The use of antibiotics in the treatment of respiratory infections

Dr. Eddie Louie/Author,
Infectious Disease Specialist

“Diseases of the respiratory tract are among the most common human diseases in all age categories. In the vast majority of cases, diseases of the respiratory tract are infectious in nature, that is, caused by various microbes. The infectious nature of the disease, as is known, suggests the possibility of using various antibiotics in its treatment. We will talk about the rationality of antibiotic therapy in the treatment of infectious diseases of the respiratory tract in this article.”

Author Biography: Dr. Eddie Louie is a Infectious Disease Specialist – General practicing in New York, NY. See Profile.

Respiratory diseases

The respiratory tract includes the nasal cavity, paranasal sinuses, nasopharynx, lower parts of the pharynx, larynx, trachea, bronchi, and alveoli of the lungs.

Causes of diseases of the respiratory organs can be very diverse: infection, chemical irritation, allergic reaction.

Regarding infectious diseases, a variety of microbes can be the cause of the disease: viruses, bacteria, fungi.

Determining the cause of the disease plays an important role in prescribing adequate treatment. In the case of infectious diseases, the main question that needs to be resolved is: should antibiotics be used or not?

Below, on the example of some of the most common respiratory diseases, we describe the main ways to solve this problem. Before proceeding to the consideration of the principles of treatment of various respiratory diseases, it is worth considering the etiological affiliation of respiratory infections, as well as the problem of infectious associations.

What microbes cause respiratory diseases and why is it important to know?

Every minute, thousands of different microbes are deposited on the mucosa of our airways. The most dangerous of them are various viruses that can cause the development of the disease in a few hours. Bacteria are in second place. Less commonly, respiratory diseases are caused by fungi.

However, this separation of infections of the respiratory tract is purely theoretical: in reality, most infections are mixed.

The most common type of microbial association is viruses + bacteria. In this pair, viruses attack first and cause primary lesion of the respiratory tract – they create favorable conditions for the accession of a bacterial infection, which will determine the further development of the disease.

If we consider this issue from the point of view of the rationality of the use of antibiotics, it is important to note that antibiotic therapy is indicated only in the case of bacterial infections and viral-bacterial associations.

Antibiotics for rhinitis

Among all diseases of the respiratory tract runny nose is the most common. In most cases, the causative agents of rhinitis are various viruses or allergens. However, secondary bacterial infection is often observed, which complicates the course of the disease.

With the usual cold (watery nasal discharge), antibiotics should not be used. Indications for the use of antibiotics is the development of chronic rhinitis. The diagnosis of chronic rhinitis is made by the ENT doctor after a detailed examination of the patient.

Antibiotics for sinusitis

Sinusitis (inflammation of the paranasal sinuses) often accompany a runny nose or other types of respiratory tract infections. The main symptoms of sinusitis are a feeling of pain or pressure in the cheeks or forehead over the nose, nasal congestion, and fever.

Unlike the common cold, the treatment of sinusitis almost always involves the use of antibiotics, since in most cases the cause of the disease is bacteria. Preferably the use of antibiotics in the form of capsules and tablets for oral administration.

The type of antibiotic, the dosage and the duration of treatment are determined by the physician by the patient’s specialist. Recently, due to an increase in the prevalence of chlamydial and mycoplasmal infections, macrolide antibiotics are increasingly being used in the treatment of sinusitis. In children, the appointment of short courses of antibiotic Azithromycin is indicated.

Antibiotics for sore throat and pharyngitis

Angina (tonsillitis) is an inflammation of the tonsils. Most often, sore throat is bacterial. A sign of the bacterial nature of angina is the appearance of purulent plaque or purulent plugs on the tonsils. In some cases, plaque or traffic jams appear only a few days after the onset of the disease – this means that a bacterial virus has joined the primary viral infection.

The use of antibiotics for sore throat is advisable only in case of severe and often recurring sore throat – in such situations it is simply necessary to use antibiotics to prevent complications of this disease. Signs of severity of tonsillitis are a significant increase in the size of the tonsils, severe pain when swallowing, swelling of the throat, high fever, deterioration of the patient’s general condition.

In children, frequent streptococcal tonsillitis occurs, which can occur in the type of scarlet fever. When scarlet fever at the same time with a sore throat, the patient appears a rash on the skin. Suspicion for scarlet fever or severe course of a common sore throat is an indication for the use of antibiotics. In most cases, as the usual sore throats, and scarlet fever used antibiotics from the group of penicillins.

If it is not possible to use penicillins, antibiotics from the group of cephalosporins or macrolides can be used.

Antibiotics (penicillins) can continue after the main treatment of angina. In this case, antibiotics are prescribed to prevent the occurrence of autoimmune complications of the disease.

Pharyngitis is an inflammation of the pharyngeal mucosa. Symptoms of pharyngitis are burning and sore throat, pain when swallowing, bad breath. In the case of pharyngitis, the use of antibiotics is indicated only for chronic forms of the disease and the presence of obvious signs of infection.

The form of the disease, the type of antibiotic and the duration of the course of treatment are selected individually for each patient.

Antibiotics in the treatment of laryngitis and tracheitis

Laryngitis (inflammation of the mucous membrane of the larynx) and tracheitis (inflammation of the mucous membrane of the trachea) are quite common as satellites of various colds. The main symptom of laryngitis is hoarseness. Children with laryngitis may develop shortness of breath. For tracheitis, the appearance of a strong chest cough, which is accompanied by severe pain behind the sternum. Both diseases occur on the background of increasing temperature and deterioration of the patient’s general condition.

In most cases, the primary cause of laryngitis and tracheitis are viruses, but very soon bacterial infection is added to the viral infection.

The use of antibiotics in the treatment of laryngitis and tracheitis is indicated only in severe cases of disease, in the presence of obvious signs of bacterial infection: the release of purulent sputum, a strong increase in temperature, chills. In these cases, it is advisable to use antibiotics from the group of penicillins. With the ineffectiveness of natural penicillins, antibiotics from the group of semi-synthetic penicillins or other groups can be used.

Antibiotics in the treatment of bronchial diseases

Among the diseases of the bronchi, the most common are the following: Bronchitis – acute or chronic inflammation of the mucous membrane of the bronchi of a predominantly bacterial nature. Despite the fact that in many cases the primary cause of bronchitis is a viral infection, the further development of the disease is determined by the accession of a bacterial infection.

Symptoms of bacterial bronchitis occur on the 3-4th day of the disease: deterioration of the patient’s general condition, the appearance of abundant purulent sputum, fever. In such cases, it is desirable to treat with antibiotics to prevent complications of bronchitis and the transition of the disease to the chronic form.

Chronic obstructive bronchitis and COPD are the most common forms of bronchial disease in adults. Bacterial infection plays an important role in the development of these diseases, as chronic bacterial inflammation contributes to the gradual narrowing of the lumen of the bronchi and the replacement of lung tissue with connective tissue.

All cases of chronic obstructive bronchitis and COPD (chronic obstructive pulmonary disease) require a course of treatment with antibiotics. The most commonly used antibiotics from the group of semi-synthetic penicillins and cephalosporins.

Bronchial asthma is manifested by the occurrence of periodic asthma attacks and chronic cough. The role of the infectious factor in the development of bronchial asthma is great in the case of infectious-allergic asthma in adults: chronic bacterial infection contributes to the establishment of increased bronchial reactivity.

For this reason, antibiotic treatment is an integral part of comprehensive asthma treatment. To avoid asthma exacerbations, antibiotics that are allergic to the patient are used during treatment.

Antibiotics in the treatment of pneumonia

Pneumonia is characterized by inflammation of the lung tissue. In most cases, inflammation in pneumonia is bacterial in nature. Prescribing antibiotics is the main treatment for pneumonia. In fact, prior to the invention of antibiotics, pneumonia was considered a disease with an increased mortality potential.

Nowadays, due to the use of modern antibiotics, deaths from pneumonia have become very rare. In the treatment of severe forms of pneumonia, antibiotics are used for intravenous administration.

Due to the high prevalence of atypical pneumonia in children (mycoplasma and chlamydial pneumonia), the use of macrolide antibiotics has been shown in these patients.

Antibiotic treatment is a complex and responsible procedure. In no case can you take antibiotics on your own; this can lead to serious complications and the formation of antibiotic-resistant strains of microbes; therefore, it is recommended to coordinate any issues related to the use of antibiotics with your doctor.

Author: Dr. Eddie Louie , Infectious Diseases & Immunology, Internal Medicine, Phone: (212) 682-9202