Martina Kelly describes well the ways in which doctors use their sense of smell, including in recognising infection.1 As well as the infections she describes, I would suggest that from my experience there can be a distinct smell in a patient with some upper and lower respiratory tract infections. When my son was 2-years-old he developed rapid onset of fever, earache, and he smelt distinctly ‘bacterially infected’. It was the latter that made me seek medical attention the same evening. He was prescribed amoxicillin and within 12 hours was afebrile, in less pain, and no longer smelt as if he was rotting; he went to nursery and I went to work. I had a clear conscience believing that he did not have a viral infection that he may spread to his peers at nursery.
Perhaps related, I know that taste comes into my decision making to use antibiotics. If a patient describes their sputum or nasal discharge as tasting foul I am more likely to resort to prescribing antibiotics. There will sometimes be an associated odour in such cases.
In this age of guidelines rightly helping us to limit our use of antibiotics, I wonder if smell would be a helpful sign to contribute to decision making. However, I suspect it will never end up in the guidelines due to a lack of randomised controlled trials to provide the evidence required.
- © British Journal of General Practice 2012
