Common colds: Wait before trying antibiotics?

If there does not appear to be any medical need for antibiotics to treat a simple cold, waiting one to two days can avoid unnecessary adverse effects.   

There is a widespread belief that antibiotics help against all infections. These medicines are therefore often used in children and adults for simple colds, sore throats and middle ear infections, even though they cannot usually help very much. This is because these conditions are usually caused by viruses, and the body usually gets them under control without help within a week. Antibiotics don't work against viruses - they are only effective against bacteria.

Even though it is widely known that antibiotics do not help much with colds, a lot of people still leave the doctor's surgery with a prescription for antibiotics when they have a cold. This is not only a waste of money: antibiotics also have adverse effects such as diarrhoea, nausea, rashes and vaginal thrush. What is more, if antibiotics are used too much, bacteria may become resistant (unresponsive) to them. If this happens, many medical conditions can no longer be treated as successfully as they used to be. You can read more about the safe use of antibiotics here.

Antibiotics as a safety net: Having a prescription – waiting before picking them up

Researchers have therefore looked at ways to reduce the unnecessary use of antibiotics, without denying people the medications they might need. One idea is this: to get a prescription for antibiotics, but with the advice from their doctor not to use it straight away. Waiting for a day or two might mean that the infection gets better by itself. If it does not get better, then they can still get the antibiotics from the pharmacy and start using them.

To see whether this strategy works, researchers from the Cochrane Collaboration (an international network of researchers) looked for randomised controlled trials in this area. These are studies that have strictly comparable groups of participants. You can read about how and why such trials are done here. The researchers found ten trials altogether in which the participants - about half of which were children - were divided into different groups. In one group, the patients were advised to take the antibiotics straight away. Another group was advised to start taking them 48 hours later at the earliest, or not take them at all.

The results showed that there was hardly any benefit from taking antibiotics straight away to treat a simple cold. For children who had sore throats or middle ear infections, pain and fever went away a bit sooner. For coughs and colds, though, taking the antibiotics early did not speed up recovery. About half of the children who waited did not need to use antibiotics at all in the end. That meant that they avoided the risk of adverse effects. This strategy hardly affected how satisfied the patients were.

You can read more about colds, their prevention and treatment here.


Author: German Institute for Quality and Efficiency in Health Care (IQWiG)

© IQWiG (Institute for Quality and Efficiency in Health Care)