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Alwayssunnyinarizona t1_izja6t1 wrote

One thing I think you're misunderstanding:

>In the absence of asthma or secondary infection

Upper/lower respiratory infections are rarely single factor. You've got a virus - influenza, parainfluenza, coronavirus, whatever, and then you've got the secondary bacterial invaders - Staph, Strep, Haemophilus, etc etc etc. Those may linger for a while because of the damage the virus has already done to the bronchial/upper airway lining, as well as to the immune system itself in some cases. Some of that damage is fixed with a temporary bandaid much like scar tissue, and can take a week or two to heal completely.

Here's a review on secondary bacterial infections in cases of viral pneumonia:

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7419580/

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RogueColin t1_izjdtdj wrote

Thanks for this. I work in a hospital compounding IV medications and I wasn't really understanding why I was making so many antibiotics for RSV infections, but this makes sense.

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[deleted] OP t1_izjes2d wrote

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contrary-contrarian t1_izjmie1 wrote

Bingo. That's why there is a shortage of amoxicillin right now. So many RSV and other respiratory viruses causing secondary infections.

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Scarlet- t1_izjoz6h wrote

I checked my supplier two days ago and the only available strength for amoxicillin suspension was 400 mg/5 ml with a quantity of 6 to supply any contracted pharmacy in Nevada and possibly Arizona. I had to order 3. 🤦‍♂️

I hope supply meets demand soon. Everything is being affected: adderall, antibiotics, antivirals, diabetic auto injectors.

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EmilyU1F984 t1_izkkfip wrote

You get liquid? Only ones we can safely get is Tablets in my part of Germany. Liquid formulations are on Backorder..

Not that I’d personally mind compounding those Tablets into a suspension ifneed be… but being a retail pharmacy… those prescriptions are virtually never for a confirmed bacterial infection, but rather ‚if things get worse‘

Like wtf if things get worse, you hand the prescription to the parents and have it picked up/delivered by the pharmacy. Don‘t have patients keep out of stock antibiotics at home -.-

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Scarlet- t1_izktgwh wrote

Yes, but the liquid stock comes and goes. For the most part they have been on back order for a few weeks.

Is compounding antibiotics from tablet to liquid a common thing in retail pharmacies in Germany?

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ChaoCobo t1_izni6y1 wrote

Wait why are adderall and daibetic auto injectors running low?

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Scarlet- t1_iznj0ai wrote

Suppliers are having trouble meeting demands.

I don’t know the exact reason for adderall, but I noticed it happened after the mislabeling of adderall 15mg generic. 20mg was produced with a 15mg label on it. That was pulled from market and then began a slow cascade of people switching to different manufacturers/strengths resulting in a shortage. Again, this is from my observation. The FDA’s website has more on this.

For the diabetic auto injectors, ozempic being used for its non-FDA indication of weight loss resulted in a shortage resulting in a cascade of events like patients switching to different strengths or trulicity, mounjaro, etc. Now all the manufacturers are having trouble keeping up with demand.

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Indemnity4 t1_izurvp6 wrote

Adderall is in short supply because two factors:

  • a main manufacturer Teva Pharmaceuticals shutdown during Covid due to worker shortages. They are still having disruptions to manufacturing.

  • prescriptions are up, way up. Highest they have ever been. Big social media campaign during the locksdowns and lots of attention on mental health diagnosis. Adderall is the first medicine most people with ADHD will attempt.

Diabetes auto injectors is because it now has two uses and one of those makes the company more money. (Semaglutide, sold as the brand name Ozempic and Wegovy) is only manufactured by one company using a very delicate and expensive process. The company split the output from the factory into two products: Ozempic for diabetes type 2 and Wegovy for non-presciption weight loss. Same product, but two different uses and the company presumably makes a lot more money as a lifestyle drug. It is immensely hugely crazy mammoth popular for off-label prescriptions for weight loss.

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Scarlet- t1_j00omc3 wrote

>Teva Pharmaceuticals shutdown

That explains a lot! Thank you.

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Steve0512 t1_izka06p wrote

I went to the clinic after three weeks of coughing and the doctor prescribed me a dosepak of Steroids. In the end it worked.

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kramsy t1_izm51vs wrote

We’ve moved on from Amoxicillin and are writing for Omnicef now…no one could get Amoxicillin.

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Pharmie2013 t1_izmckvx wrote

Oddly enough I can’t find cefdinir but have been lucky to stay ahead of my amox supply.

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IGotNoStringsOnMe t1_izjqr0x wrote

Would some of the coughing be due to the scar tissue healing like when scabs itch like mad? Or is it all down to the secondary invaders?

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Alwayssunnyinarizona t1_izk8og8 wrote

A bit of both :) your respiratory tract is lined with cilliated cells - they have little finger-like projections that help move mucus and debris from your lungs to your mouth. When you wake up in the morning with crap in your throat - that's why. Some respiratory viruses and bacteria can damage those cells, and affect how well they move stuff up, so the lining is more like flattered cells for a few days. While that continues to heal, bacteria have a better chance of growing there, but eventually either your immune system clears it and the cells heal, or it gets worse and you die ;)

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yayreddit02 t1_izmzmch wrote

That last part made me laugh (even though im reading this thread because my covid cough hasn’t gone away after 2 months)

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tehbored t1_izm20wo wrote

Is this true even for an ordinary cold? Because I often have residual mucus for a week or so after the main symptoms go away.

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Alwayssunnyinarizona t1_izm403h wrote

There are always bacterial agents waiting to take advantage of weakened defenses, but severity varies quite a bit for all sorts of reason. Some lagging symptoms may also be things like the body's healing response.

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Kabc t1_izjd1fr wrote

Work as a provider and get to explain this a bit!

Your sinuses during the virus get filled up with mucus and cause a post nasal drip (mucus running back in down your throat which irritates your throat and causes you to cough due to that irritation and your bodies desire to keep that pathway clear). The virus also irritates your oropharynx, which is then irritated MORE by the PND. This is why when you lay down, you tend to cough more.

Once the virus is defeated, the inflammatory responses are still in place dealing with the “damage” caused by the virus.. your congestion needs to drain from your sinuses, but in doing so your throat stays irritated, even after the virus is donzo. This CAN lead to secondary infection, but doesn’t always.

Doing things like nasal sprays (normal saline rinses) can help clear your sinuses. Using things like Flonase can also help. Taking antihistamines can also alleviate these symptoms. HOWEVER, sometimes antihistamines can have the opposite affect and cause your congestion to linger further—so it’s not ALWAYS the best choice.

Edit; this got more updoots then I expected. But please remember; I am a random dude on Reddit; don’t take medical advice form this website, if you are concerned see someone.

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bawki t1_izkhzqf wrote

I just want to emphasise one point you made: usually there is no bacterial superinfection, the symptoms are, as you rightly pointed out, due to the damaged/irritated lining of the upper respiratory tract. Sadly that takes some time to heal.

I did a quick search and found one study which tried to estimate the rate of superinfection by evaluating CRP levels on first presentation compared to subsequent visits. This approach has its obvious limitations, but if we are conservative in our estimate by doubling the reported likelihood of 8,1%, it still shows how rare bacterial superinfections in URTI are.

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obsidianop t1_izl3zvq wrote

Is it the case, then, that once the initial sinus congestion has cleared you are not contagious with virus even if the cough remains? I want to avoid getting others sick but I don't know how realistic it is to remain alone in my apartment for a week or two or more.

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OnenonlyAl t1_izm8x8b wrote

Most infectious between 3-7 days with a viral illness. Usually peaks at 5 or so.

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Kabc t1_izkjgjs wrote

Awesome! Thanks for that!

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Nyrin t1_izlql9p wrote

A potential crude analogy to this with a healing process that's much more visible to us is with sunburns.

While your skin is actively damaged by overexposure, you may or may not experience a certain set of symptoms with flushing, itching, irritation and sensitivity. For a long time afterwards, even with no active damage continuing to happen, you then deal with itchiness, sensitivity, flaking, peeling, and all the other delights of dermal repair.

Respiratory infections damage respiratory tissue in a parallel way to the sunburn. Once infection has been fought off, a lot of inflamed, compromised structure needs to be repaired and replaced and we respond to inflammation and debris by coughing.

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[deleted] OP t1_izjnvh5 wrote

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[deleted] OP t1_izjo9n4 wrote

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[deleted] OP t1_izjpbnq wrote

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[deleted] OP t1_izjru5w wrote

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[deleted] OP t1_izjvhix wrote

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StJimmy75 t1_izkygzt wrote

Are there any signs that antihistamines would make it worse or is it just try it and stop if it gets worse?

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Kabc t1_izl9v2e wrote

It varies. I would say that if you have a more rhinorrhea (nasal drippings) antihistamines will work better.

Sometimes, you can have tympanic membrane bulging (TM for short) from sinus pressure. This can be without an infection. Antihistamines CAN help with that (Benadryl seems to work well, but obvious need to take it at night). Short course of steroids are really effective to help that as well.

NOTE; I wouldn’t take random advice from peeps on Reddit, but this is what I have seen in my personal bubble of patients I have

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[deleted] OP t1_izm9j05 wrote

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Pharmie2013 t1_izmd8cs wrote

2nd gen antihistamines don’t typically work as well for this. Diphenhydramine and chlorpheniramine should be the go to.

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OnenonlyAl t1_izmdt07 wrote

That's great info, I'll start to have to incorporate that more. Surprised my the otolaryngologist I followed recommended more 2nd generations. Maybe due to less drowsiness during the day. Makes sense though!

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[deleted] OP t1_izkfw0o wrote

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mtx013 t1_izkbkow wrote

People going way out of the way.

What you are describing usually falls into tracheobronchitis diagnosis, which is really common after an upper airway viral infection (common cold, but covid too).

While the overall cold symptoms usually resolve in less than an week, the same infection also happens on your trachea and bronchi, and there it takes a little more time to heal and properly return the mucosa to it's healthy state. Until then, said airways remain mildly inflamated and sensitive, which causes the nagging cough.

As a side note, there are two conditions which may look similar, but whose cause and treatment differ. One is postnasal drip, which happens due to filled sinuses slowly dripping secretion on the throat and making it irritated (mainly while laying down your head). The other is a bacterial tracheobronchitis, which usually has systemic symptoms like fever and purulent coughing and could be thought as a pneumonia-like infection (to make it really simple).

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CarboniferousCreek t1_izkfqsl wrote

Thanks for your answer!

I think people are giving complex answers because I asked why the post viral cough only starts / gets worse after you start getting better or have cleared the virus.

As an example, I had mild covid a few months back (vaxxed + boosted). I hardly had a cough. I started testing negative on ag tests after 7 days. And then I got this horrible dry cough for like a week.

So whether or not I had fully cleared the virus — maybe it was still chilling in my bronchi — where was that cough when I first got sick?

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mtx013 t1_izkjprz wrote

Great question! Upper airway virus start and do their main business between up until the larynx (not necessarily with same strength on all structures, usually it's more nose/throat/sinus). They do infect our trachea and bronchi, but it's a different kind of cell lining so things are usually not too intense.

From there, we have two things happening at same time:

  • the virus is not as efficient getting into your lower airway cells, taking longer (or not! e.g. omicron COVID)

  • your immune system is not interested in being kind. The inflammatory response is meant to target infected cells, but it does damage to the surrounding environment and healthy cells.

While your upper airways are meant to be attacked and quickly recover (afterall, it's exposed to the outside world), lower airways are not, they take longer to heal and to return it's inflammatory response back to base levels.

Edit: formatting

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hands-solooo t1_izmzz8g wrote

The building only gets bullet holes once the cops show up to shoot the bad guys.

Most symptoms of infection are the immune system and not the infection itself. And considering that a big part of immune response to viral infections is to just kill every infected cell, it makes sense that some symptoms appear once the infection is under control.

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ratpH1nk t1_izk5pmo wrote

It is interestingly enough a really complicated topic (and chronic cough in general). It ranges from ciliary damage/reconstruction to alteration in the sensitivity of the nerves of the thorax/lungs/ribs etc...

General teaching point is post viral cough can last 6 weeks post illness, but it varies greatly from a few days to permanent.

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hebch t1_izjlv87 wrote

Partly because the damage done to the respiratory lining needs to be cleared out. Coughing helps clear out the junk that built up in the fight and the junk that continues to be produced in varying degrees during the repair.

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ashvinvk t1_izmbl78 wrote

So we're talking specifically about post viral syndrome. This is a great question - the condition is often poorly understood and always underestimated, and as you highlighted, always frustrating. Sometimes more so than the initial disease.

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The initial viral replication from a mild viral infection triggers a local inflammatory response - hence the nasal drip, swelling, chest congestion, maybe mild sore throat or sinus congestion, etc. A person with full immunity (no underlying immune, sinus, pulmonary disease) will clear a mild viral infection by their immune system in 3-4 days.

Day 3-5 is when sloughing of the superficial mucosal layers peaks (hence day 4 is usually the worst of the viral symptoms), and the exposed underlying tissue has 'increased sensitivity' to dry air and nasal drip.

Once new tissue is in place, the symptoms are fully resolved, but this can take 3-4 weeks and even longer if the cough and nasal dripping persist even longer -- this is why the humidity and decongestants and hydration are important. Conservative therapy (humidifier, vicks on feet and neck, day and night decongestants/'cough syrups', honey, tea, soups, lemon) are crucial to healing - take your grandma's advice.

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CarboniferousCreek t1_izn4qu0 wrote

This is really well explained, thank you!

Can you expand a bit more on the sloughing of superficial mucosal layers? Does the virus/your immune system just destroy those layers? Would it be similar to like a scab or dead skin with new skin underneath ?

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stalkthepootiepoot t1_izmjg0b wrote

Cough is a reflex initiated by the activation of a subset of sensory nerves innervating the larynx, trachea and bronchi. These sensory nerves are activated by irritants like acid and capsaicin, but also by inflammatory mediators produced in asthma and in viral infections. Importantly, viral infections also produce neurotrophins like nerve growth factor that activate Trk receptors on these nerves cause a sub chronic increase in their sensitivity. This can last for weeks after the removal of the infection, and is much worse in asthmatics. With super sensitive sensory nerves your cough reflex is triggered by even innocuous stimuli. Sauce: I am a professor of neurophysiology who studies this.

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tzippora t1_izn9srh wrote

What can makes these nerves less sensitive?

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stalkthepootiepoot t1_izom838 wrote

Nothing that we know of at the moment. Certainly not ‘cough drops’ which are borderline useless. We don’t know all the molecular mechanisms underlying this hypersensitivity, but hopefully new therapeutic targets will be uncovered.

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EmpatheticPorpoise t1_izm9fcp wrote

Think about it like a cut/scab. You have the cut and and the scab (takes a few days to a week to form) Then you keep banging/scraping etc to the scab and you keep re-opening the wound until you can avoid removing the scab long enough for it to heal completely..

Bronchospasms caused by Repetitive coughing during the virus create a vicious cycle of irritation-cough-irritation- cough more… and so on

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jvsews t1_izlpp8f wrote

Yes your lungs insides passages are swollen and irritated and take a long time to calm down. I have scaring from prior illnesses and I must use steroids for a month any time things hit my lungs. A few years ago my bad virus turned into pneumonia. It took 10 months to start feeling better

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thebootsesrules t1_izj8x8q wrote

This is likely more subjectively true than objectively and is relative. When you have the virus the cough doesn’t seem that bad because you have several other symptoms. Then once the virus clears and you’re stuck with mostly just a cough it’s the only thing your brain is focused on. It’s also worth noting coughing begets coughing, so using cough drops to reduce cough frequency will help reduce severity of cough after the effect of the cough drop wears off.

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