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Antibiotics for the flu?

When can antibiotics help, and when do they hurt?
By R. Morgan Griffin
WebMD Feature
Medically Reviewed by Dr Rob Hicks

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 Dr William Schaffner, of Vanderbilt University’s School of Medicine in the US. "You might as well take a placebo".

Instead, antiviral medication can be used to treat the viral infections like the flu - but it is a different type of medicine from antibiotics. Even so, it’s not quite as clear 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. According to the NHS in the UK around 600 people a year die from seasonal flu. This rises to around 13,000 during an epidemic. Secondary bacterial complications are the main culprits.

So how does a person know whether he or she just has the flu virus, or something worse that needs treatment? BootsWebMD 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 it 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 Dr Christine Hay, of the University of Rochester Medical Center in the US. "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.  However, the flu and its complications are considered high risk for people who:

  • Are over 65 years old
  • Infants and babies
  • Pregnant women
  • 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 anaemia
  • Have a suppressed immune system, either from a disease or its treatment
  • Live in a nursing home or long-term care facility.

If you fit any of these categories, you need to be especially aware of the signs of a secondary bacterial infection. In addition, of course, you should get the flu jab if advised to do so.

How do I know if I need antibiotics for flu complications?

Here’s the problem: How is a person who’s ill 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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