As a GP, I regularly see many patients complain of coughing and blocked noses. Almost invariably they are viral throat infections, but why is this common condition such a frequent presentation and cause many to seek medical help?
This may be owing to how dreadful it can make a person feel, or an expectation that a course of antibiotics may 'cure' the illness. Typical symptoms include coughing, a runny or blocked nose, a sore throat, and fever. Others include general muscle aches, headaches, and sensitivity to light.
It's not really possible to tell the difference between a sore throat caused by bacteria and those caused by viruses from the symptoms and examination alone. Doctors work on probability based on certain features to help them determine if it might be an infection caused by bacteria. The factors which increase the probability of it being a bacterial infection include:
- presence of a fever
- absence of a cough
- presence of exudates (whitish spots on the tonsils/back of the throat)
- presence of tender lymph nodes on the front part of the neck (lymph nodes are felt like small nodules, and they increase in size and sometimes become painful in the presence of a nearby infection)
These form the Centor criteria, and having all 4 features makes it around 70% likely to be a bacterial infection. We have to bear in mind that around 30% of people normally carry the main bacteria that causes bacterial throat infections, so it doesn't necessary follow that all infections with bacteria are truly bacterial in origin. This is because the mere presence of bacteria does not cause an infection. The bacteria need to increase to a high enough amount, and then ‘infect’ the surrounding tissue for it to be a true bacterial infection.
I usually reserve antibiotics for those that are unwell e.g. high fever, sweating, shaking episodes called rigors, very red throat with multiple white spots on the tonsils and surrounding area, high pulse rate and/or low blood pressure, prolonged duration of symptoms, etc. These are suggestive that the body is compromised by the infection, so needs additional support through antibiotics. Simply ‘feeling unwell’ isn’t quite enough to justify using antibiotics.
It's easy for a GP to give the patient what they want (antibiotics) but that would end up being a decision of convenience over evidence. So, the next time you have a sore throat, think twice or thrice and ask yourself if you are truly unwell and work out the probability of having a bacterial infection using the above 4 criteria.
For symptomatic relief, regular steam inhalation will be most helpful in cases where blocked nose, facial pain, pain behind the eyes or headache around the forehead area are prominent features, suggesting inflammation of the sinuses. This involves either filling a bowl with freshly boiled water and then using a towel over the head to create a localised sauna, or putting the shower on high heat and closing the window and doors in the bathroom, and breathing in the steam.
Other measures include gargling for around a minute a solution formed using dispersible anti-inflammatory medication (e.g. Aspirin or Ibuprofen) every 2-3 hours (evidence not great, but worth a try); and using saline (salt mixed with water) for nasal douching (sniff up the nostrils). It is of course expected that most will already be taking Paracetamol (and Ibuprofen if tolerated) to regulate the temperature and minimise pain.
It is worth bearing in mind that the effects of viral throat infections can last up to 5 or 6 weeks, in particular the cough. But if any symptoms last longer than 6 weeks, then it would be sensible to seek medical advice to make sure there is nothing else going on.
Disclaimer: the above article denotes the professional medical opinion of the author, and the general advice contained therein should not be used in isolation as personal medical advice. It is always recommended that you see a medical professional such as your own GP for any personal matters.
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