Should you take anti-inflammatory drugs for yellow sputum caused by COVID-19? Beware of these 9 side effects!

As a respiratory doctor, the most frequently asked question recently is: Doctor, I have positive test results and now I have yellow phlegm. Should I take some anti-inflammatory drugs? Cephalexin? Amoxicillin? Or erythromycin?

Anti-inflammatory drugs are the common name for antibacterial drugs. The most familiar ones are various antibiotics. The three types mentioned in the patient's question are very representative. So, do you need to take antibiotics if you cough up yellow phlegm?
My answer is - don't eat it.

Coughing up yellow sputum = bacterial infection = need for antibacterial treatment?

This view is wrong.

01

How is phlegm produced?

Under normal circumstances, the surface of our respiratory mucosa is covered with a small amount of mucus secreted by goblet cells and glands. This mucus moisturizes and protects the respiratory tract, and there is no sputum to cough up at this time.

If dust particles, bacteria, and other foreign bodies are inhaled into the trachea and bronchi, the mucus secreted by the goblet cells and glands will wrap them up. Accompanied by the cilia beating, the foreign bodies are discharged to the upper end of the trachea, stimulating the nerve ending receptors and causing a complex and coordinated coughing action, thereby spitting out the mixture from the mouth. This mixture is sputum.

When the trachea, bronchi and lung tissues are infected by pathogenic microorganisms (such as viruses and bacteria) and inflammation occurs, a large number of inflammatory cells infiltrate these tissues and organs, blood vessels dilate, mucosal congestion and edema increase, exudation increases, mucus secretion increases, and some tissue cells degenerate and necrotize. A large amount of mucus and necrotic tissues form purulent sputum.

02

Yellow sputum, why is it yellow?

In fact, bacterial infections, viral infections, allergies, etc. may produce yellow purulent sputum.

In acute viral or bacterial infections, in addition to necrotic tissue, there are also live neutrophils in the sputum, which makes the sputum yellow. In airway allergies, light yellow sputum appears due to the presence of eosinophils.

Neutrophils and eosinophils are both white blood cells. The yellow and green colors in sputum are caused by the crystalline peroxidase released by white blood cells.

White blood cells are part of the general immune response. That is to say, at a specific time during a respiratory viral infection, the sputum becomes white, yellow or green, not as a result of secondary bacterial infection, but as a result of a significant increase in the number of white blood cells, especially neutrophils, involved in the inflammatory response.

Therefore, we cannot determine that it is a bacterial infection based solely on the color of the sputum, nor should we think of using antibiotics as soon as we see yellow sputum.

03

How to determine if there is a bacterial infection?

1. Routine blood test is a commonly used test to identify bacteria and viruses.

Bacterial infections are mostly manifested by an increase in WBC (white blood cell count) to more than 10×109/L, with N (neutrophils) being the main component. In the early stages of viral infections, the total WBC count generally does not increase, and may even decrease (such as Epstein-Barr virus infection), and N is mostly not high, with L (lymphocytes) being the main component.

2. Commonly used clinical infection markers such as procalcitonin (PCT), C-reactive protein (CRP), and serum amyloid A (SAA) can indicate infection.

A significant increase in CRP (>50 mg/L) and SAA (100-500 mg/L) indicate a high possibility of bacterial inflammation.

CRP is elevated but <50 mg/L, and SAA is significantly elevated (>500 mg/L), indicating viral infection (severe) or bacterial infection;

Normal or only slightly elevated CRP and elevated SAA (10-100 mg/L) suggest a viral infection (mild).

04

Should I take antibiotics after COVID-19?

Antibiotics are antibacterial drugs, and yellow sputum does not mean secondary bacterial infection. If there is no bacterial infection, antibiotics are useless and will only cause side effects.

In the just released "Diagnosis and Treatment Plan for Novel Coronavirus Infection (Trial Tenth Edition)" (click here to learn more → Important! Key Adjustments to the Tenth Edition of the New Coronavirus Diagnosis and Treatment Plan), it is mentioned to avoid blind or inappropriate use of antibiotics, especially the combined use of broad-spectrum antibiotics.

The "Recommendations and Appropriate Technologies for Primary Diagnosis and Treatment of Novel Coronavirus Infections in Peking Union Medical College Hospital (First Edition)" released on January 3 also clearly pointed out that the new coronavirus itself can cause fever, purulent sputum or purulent nasal discharge, and some patients may experience hemoptysis due to severe coughing. Antibiotic treatment is ineffective and may bring related adverse reactions. Therefore, the routine use of antibiotics is not recommended.

The relevant guidelines issued by West China Hospital and Xiangya Hospital also did not mention the routine use of antibiotics for COVID-19 patients.

05

What are the adverse reactions of antibiotics?

Most antibiotics have five common side effects:

① Mild rash or other allergic reactions;

② Stomach discomfort, nausea;

③Loss of appetite;

④ Diarrhea;

⑤ Yeast infection (vaginal, oral).

More serious side effects of antibiotics include:

① Severe allergic reaction, resulting in difficulty breathing and facial swelling;

② Antibiotic-associated diarrhea (severe watery or bloody diarrhea, Clostridium difficile infection);

③Stomach cramps;

④Severe skin allergic reaction.

06

summary

In summary, the yellow-green color of sputum comes from white blood cells involved in the immune response. For patients with COVID-19 infection and cough who do not have underlying chronic lung disease, the presence of yellow sputum does not necessarily mean bacterial infection, nor is it necessarily a bad thing. Doctors also need to use blood routine tests and infection markers to determine whether there is bacterial infection.

If there is no bacterial infection, antibiotic treatment is ineffective and may cause side effects. Antibiotic treatment is not recommended for patients with cough caused by COVID-19 without clear evidence of infection.

References:

[1] https://www.healthhype.com/sputum-color-causes-and-meaning.html

[2] AltinerA1,Wilm S,et al.Sputum color for diagnosis of a bacterial infection in patients with acute cough. J.Scandinavian Journal of Primary Health Care2009,27:70-73

[3] Mayo Clinic bronchitis. https:// www.mavoclinic.org/ diseases-conditions/ bronchitis/diagnosis-treatme nt/drc-20355572

[4] WINTHER. S. BROFELDT. H. GRONBORG, et al Study of Bacteria in the Nasal Cavity and Nasopharynx during Naturally Acquired Common Colds, Acta Otolaryngol (Stockh) 1984;98:315-320

Author: Sun Siqing, Chief Physician of the Department of Respiratory and Critical Care Medicine, Nanjing Second Hospital

Review | Li Dongzeng, Chief Physician, Department of Infectious Diseases, Beijing You'an Hospital, Capital Medical University