Antibiotic for Chest Cold

Dear Dr. Mahler: I usually get 1 to 2 chest colds each winter.  Typically, I have some congestion, may cough up mucus, and find that my breathing is harder. Sometimes the mucus is clear white, and other times it is yellow or green color. Otherwise, I do pretty good with my breathing taking Spiriva and Symbicort for my COPD. I am confused because some times my doctor will prescribe an antibiotic like Z-pak, while other times his nurse says “to wait it out.”  What are your thoughts? Ken from Rancho Palos Verdes, CA  Dear Ken: Many healthy people have a chest cold each year, usually in the winter time. A chest cold may be due to viruses (at least 25 different kinds) and bacteria (probably more than 100 possible bacteria). For someone like you who has COPD, the most important sign that the chest infection is caused by a bacteria is the  color of the mucus that you cough up. Yellow or green mucus is generally due to a bacterial infection. If the infection involves your breathing tubes, it is called “acute bronchitis;” if the infection involves your air sacs (alveoli), it is called “pneumonia.”  A fever, a sick feeling, and fatigue are more likely with pneumonia compared with acute bronchitis. Different antibiotics are prescribed to treat chest infections. Your doctor will select an antibiotic based on answers to the following questions:
  1. how severe is your COPD?
  2. when was your last chest infection and what antibiotic was used?
  3. how many chest infections have you had in the past 6 – 12 months?
I encourage you to discuss this information with your doctor so that together you have a “game plan,” also called an Action Plan, if/when you have another chest infection. Also, make sure to tell your doctor if you have any allergies to medications. Best wishes, Donald A. Mahler, M.D.  

Donald A. Mahler, M.D. is Emeritus Professor of Medicine at Geisel School of Medicine at Dartmouth in Hanover, New Hampshire. He works as a pulmonary physician at Valley Regional Hospital in Claremont, NH, where he is Director of Respiratory Services.