Q&A: antibiotics for URIs; how bad is gluten; getting shingles despite the vaccine, & does steroid use affect the flu shot

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ICYMI 👉

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In this week’s reader-submitted Q&A, we’re tackling these questions:

• Why won’t my doctor prescribe antibiotics when I’m sick?

• Is gluten bad for me if I’m not celiac?

• Can you get shingles from - and after - the vaccine?

• Do steroids and antibiotics impact the effectiveness of the flu vaccine?

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Disclaimer: The views expressed here are entirely my own. They are not a substitute for advice from your personal physician.

Photo by Spring Fed Images on Unsplash

The following subscriber questions have been lightly edited for length and clarity.

QUESTION #1: WHEN TO TAKE ANTIBIOTICS

I am frustrated because for the second time this year, I’ve had a cough and runny nose for 6 days and my doctor refuses to prescribe a Zpack antibiotic… which is what my son took for the same thing and got better right away. She says that it is a virus because my lungs are normal (a few wheezes that go away when I cough) and I don’t have a fever or heavy mucus, but I feel like she is not listening to me. What do I need to prove or show her to get the medication I need?

- Kate

Dear Kate,

I hate to disappoint, but based on the description of your symptoms, I probably would agree with your doctor that antibiotics are not appropriate in this case. Of course, the recommendation would depend on the trajectory of your symptoms, your underlying health conditions, and any lab test results, but the vast majority of these respiratory infections (URIs) are due to viral causes, not bacteria. And antibiotics are ineffective against viruses. 

Your symptoms suggest a typical viral URI, which commonly evolves into a cough due to post-nasal drip and lingering airway inflammation. The absence of fever, chills, significant chest pain, and shortness of breath, along with the clear lungs and only a few wheezes that clear with coughing, further supports a diagnosis of a post-viral cough or residual cough following a URI.

I wrote about my favorite drug store fixes for viral URI symptoms here. In your case, I might suggest Guaifenesin, an expectorant that helps loosen mucus and can aid in the clearance of sputum. 

Azithromycin (Zpack) is an antibiotic that should not be used unless there is evidence of a bacterial infection, such as a bacterial pneumonia, bronchitis, or sinusitis. Could a viral infection like yours lead to a secondary bacterial infection, for which antibiotics are appropriate? Absolutely! This is why it’s important to monitor your symptoms over time. At a minimum, you should revisit your doctor if your symptoms aren’t improving and/or you develop symptoms such as fever, sinus pain, chest pain, or thick, colored mucus. 

A lingering cough doesn’t necessarily mean you have a bacterial infection. Viral infections can last for weeks; the cough can last even longer, and well after the virus has been cleared. Of course, check with your doctor for specific recommendations, but at day 6 into a viral URI, I am guessing you could benefit from some over-the-counter meds for symptomatic relief more than anything else.

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QUESTION #2: HOW BAD IS GLUTEN

How bad is gluten for a person who is not celiac?

-Liz

Hi Liz,