When to consider antibiotics?

Dear Friend,

We received a fair amount of response to the last pneumonia newsletter, so I wanted to follow up with some needed clarifications.

Thanks to all who reached out for my personal health, I’m doing great and almost back to 100%. I feel out of breath in the gym, but that’s probably deconditioning from not working out as regularly or intensely during the process.

Question: Should I have started antibiotics prior to getting checked out 3 weeks into my symptoms that eventually diagnosed a left lower lobe pneumonia?

Respiratory illnesses (sinuses, ears, throat, lungs) start out as a viral infections. Later the mucus or congestion, which the body cannot clear with the immune system can be populated by bacteria.

Pattern in the clinic: Too quick to treat with antibiotics

• Sinusitis

• Bronchitis

• Ear infection

Sinusitis: Text book recommendation is to wait 10 days of sinus congestion prior to antibiotics because these are more likely viral and require time to develop into a bacterial infection.

Bronchitis: By definition, this is in the large airways (Bronchi) and is a viral process.

Ear infection: Begins from sinus congestion and resulting pressure in the ears, thus a viral pattern. When I see a double ear infection (bilateral), I suspect this is more likely viral sinus congestion and pressure related. If only one ear is painful and the ear drum is red, then I consider a bacterial infection, but I still like to wait 2-3 days with over the counter treatment like Ibuprofen or Tylenol. If the symptoms improve, then there is no need for antibiotics as this is likely viral.

The Hasegawa kids have NEVER required antibiotics to date with this approach.

BACK to the question:

Knowing that it ended up being bacterial, antibiotics earlier would have limited the severity and progression. That said, starting antibiotics too early would have likely treated a viral picture and would have been ineffective.

Secondly, getting a chest XR too soon would not have shown a pneumonia. I would likely have persisted thinking it was viral and have been hesitant to get a second chest XR down the road, maybe delaying diagnosis and treatment further.

Looking back, the entire process felt different than any other respiratory illness including the original Covid which kicked my butt. Main symptoms being unable to take a full deep breath or it would cause uncontrollable coughing spells. The lesson being, trust your instincts if something is out of the norm.

In the future, if I get an illness that feels different from the typical symptoms, I would get a chest XR at 10-14 days into the symptoms. This would maximize the chances to see something on the chest XR and get antibiotics started at the ideal time.

At BodyTimeMD, we combine our existing knowledge and continuously adapt our practice style with new data including our own personal experiences. Let’s talk if you are interested in finding out more about your body.

 This newsletter is intended for informational purposes only and does not constitute giving medical advice or endorsing any treatment. The use or application of the content herein forms no doctor-patient relationship. The information in this newsletter should not substitute for professional medical evaluation, advice, diagnosis, or treatment. Always seek the advice of your physician or another qualified healthcare provider with any questions you may have regarding a medical condition.

Thanks,

Mike