Viral vs Bacterial - What's the Difference?

We've all been there. Your child sneezes in your face, or you're forced to shake hands with a client who just finished a coughing fit. You reach for hand sanitizer and vitamin C, but two or three days later you start to feel that scratchy tickle in the back of your throat. Soon, your nose hurts from using scratchy tissues, your voice is reduced to a whisper, and you're sure you'll never recover without outside help. You call your family doctor and head in. She listens carefully to your story, expresses genuine empathy for your pain, then tells you it's likely a virus and you don't need an antibiotic. Now what?

Standard advice includes rest and fluid. You can also take ibuprofen or acetaminophen to help with your fever and aches. Lozenges and throat sprays can help with sore throats, and dextromethorphan found in most cough syrups can help minimize coughing in children. (Studies show cough syrups don't seem to help adults). You can also try some nasal sprays and oral decongestants such as "Afrin" and pseudoephedrine, but don't use these for more than a few days - check the label for instructions. A humidifier makes breathing easier, and saline drops can help loosen some of that drainage for kids who haven't yet learned to blow their nose. "Vicks VapoRub" can help children ages 2 and up when applied to their chests, and if they're younger you can put a little on their feet under socks or a sleeper. Honey is safe for kids over a year. Just remember no OTC cold and cough remedies are approved for anyone under 4, so talk to your doctor before giving them anything.

How can you tell the difference between a viral infection that mostly relies on time to recover, versus a bacterial infection that will only resolve with an antibiotic? While it does require training and clinical skills to make a proper diagnosis, there are some tricks to determine if you should see your physician. Or if resting at home and saving that copay is the most appropriate care. 

If you have a fever, it does not mean you have a bacterial infection, as fevers are common with viral infections. Unless you're under a year old or have certain medical conditions, we don't get too excited about temperatures under 103F. Fevers are the body's natural way of fighting off infection by turning up the temperature to kill off the offending bug. If you or your child is miserable, a dose of acetaminophen or ibuprofen can minimize the fever and reduce other symptoms. If you have a fever of 103F or higher, you're more likely to have a bacterial infection. However, one virus that tends to cause high fevers and body aches this time of year is influenza or the respiratory flu. Discuss with your physician whether you would benefit from the antiviral medication Tamiflu; you need to start it within 48 hours of becoming ill.

Speaking of timing, are there ways to know what's causing your infection based on how long you've been sick? Absolutely! If you've only been sick for a few days, chances are you have a virus. If your symptoms are persisting past ten days, or you suddenly start getting worse about a week into your illness, it's more likely that you need antibiotics. You can often save yourself a visit if you wait it out at home for at least a week before seeing your doctor. 

What about the color of your nasal drainage? You may have heard that green or yellow mucus is a sign of a bacterial infection, but that isn't always true. The color is probably due to an increase in the number of certain immune system cells fighting off the infection. If at the 7 to 10 day mark your drainage seems to be getting worse, or you're developing sinus or dental pain in one area of your face or head, it's more likely you have a bacterial sinus infection.

A few notes about other illnesses: Whooping cough, which requires antibiotics, is characterized by a coughing fit with a gasp of air that makes a "whoop" sound. Croup is viral involves a barking cough and a hoarse throat, and tends to affect kids ages 3 and younger. Most bronchitis is viral, and almost never requires antibiotics unless you have an underlying chronic lung disease. Steroids or inhalers can help with some of these coughs. So, if you're not sure what you have or you're not getting better, see your doctor. Strep throat is a bacterial illness, and usually the sore throat is the most prominent symptom; if you have a runny nose and cough too it's probably viral. Mononucleosis or "mono" is also characterized by a sore throat, but is viral and taking antibiotics can cause a rash reaction. We tend to treat ear infections in little ones, but older children and adults will almost always recover without antibiotics. 

If you're still uncertain about your diagnosis, a visit to your primary care doctor is a great option to make sure you aren't missing anything more serious. Also, don't forget to cover your cough and wash your hands often to prevent spreading the germs to your friends and family. Wishing you all a healthy 2020!