Published Aug 27, 2026 | 8:24 AM ⚊ Updated Aug 27, 2026 | 8:24 AM
Azithromycin and amoxicillin-clavulanate are among the antibiotics that patients may commonly associate with respiratory infections.
Synopsis: As influenza cases rise across India, doctors warn against using antibiotics such as azithromycin and amoxicillin-clavulanate for uncomplicated flu. Experts explain when bacterial infections may require antibiotics, why worsening symptoms need medical evaluation, how unnecessary antibiotic use fuels antimicrobial resistance, and when antivirals such as oseltamivir may be appropriate.
As influenza cases rise across several parts of India, doctors are warning against a familiar response to fever and cough: reaching for antibiotics before establishing whether there is a bacterial infection.
Karnataka has recorded 4,212 laboratory-confirmed influenza-positive cases across 32 districts up to 22 August, with Bengaluru accounting for nearly three-fourths of the total. Delhi and several other states have also reported increased influenza activity.
While health authorities and doctors describe the broader rise as seasonal, the surge brings a parallel concern into focus: whether patients with fever, cough, sore throat and body aches are taking antibiotics such as azithromycin or amoxicillin-clavulanate even when the underlying infection is viral.
Doctors say the distinction matters because antibiotics do not treat influenza itself.
“Antibiotics are for bacteria. Influenza is caused by a virus. Therefore, antibiotics do not cure the influenza virus itself. Only if there is a suspected or known bacterial infection with influenza can antibiotics be used,” says Dr Srivatsa Lokeshwaran, Director, Interventional Pulmonology, Fortis Hospital, Bannerghatta Road, Bengaluru to South First.
Dr Judhajit Sengupta, Consultant, Critical Care Medicine, Narayana RN Tagore Hospital, Kolkata, makes the distinction even more directly.
“Antibiotics have no role in treating uncomplicated influenza because influenza is caused by a virus, whereas antibiotics act against bacteria. Giving an antibiotic simply because a patient has fever, cough or a sore throat does not treat the influenza virus and does not necessarily speed up recovery,” he told South First.
The answer is not that antibiotics are never used in patients with influenza. Doctors say they may become necessary when the viral infection is accompanied by, or followed by, a bacterial infection.
Influenza can affect the lower respiratory tract and cause viral pneumonia. It can also weaken respiratory defences and make it easier for bacteria to cause a secondary infection.
“Influenza can temporarily weaken the respiratory tract’s defence mechanisms, making it easier for bacteria to cause a secondary infection. This can occur during the course of influenza or after the initial viral illness,” Dr Sengupta says.
Dr Lokeshwaran says influenza itself can predispose patients to secondary bacterial pneumonia, particularly when the illness is severe or when patients have underlying health conditions.
“Antibiotics may be considered if a doctor suspects or confirms a bacterial co-infection such as bacterial pneumonia. But they are not needed for every person with influenza or a lingering cough,” he says.
Dr Hemanth Kumar M, Senior Consultant, Pulmonologist, Narayana Health Bengaluru, said the choice of antibiotics depended on “the suspected organism, severity of illness, patient’s age and comorbidities, previous antibiotic exposure and local antimicrobial-resistance patterns.”
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One of the most important clues to bacterial infection is what happens to the patient after the initial phase of illness.
Doctors say a patient who begins recovering and then suddenly deteriorates needs to be reassessed.
“One important warning sign is when a patient initially starts improving but then becomes unwell again. Persistent or recurring fever, worsening cough, increasing breathlessness, falling oxygen levels or an overall deterioration in the patient’s condition may raise concern about a secondary bacterial infection or another complication,” Dr Lokeshwaran said.
Dr Kumar described the same change in clinical trajectory as a reason for concern.
“If a patient initially appears to be recovering and then develops a new fever, worsening cough, increased sputum production, breathlessness, chest pain or a drop in oxygen saturation, we become concerned about a secondary bacterial infection or pneumonia,” he says.
But neither doctor recommends treating these symptoms with antibiotics without an assessment.
“These symptoms are not diagnostic of bacterial infection by themselves. They should prompt a clinical assessment rather than automatic initiation of antibiotics,” Dr Kumar says.
Dr Sengupta also cautions that symptoms such as fever, coloured sputum or a severe cough alone do not automatically mean an antibiotic is required.
“The decision should follow a clinical assessment rather than self-medication,” he says.
Azithromycin and amoxicillin-clavulanate are among the antibiotics that patients may commonly associate with respiratory infections. But doctors say neither should be taken simply because someone has influenza symptoms.
“Azithromycin, amoxicillin-clavulanate or another antibiotic may be appropriate when a bacterial infection is clinically diagnosed or there is sufficient suspicion of bacterial infection. The choice depends on the suspected site of infection, severity, the patient’s medical history and local antibiotic-resistance patterns,” Dr Sengupta said.
This distinction becomes particularly important during a period when large numbers of people may have similar symptoms. Fever, cough and sore throat can occur with influenza as well as several other respiratory infections, and symptoms alone do not always establish whether bacteria are involved.
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Dr Sengupta says the expectation of receiving an antibiotic during respiratory infection seasons remains common.
“During respiratory infection seasons, we do see patients who either request antibiotics or start them on their own because they believe an antibiotic will make them recover faster. This is a common misconception, particularly when fever and cough are present,” he says.
That practice can expose patients to medication without addressing the actual cause of their illness.
“Starting an antibiotic without establishing a bacterial indication exposes the patient to unnecessary medication and contributes to the larger problem of antimicrobial resistance,” Dr Sengupta says.
Dr Kumar says unnecessary antibiotic use can also create a false sense that the illness is being adequately treated.
“It can also create a false sense that the underlying infection is being adequately treated, potentially delaying appropriate medical assessment if the patient’s condition continues to deteriorate,” he says.
Unnecessary exposure to antibiotics can contribute to antimicrobial resistance, making future bacterial infections more difficult to treat.
“Antibiotic resistance is driven in part by unnecessary and inappropriate antibiotic exposure. When antibiotics are used without a bacterial infection, they do not provide benefit against the virus, but they can exert selective pressure that favours resistant bacteria,” Dr Sengupta says.
Over time, this can leave doctors with fewer effective treatment options.
“Over time, this can make bacterial infections more difficult to treat and can result in the need for broader-spectrum or more toxic antibiotics. Responsible antibiotic use is therefore not just an individual patient issue; it is an important public-health responsibility,” he says.
Dr Lokeshwaran adds that unnecessary antibiotic use can expose patients to avoidable adverse effects while doing nothing to treat the influenza virus.
“Using antibiotics when they are not needed is not helpful in treating the influenza virus and can expose patients to avoidable side effects,” he says.
Another distinction doctors want patients to understand is the difference between antibiotics and antiviral medicines.
Oseltamivir, for example, acts against influenza viruses, while antibiotics target bacteria.
“Oseltamivir is an antiviral medication that acts against influenza viruses, whereas antibiotics target bacteria. So, they address two fundamentally different causes of infection,” Dr Sengupta says.
For patients at higher risk of complications, or those with severe or progressive influenza, an antiviral may be prescribed by a treating physician. Dr Sengupta says antivirals are generally most effective when started early, although they can still have a role in some patients who present later with severe illness.
Importantly, however, an antiviral does not replace an antibiotic when a genuine bacterial infection is present.
Doctors say the threshold for seeking medical advice should be lower among people who are more vulnerable to severe influenza.
Patients with asthma, COPD and other chronic lung conditions may be at greater risk because influenza can worsen underlying respiratory disease.
“Influenza can trigger an asthma or COPD exacerbation and, in some cases, can lead to pneumonia or respiratory failure,” said Dr Kumar.
Older adults, very young children, immunocompromised people and those with significant underlying heart or lung disease are also at higher risk of severe complications.
For uncomplicated viral illness, patients may require rest, hydration, symptomatic treatment and monitoring, depending on their condition.
“Most uncomplicated respiratory viral infections can be managed with adequate hydration, rest, appropriate symptomatic treatment and monitoring, depending on the patient’s condition,” said Dr Sengupta.
But worsening symptoms require medical evaluation, particularly when accompanied by breathing difficulty, chest pain, persistent high fever, confusion, dehydration or low oxygen levels.
Dr Lokeshwaran’s advice is straightforward: if fever, cough or breathlessness worsens after an initial improvement, patients should seek medical advice rather than starting antibiotics on their own.
As influenza continues to circulate across India, doctors say the important distinction is not simply between taking or avoiding antibiotics. It is determining what infection the patient actually has, whether a bacterial complication has developed, and what treatment is appropriate for that specific condition.
(Edited by Fayisa CA)
