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Antibiotics for the Flu?

When can antibiotics help, and when do they hurt?
WebMD Feature

Ask any doctor if you should take antibiotics for the flu, and you’ll get a weary shake of the head and a resounding no.  “Viral infections like the flu aren’t affected by antibiotics,” says William Schaffner, MD, chairman of the department of preventive medicine at Vanderbilt University’s School of Medicine in Nashville.  “You might as well take a placebo.”

Instead, antiviral medication can be used to treat the viral infections like the flu. But that is a different type of medicine than antibiotics.

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Even so, it’s not quite as cut and dried as it might seem.  People can get bacterial complications from the flu.  And these can be quite serious -- even life-threatening -- unless treated with antibiotics.  The flu and its complications hospitalize about 200,000 people a year in the U.S. and kill about 36,000.  Secondary bacterial complications are the main culprits.

So how’s a person to know whether he or she just has the flu virus, or something worse that needs treatment? WebMD turned to the experts to find out.

Who Needs Antibiotics for Flu Complications?

When you have the flu, your body’s immune system may be weakened.  The lungs become irritated and inflamed.  Both make is easier for bacteria to invade your body. What kind of bacterial complications can develop?

  • Pneumonia, infection of the lungs
  • Bronchitis, infection of the airways that lead to the lungs
  • Sinusitis, infection of the sinuses
  • Ear infections, which are most common in children

The most worrying, and most common, is pneumonia.  “Bacterial pneumonia is the most likely cause of death in older people with the flu,” says Christine Hay, MD, assistant professor at the University of Rochester Medical Center. “It can be a serious problem for young children with the flu as well.”

Who’s most at risk? The odds that you’ll end up with a bacterial complication depend on several factors.  If you’re a healthy young adult, the chances are low.  But the flu and its complications are considered high risk for people who:

  • Are pregnant during flu season
  • Are over 50 years old
  • Are under 2 years old
  • Have a chronic lung disease such as asthma, bronchitis, or other conditions
  • Have heart or kidney disease
  • Have diabetes or another metabolic disorder
  • Have severe anemia
  • Have a suppressed immune system, either from a disease or its treatment
  • Live in a nursing home or care facility

If you fit any of these categories, you need to be especially aware of the signs of a secondary bacterial infection.  And, of course, you need to get the flu vaccine unless your doctor tells you otherwise.

How Do I Know if I Need Antibiotics for Flu Complications?

But here’s the problem: How is a person who’s laid up in bed, coughing and miserable, to know whether he or she has the flu or a bacterial complication from the flu? Since the symptoms are so similar, it can be hard to tell.

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