Gargling May Still Be Best For a Cold

NEW YORK (Reuters Health) - Although some people may demand antibiotics at the first sign of a sniffle, a physician's group says most upper-respiratory infections do not require antibiotics and are better treated with over-the-counter cold remedies and old-fashioned salt water gargles.

Antibiotics are effective only against bacteria, and since a majority of cases of acute bronchitis, sinus infection, sore throat and general upper-respiratory infection are caused by viruses, antibiotics will not wipe away most patients' misery. In fact, antibiotic treatment of colds, bronchitis and other upper-respiratory infections is ``almost always inappropriate,'' according to the American College of Physicians-American Society of Internal Medicine (ACP-ASIM).

Inappropriate use of antibiotics is a major reason that certain bacterial infections have become resistant to the drugs that once kept them in check. The more an antibiotic is used, the more often bacteria are exposed to it, which helps the germs mutate into forms that resist treatment. According to the ACP-ASIM, up to 75% of antibiotic prescriptions each year in the US are for acute respiratory infections.

To stem the tide of treatment-resistant bacteria that has risen over the past decade, the organization has issued guidelines on antibiotic use in the March 20th issue of the Annals of Internal Medicine.

Although certain upper-respiratory infections such as strep throat and some sinus infections may require antibiotics, the majority do not, according to the guidelines. Strep bacteria cause about 10% of sore throat cases in adults, and sinusitis is sometimes caused by bacteria.

According to the ACP-ASIM, doctors may indiscriminately use antibiotics because they believe they will help a small percentage of patients or because they want to prevent the complications of an undiagnosed bacterial infection.

However, the ACP-ASIM notes, these benefits are theoretical, while the ``potential harm of this practice is well established at the level of the patient and society.''

The guidelines are based on data from the Centers for Disease Control and Prevention in Atlanta, Georgia.

SOURCE: Annals of Internal Medicine 2001;134:479-486.

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