Let’s start with the basics: Antibiotics are not preventive treatment.
We know that seasonal flu (virus A and virus B) as well as other respiratory viruses can cause high fever and cough for several days, such as Adenovirus, Rhinovirus, RSV respiratory syncytial virus.
Let’s talk about RSV
RSV is the one that last winter caused 15,000 hospitalizations in Italy alone, of which 3,000 ended up in pediatric intensive care and 16 DIED.
RSV is the one where the only children I saw hospitalized this year for bronchiolitis were children of super-informed parents who had refused prophylaxis with Nirsevimab, a highly effective and very safe monoclonal antibody.
It will be interesting to see the numbers at the end of the season, and hear what the web charlatans who dissuaded those same parents from protecting their children will have to say.
But what if the fever lasts long?
We know that bacterial pneumonia is generally the (rare) complication of a viral infection that presents its symptoms (fever, cough, fatigue, loss of appetite) for many days (more than the canonical 5 days but sometimes many more) and without showing signs of improvement, and indeed showing signs of worsening, as is frequent in children who present with worsening fever, cough, loss of appetite and fatigue.
That don’t go away.
Respiratory virus infections have one characteristic: they can cause multiple symptoms simultaneously affecting different organs, and cause different symptoms in different people to whom they are transmitted within a few days (this happens very often in families).
Remember SARS-CoV-2? Yes, Covid. How could we forget, you might say!
Which could cause:
- fever
- rhinitis
- pharyngitis
- cough
- laryngitis
- bronchospasm
- pneumonia
- hives
- gastroenteritis
- myocarditis
In some people one, in others another.
The infamous “bronchitis”
These days I often examine children with flu (which I diagnose with a rapid swab and discharge without any specific therapy) whose parents tell me they are also sick and already on antibiotic therapy for the infamous “bronchitis”.
What could they have, if they’ve had fever, cough, rhinitis, pharyngodynia, etc. in the same days?
Antibiotics for bacterial respiratory complications should be given ONLY once their presence has been verified, and not to prevent their onset, as some did during the pandemic during COVID, convinced this would treat the viral infection (against all knowledge of the last 100 years) or prevent bacterial superinfection;
Bacterial superinfection that however affected LESS than 4% of patients hospitalized for severe symptoms, let alone the % of those “treated” – falsely – with more or less early “home therapies”, on the home couch (source at the end of the article).
The discriminating factor is not fever.
If a person, adult or child, has the flu, the discriminating factor cannot be the duration of fever, exceeding 3-5-7-9 days; and even less its appearance after a variable number of days of cough
“I started antibiotics because fever appeared and the weekend was ahead” or similar things
One day it will become mandatory to diagnose bacterial respiratory complications (which will have to be called pneumonia and no longer “bronchitis”, which I don’t know what it is and which certainly doesn’t imply a bacterial cause) at least with CRP (C-Reactive Protein) testing and possibly also with radiological diagnosis (lung ultrasound or X-ray), BEFORE being able to prescribe antibiotics.
This will happen when the annual death of 12,000 people from antibiotic resistance in Italy alone, 1/3 of the total in all of Europe, will start to interest someone (politicians, not doctors!)
Viruses, including flu, can also cause pharyngitis.
With or without tonsillitis.
With or without “tonsil stones“.
How to proceed, then?
70% of pharyngo-tonsillitis are viral and to understand this it is NECESSARY to do a strep test (possibly rapid otherwise you have to wait 3-5 days for the result and poor children) BEFORE starting the only right therapy which is simple amoxicillin, in children at a dosage of 50 mg/kg per day divided into 2 doses, in adults 1 g once daily or 500 mg every 12 hours, in all cases for 10 days.
A paradox, in my opinion, that we do the swab in children before starting antibiotics, and not in adults.
Right?
Augmentin, Neoduplamox, Klacid, Zitromax, Cefixoral, Panacef, etc., are all, initially, wrong (leaving aside azithromycin which becomes first choice only in case of allergy to amoxicillin, keeping in mind however that 95% of hives occurring during amoxicillin therapy are parainfective and not related to the drug, but I’ve already gone on too long), as group A beta-hemolytic streptococcus (GABHS) has not yet developed resistance to simple amoxicillin.
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SOURCES
1. Westblade LF, Simon MS, Satlin MJ. Bacterial Coinfections in Coronavirus Disease 2019. Trends Microbiol. 2021 Oct;29(10):930-941. doi: 10.1016/j.tim.2021.03.018. Epub 2021 Apr 8. PMID: 33934980; PMCID: PMC8026275.
2. https://www.ansa.it/canale_saluteebenessere/notizie/medicina/2024/11/18/antibioticoresistenza-litalia-prima-in-ue12mila-morti-anno_c5b8631c-9005-442d-bb2b-016d9bd91e62.html
3. https://sip.it/2023/05/30/uso-dei-test-rapidi-per-la-faringotonsillite-e-trattamento-con-amoxicillina/