Remember That Antibiotics Should Not Always Be the First Answer During Cold and Flu Season

Most common infections during cold and flu season are viral and thus cannot be cured with antibiotics

Cold and flu season brings a familiar hit of stuffy noses, coughs, sore throats, body aches and fatigue. When someone we care about is sick, we often want to act fast, even reaching for leftover antibiotics or rushing to the doctor. That is not always smart. Most illnesses this season are viral, not bacterial. Using antibiotics when they are not needed does more harm than good.

Why most infections in cold and flu season are viral

Viruses are tiny infectious agents that require living cells to multiply. They hijack our body’s cells to replicate and spread. Common cold viruses and influenza viruses are viral. Antibiotics only work against bacteria, not viruses. Using antibiotics against a cold or the flu does nothing to cure it, ease symptoms or prevent spread.

Antibiotic resistance and stewardship

Using antibiotics when not required leads to antibiotic resistance, when bacteria evolve and survive treatments that once killed them. Resistance makes future infections harder and more expensive to treat. Combating this requires antimicrobial stewardship: using the right drug, at the right dose, only when needed1{index=1}.

At the national level, efforts exist to reduce antibiotic-resistant infections by 10 percent in the community by 2025 through improved detection, prevention and stewardship2{index=2}.

Understanding the flu and severe respiratory infections

The flu is a contagious respiratory illness caused by influenza viruses. It affects the nose, throat and lungs and can be dangerous, leading to hospitalization or even death, especially in young children, older adults or people with chronic conditions.

The 2024–2025 flu season in the U.S. was classified as high severity across all ages. That season saw at least 47 million illnesses, 21 million medical visits, 610 000 hospitalizations and 27 000 deaths, including 266 pediatric deaths3{index=3}.

Preventing flu with vaccination

The flu vaccine is the best preventive tool. Everyone aged six months and older should get vaccinated annually. Although early fall is ideal, getting vaccinated anytime during flu season still helps4{index=4}.

In North Carolina, flu flu-shot clinics are widely available at pharmacies, clinics and county health departments, often covered in full by insurance or public health programs.

Antiviral medications for treating flu

If you do contract the flu, antiviral medications can help reduce severity and shorten illness, especially if started within 48 hours of symptom onset5{index=5}. The U.S. Food and Drug Administration has approved four antivirals for this flu season:

• Oseltamivir (Tamiflu or generic), oral pills or liquid
• Zanamivir (Relenza), inhaled powder, not suitable for people with asthma or COPD6{index=6}
• Peramivir (Rapivab), administered intravenously7{index=7}
• Baloxavir marboxil (Xofluza), single-dose oral cap-dependent endonuclease inhibitor8{index=8}

All four target influenza A and B viruses. Three (oseltamivir, zanamivir, peramivir) are neuraminidase inhibitors, while baloxavir works via a different mechanism9{index=9}.

Who should consider antiviral treatment

The CDC recommends antivirals for people who are hospitalized, very ill, or at higher risk of complications, such as those with asthma, chronic lung or heart disease, diabetes or pregnant people10{index=10}.

Tamiflu is widely prescribed because of its track record. It can reduce illness duration by about one day and is most effective when started early. Side effects may include nausea, vomiting and headache. It is covered by many insurance plans and generic versions are more affordable11{index=11}.

Baloxavir offers the convenience of a single dose, but is not recommended for pregnant or breastfeeding individuals or those with complicated illness12{index=12}. Relenza may reduce transmission but is not suitable for people with breathing issues. Peramivir requires IV administration, typically in a clinic or hospital setting13{index=13}.

Home care for viral infections

Viruses don’t respond to antibiotics, but you can manage symptoms at home. Key steps include:

• Plenty of rest
• Staying hydrated
• Over-the-counter pain and cough remedies
• Cool-mist humidifiers or saline sprays for congestion

Most healthy people recover within two weeks with self-care alone. Seek medical attention if symptoms worsen or don’t improve14{index=14}.

When to call the doctor

Reach out for care if you or your child has any of the following:

• Infant younger than 3 months showing signs of illness
• Fever of 102 °F or higher at any age
• Labored breathing, wheezing or visible ribs
• Blue lips
• Not drinking or showing dehydration
• Ear pain
• Excessive sleepiness or irritability
• Cough lasting more than three weeks
• Symptoms getting worse not better

Using antibiotics for viral illnesses isn’t harmless. Stick to prevention, home care and vaccination. Use antivirals when appropriate. That is how to stay smart, and healthy—this cold and flu season.