportive care - not antibiotics 1, 7, 4