Q: Every time I have a cold, which is about once a year, it takes me a long time to recover. The running nose stops after about a week, but I keep coughing for another three weeks. I do not have a tight chest or any difficulty breathing. The cough is the tickly type. Should I see the doctor or will he tell me to go away because it’s just a normal cold? I don’t feel really ill.
A: If cold symptoms persist for more than two weeks, it is a good idea to see your doctor. There is a possibility of a secondary infection such as sinusitis or bronchitis that could require treatment with antibiotics.
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A tickly cough is probably due to a post-nasal drip. This is caused by mucous dripping down your throat from the back of the nose and might be a symptom of sinusitis. Most cases of sinusitis following a cold are the result of the cold virus itself, called rhinovirus. These viruses are 200 times more likely to be the culprits compared to a bacterial infection.
If it is a bacterial infection, it is usually caused by Strep pneumoniae or Haemophilus influenzae. These respond to antibiotics but rhinoviruses do not. It is not always easy to tell the difference, but you would probably feel much sicker if you had a bacterial sinusitis.
You would have swelling and tenderness around your eyes and on either side of your nose, accompanied by a fever. There might be earache and a headache as well as the cough. There could even be pain in the upper teeth, so that you might confuse this with dental decay. The facial pain is worse when you bend forward.
Antibiotic therapy for sinusitis is Amoxicillin 500 milligrams three times a day for 10 days, unless you are allergic to penicillin, in which case other antibiotics may be given. Sometimes sinusitis becomes chronic and then a more powerful antibiotic such as Clindomycin is prescribed.
If your doctor thinks that the sinus infection is viral rather than bacterial, there are still treatment options.
A few days of taking a decongestant and analgesic medication such as Tylenol or Advil Sinus, which you can get over the counter, may be all that is required. Using a cool mist humidifier can help. There are also commercial nasal sprays containing saline that can be squirted up the nose, or people can make their own salt solution and sniff it up for a few days. A small teaspoonful of salt dissolved in a glass of warm water should be about right.
Clare Rowson is a retired medical doctor living near Belleville, Ont. Her columns are intended for general information only. Individuals are encouraged to also seek the advice of their own doctor regarding medical questions and treatments.
