Bacteria or virus? You’ll fight it either way

5 August 2019

Asking the age-old question ‘is it a bacteria or is it a virus?’ is what doctors often consider when treating patients with an upper respiratory tract infection (URTI).

Doctors from The University of Queensland argue trying to determine what causes the infection can lead to prescribing unnecessary antibiotics.

UQ researcher Professor Mieke van Driel said doctors needed to embrace an evidence-based approach to the management of URTIs.

“We need to change the narrative of how we negotiate with patients about the need for antibiotics,” Professor van Driel said.

“If it’s a virus causing the infection, then we know antibiotics are not useful.

“However, this opens a divide that suggests if it is a bacteria causing the infection, then it is appropriate to use antibiotics.

“Lots of good evidence tells us that most bacterial infections in URTIs are self-limiting.

“Our immune systems are more than capable of fighting these bacterial infections on their own without using antibiotics.”

Antibiotics can seriously disrupt the natural microbiome found in the airway and gut and it can take up to 12 months to balance back to equilibrium.

“Antibiotics are not very selective; they’ll wipe out all bacteria in your system, including the good bacteria in your airways and gut which makes up your defence system,” she said.

“A single course of antibiotics can change this balance for up to 12 months, and antibiotic resistance can exist for that long as well.

“What you are doing to your immune system has far-reaching consequences which go way beyond the annoying few days it would take for you to get over a cough or sore throat.”

Professor van Driel believes doctors should embrace an approach that supports patients’ natural immune defence system.

“Giving patients more confidence in their immune system is important,” she said. “Our immune system is our first line of defence, and it’s a pretty good defence. We need to nurture it rather than ignore it.

“Letting your body rest and recover is the best treatment for a winter cold and cough.

“Seek further medical advice if your symptoms persist or become more severe.”

This perspective is published in the Medical Journal of Australia (DOI: 10.5694/mja2.50250).

Media: Professor Mieke van Driel,, +61 7 3365 2924; Faculty of Medicine Communications,, +61 7 3365 5118, +61 436 368 746.