How well have you responded to antibiotics when you have bronchitis?

September 10, 2014 5:15 PM

I have this problem: every time I'm stressed and the temperature changes, I start to get sick. Not really sick - just a sore throat and chest pain and a general feeling of being unwell. But then I get really sick - the sore throat disappears, I get feverish, I'm exhausted and I cough up tons of nasty mucus, and I am basically not functional at all.

I'm fairly certain that what I get is bronchitis - usually a doctor now and then will hear it in my chest. Most doctors are very reluctant to give me antibiotics for it. I understand that there is a big problem with overprescription of antibiotics. I also get the fact that bronchitis is usually caused by viruses and that antibiotics won't work against a viral infection.

But the thing is, when I don't get antibiotics, I remain sick and I actually get sicker. Once I get antibiotics (Biaxin twice a day), within 48 hours I feel much better. It is always 48 hours, never more, never less. I can think straight, I can walk without feeling exhausted, and I don't feel that feverish anymore. The issue is that it takes usually a week for me to find a doctor who will give me antibiotics. By that point, my body is almost totally depleted of energy and I can barely get up.

But since obviously Metafilter is not all doctors, I'm really wondering what your experience has been like with bronchitis. Did it respond to antibiotics? Or did you get better on your own?

posted by thelivingsea to Health & Fitness (23 answers total)

This question is written to specifically exclude evidence based answers, so I will not provide them.

My experience with bronchitis is that it got better on its own.
posted by saeculorum at 5:22 PM on September 10, 2014 [2 favorites]

I had bouts of bronchitis due to mold in my house and every time I was prescribed Levaquin (levofloxacin). Granted, the mold cause wasn't figured out until later, but I really don't think it made a huge difference as far as how long the illness listed. What DID help was a vaporizer in the bedroom and a codeine based cough suppressant. The late, lamented Histonex being the best. So my advice, check for mold because no amount of pills is going to solve that problem.
posted by asockpuppet at 5:23 PM on September 10, 2014

Obvy, the biggest help was finding out that the house mold was at its worst in humid temps. Root cause analysis may be more helpful long term than Biaxin.
posted by asockpuppet at 5:25 PM on September 10, 2014 [1 favorite]

I am a nurse, but not your nurse.

Sometimes viral bronchitis takes a couple of weeks to resolve on its own. Usually antibiotics only get prescribed if there is a concern that a secondary bacterial infection or pneumonia is present, or if the patient has a history of lung disease of some stripe. After a week of being sick, you might have felt better after 48 more hours even without antibiotics. Supportive care like resting, drinking lots of fluids, using a humidifier at night, or taking an over the counter expectorant like Mucinex can all help you feel better.

The way you describe "finding a doctor" to prescribe antibiotics makes me wonder if you actually have a regular primary care provider? Having a regular PCP who knows you and knows your history of (recurring?) respiratory illnesses would be optimal, rather than going to random urgent cares or something. Some of what you describe (sore throat, post nasal drip/mucus) could be caused by allergies rather than a virus. A PCP could help you figure that out.
posted by little mouth at 5:26 PM on September 10, 2014 [6 favorites]

I have a pretty regular bronchitis history, ever since I was a kid. When I was a kid I always got antibiotics; as an adult, understanding about antibiotic resistance, my first round of defense is not antibiotics, but prescription cough syrup so I can get real rest at night, and sometimes an inhaler if I'm wheezy. Often that's enough to clear things up after a week or two. Once in a while it is not, and then I go to the second round, asking for antibiotics after a week or two. That usually clears things up - but of course by that time I've also been sick for quite a while so it could be clearing up on its own, there's not really any way to know.

I don't recommend jumping right to antibiotics immediately every time (even though I know how tempting it is), but if that is the way you want to go, I suggest a walk-in clinic. Most resistance to immediate antibiotic prescriptions in my experience comes from your regular GP; the MedExpress (or similar) goal is pretty much just to take your money, write you a script, and shove you out the door.
posted by Stacey at 5:28 PM on September 10, 2014

I would ask your GP if they would be willing to culture your sputum next time you get a bronchial infection like this, so you could know if it was viral or bacterial. If you're getting recurring bacterial infections, you may need to have that dealt with. If this is happened this often and this miserably, your doctor should be working with you to help you figure out why, and to give you things to have on hand (like an inhaler or Rx cough syrup) to control the symptoms before they get so serious.

I was getting bronchitis over and over and over, and working with my doctor we finally hit on a change in allergy medicine, which cleared up a good 80% of it ... I wasn't so post-nasal-drip-y and low-immune-system-y all the time so I stopped catching every damn bug that wandered past my mucus membranes.
posted by Eyebrows McGee at 5:33 PM on September 10, 2014 [5 favorites]

So, bronchitis and other hacky coughy symptoms can be caused by lots of things. One of them is asthma. If you regularly (like, every year or two) get bad bronchitis-like symptoms, tell your doc this. There may be an underlying cause like asthma which is itself treatable, and treatment can make your hacky coughy times much shorter and milder, if not eliminate them entirely.

But to answer the question, sometimes symptoms like what you describe can go away quickly, other times they can hang around for weeks. There are several possible causes of these symptoms, and most cases won't get better with antibiotics.
posted by zippy at 5:34 PM on September 10, 2014

I can comment personally and professionally.

Personally - yes, I get sick like that too, and antibiotics do help me start to feel better faster than I would on my own.

Professionally - I work in healthcare (not as a doctor or nurse), and I can tell you that most health insurance companies are ranked by an organization called NCQA based on quality measures that count toward their rankings. One of those measures is prescribing antibiotics for acute bronchitis. To do well on that measure, health insurance plans encourage providers in their networks to NOT prescribe antibiotics for people like you and me.

The purpose of the measure is to safeguard public health at the population level. Even if - at the personal level - you and I may feel better after a round of antibiotics, we'd be helping to breed super-bacteria (and in the process, doing horrible things to our gut biomes, ugh). Plus, even acute bronchitis is still most often viral, and antibiotics don't help with that except maybe as a placebo. Even if your doctor lets you convince her to give you antibiotics, it's probably not good for you, and it definitely doesn't end well for the town.

I would suggest sucking up the few extra days of sickness unless your doctor has reason to believe you have a secondary bacterial infection. It's just a few extra days on the couch for most people without comorbid health conditions, and all the people who don't catch superbugs will thank you for it.
posted by kythuen at 5:36 PM on September 10, 2014 [5 favorites]

My family doctor gives me antibiotics for nearly every infection because I have a decade now with him where it has 90% of the time become a bacterial infection on top of the viral infection. He does not do that with the rest of my family, so if both me and my teenager go to the doctor for the same cold, I get antibiotics and the kid gets symptomatic relief. It really makes a difference to have the same doctor or practice where they know your particular medical history.

However, I am a total outlier for this and it took a year of back and forth over six infections to come up with the antibiotics first approach after 2-3 days of symptoms.

I have found that taking to bed with total rest, lots of fluids and strong cough medicine at night (plus sleeping upright to drain sinuses) helps hugely. If I'm still sick after 2-3 days of this, then it's antibiotics.

Ask for an ENT referral too - I have some issues that turned up, and explained why I got sick so often, not enough to warrant surgery but to explain why and make me decide the risk of frequent antibiotics vs the risk of frequent infections was worth it.
posted by viggorlijah at 5:37 PM on September 10, 2014

The last three times I've had bronchitis as an adult, I get a double ear infection with it. The antibiotics clear up that mess (within 48 hours) which allows the rest of me to fight the bronchitis faster (that part takes weeks.)

I second little mouth's suggestion to find a PCP. A physical a year gives you the magic words "I'm a patient of Doctor Blah" which gets you in faster. At this point, I can call my doctor and say, "Hey, I'm kimberussell, a patient of Doctor Blah, and I'm getting the same bronchitis/ear infection combo that I had in January 2012 and March, 2009.

Feel better!
posted by kimberussell at 5:38 PM on September 10, 2014

I used to get bronchitis all the time as a result of Valley Fever. I was prescribed steroids, and that helped a LOT.

Get a PCP, get a physical and if you've lived in the central valley of California or in Arizona, get tested for Valley Fever.
posted by Ruthless Bunny at 5:42 PM on September 10, 2014

Hey there! This was me, several weeks ago. I have to tell you, after I asked this, I actually got sicker. I got on a Z-Pack, which did not work at all. I finally went to a doctor for the FOURTH time, and was prescribed steroids. That was what finally did the trick, mostly. I'm 95% better now, almost a month after I got sick.
posted by roomthreeseventeen at 5:56 PM on September 10, 2014

I have responded to antibiotics, but I responded a thousand times better to treating the athsma underlying the thick-mucus, shutting-my-lungs-down, feeling crappy because I wasn't getting enough oxygen, and you know the rest, inflammatory reaction within my lungs.
posted by Dashy at 6:44 PM on September 10, 2014

Best answer: You gotta stop it from ever turning into bronchitis in the first place. As soon as your throat becomes sore, start gargling with warm salt water (as warm and salty as you can stand, as often as you can stand) and taking pseudoephedrine to stop your post-nasal drip. Also, spend a lot of time shut up in a steamy bathroom and cough/hack up any throat crud you may have. If the crap never gets into your lungs then it can't turn into bronchitis. I used to get bronchitis at least once every fall and I haven't gotten it in years since adopting this preventative strategy.

But, if you do all the above and get bronchitis anyway, it's been my experience that I do need antibiotics to clear it up. It's weird that you're having a problem finding a doctor to prescribe them for you because it's never been a problem for me, even when going to a walk-in clinic. But it's been almost a decade since I last had bronchitis (thanks to my preventative measures) so perhaps the medical climate has changed.

If you can't find a doctor to prescribe your preferred antibiotic, you can order most antibiotics from aquarium supply stores. While they all have the disclaimer that their antibiotics aren't for human consumption, it's the same drug. My husband regularly treats himself with fish antibiotics and he hasn't died yet! Just make sure that you take the same human-sized dose for the same duration as you're usually prescribed -- taking not enough antibiotics not long enough is how antibiotic-resistant strains develop.
posted by Jacqueline at 6:53 PM on September 10, 2014

Response by poster: Sorry, I should have said that I have asthma. However, when I have bronchitis, I do wheeze and have shortness of breath, but the rescue inhalers do absolutely nothing. The docs always tell me take them and it's frustrating when they really do not work.

This illness is not something that I could let go on for weeks. One time I did while I was in undergrad and I got so sick my parents flew me home so I could see my family doc. I had borderline pneumonia. The doc was very close to hospitalizing me.

When I get this, after about 3-4 days of it, I feel like I've been hit by a truck. No exaggeration. I am not functional. My rescue inhalers do not work. I still go to classes but if I didn't absolutely have to, I would be flat on my back 24/7.
posted by thelivingsea at 7:23 PM on September 10, 2014

I have the same asthma/bronchitis issue and my solution is to head to an urgent care clinic. I tell them my symptoms, the date of my last bout of bronchitis, what didn't work last time (or doesn't work in general) and then ask for what I want. The doc in the box places seem to give you what you ask for if you're confident about it and not asking for Oxy. What works best for me is Cheratussin, a Prednisone taper pack and Albuterol for nebulizer treatments. Antibiotics only help me once it's clear that I've moved into the pneumonia zone (after ignoring my symptoms for too long).
posted by PorcineWithMe at 7:41 PM on September 10, 2014

A doctor should be able to identify bacterial involvement with the right tests. The key is to emphasize the chest symptoms and that this is a recurring phenomenon. Make it clear that it is triggered by stress, not because there's something nasty going through the office at work.
posted by kisch mokusch at 5:42 AM on September 11, 2014

I wonder if you have unmanaged allergies. I spent decades with colds, sinus infections, etc. Only when I started taking OTC antihistamines every day have I gotten healthier. Ask your doctor's advice.
posted by Carol Anne at 6:37 AM on September 11, 2014 [1 favorite]

I had a bad case of bronchitis years ago. I could barely get a sentence out without wheezing (a result of being 21, stupid, and resisting a doctor's visit until it was way out of hand). I spent a night in the hospital hooked up to ventilation. After that, they gave me antibiotics (sorry don't remember which ones), a week of prednisone, and a puffer (salbutamol). I was pretty much cured within a day or two. For what it's worth, I had never ever taken antibiotics before that. 14 years later and nothing like that has happened to me since.
posted by futureisunwritten at 8:09 AM on September 11, 2014

The bottom line is this: To know whether or not there's actually a bacterial infection there (secondary or primary), you need a culture of the material you're hacking up when you have this.

Chances are very high that you don't actually have any sort of bacterial infection and that the antibiotics are just acting as a placebo. If that's the case, you really should not be taking them--both for your own sake and everyone else's.
posted by yellowcandy at 10:48 AM on September 11, 2014

IANYD, but oftentimes when people with asthma get a regular old viral upper respiratory infection, they get it worse than other people, because they have asthma. The infection causes their asthma to flare up, this is called an asthma exacerbation. Asthma exacerbations where the rescue inhaler is not enough often require steroid treatment.

No person with asthma should let the situation go if they are having a worsening asthma exacerbation and the rescue inhaler is not working. They must go to the doctor to be evaluated for need for steroids. Asthma can kill you. Please take it very seriously.

I'd also like to dispense with the notion that cultures would be useful to look for bacterial infection. I wish it were that easy, but sputum cultures are not that reliable, and they are not done routinely on people with respiratory infections. The decision to prescribe antibiotics is generally made based on the clinical impression of the likelihood of a bacterial infection, and sometimes a chest xray. I encourage folks not to doctor shop looking for people to prescribe antibiotics when a bacterial infection like pneumonia is not suspected. There are good reasons why this has become a very important healthcare quality measure and a target for the healthcare Choosing Wisely campaign. Hope you are able to find a good primary care doctor to address your recurrent respiratory symptoms.
posted by treehorn+bunny at 3:58 PM on September 11, 2014 [1 favorite]

Clarithromycin (Biaxin) also has anti-inflammatory effects, as do several of its siblings. That may be why your symptoms improve when you're on it. Unfortunately, most of the macrolides that aren't antibiotics are powerful immunosuppressants, which are also not a great idea to take if you don't absolutely have to.

So, yeah, nthing that you should find a doctor who's willing to consider prescribing steroids, and also one who will seriously look into why you're getting recurrent bronchitis.
posted by kagredon at 7:55 PM on September 11, 2014

Response by poster: I just want to comment on how this was resolved after I saw a respirologist. Here's what she told me:

1. I do have asthma

2. People with asthma often have sinus problems, including bad sinus infections that go from viral to bacterial really quickly. These infections then travel down to the lungs.

3. Most people with bronchitis (even bacterial) can withstand it and get better quickly. It causes an asthma flare-up in people with asthma, however. Asthmatics likely need antibiotics, but they also need regular puffer use and sinus rinses when they get a cold. The strategy is to stop it from becoming full-blown bronchitis.

Moral of the story for me: trust your gut and don't always listen to GPs when they tell you don't need something and should just suck it up/take more puffers. See a specialist if you have a hunch they're wrong.

Thanks for all your input.
posted by thelivingsea at 4:32 PM on November 12, 2014 [2 favorites]