Upper Respiratory Tract Infections

 "I gotta sore throat, doc.  I need an antibiotic."


Most instances of sore throat, need, most instances of upper respiratory tract infections, are viral, and self resolve in a short time.  These are are treated with "symptomatic" therapies - throat lozenges, decongestants, etc.  Antibiotics will not help.  The fact that the infection resolves after a few days of an antibiotic is usually coincidence. It would have gotten better regardless. 


When assessing the sore throat, we look for four things - tender tonsillar lymph nodes (those that are just under the angle of the jaw); high fever; exudates on the tonsils; absence of a cough. If present, they can be suggestive of a bacterial - streptococcal - infection.  Absent these, the sore throat is likely viral in origin. 

Now, sometimes a person will comes in with a cold that has lasted three weeks - runny nose, sore throat, cough.  They give a history that is described as a "double sickening:"  they got sick, got a little better, then got sick again.  What has happened here is that the individual had a viral infection, which got better in the usual course of time.  That infection, however, caused enough inflammation of the nasal mucus membranes that it impaired proper drainage of the sinus cavities.  Allowing a proliferation of the typical bacterial flora of the nasal passages in the sinuses, this evolves into a bacterial sinus infection, which may warrant antibiotics (though, to be honest,  most will resolve untreated). 

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