Probiotics are a little bit the rage these days. The more we learn about the microbiome (all the bacteria that happily live in and on us to support digestion and immune function), the more we learn we want to preserve them. Probiotics are supplements (not medicines) so the data on their use is in the early stages but taking probiotics while taking antibiotics really does make medical sense. New data out in JAMA Pediatrics makes this more compelling. Taken orally, probiotics re-populate your gastrointestinal tract with “good” bacteria to help aid in digestion — so using them at the time you are taking antibiotics for an infection may help alleviate side effects like diarrhea that result after the “good” bacteria are killed off.
Antibiotics are the most commonly prescribed medication to children yet estimates show that 1 in 3 to half of antibiotics prescribed are unnecessary. Typically that means that antibiotics are prescribed when they won’t do any good for a viral infection or when a child will recover from an infection without intervention. Trouble is, antibiotics kill BOTH the good and bad bacteria in our bodies. Sometimes this is necessary when it comes to treating things like whooping cough, strep throat and urinary tract infections, while others it is not (colds, bronchitis and fluid in the ear). Of course in addition to using antibiotics more than we’d like to, antibiotics also cause side effects like: diarrhea, abdominal cramping, hives and nausea.
The estimated incidence of antibiotic-associated diarrhea among children is 11% among outpatients and 21% among inpatients — Probiotics and Prevention of Antibiotic Associated Diarrhea in Infants and Children, JAMA Pediatrics
The recent JAMA Pediatrics clinical synopsis (summary of a larger Cochrane review) provides us new insights on how we can help children who may be struggling with side effects caused by antibiotics. The study found that providing children with probiotics during antibiotic use can reduce both the chance of diarrhea and the number of days it lasts. Probiotics are live bacteria and yeasts that can help replenish the bacteria in our guts that antibiotics kill. Probiotics often come in capsules you can open up in your children’s food or bottle or they come in packets you can sprinkle.
Most parents know that it’s not a good idea to beg your provider or child’s pediatrician for antibiotics — hoping to find a quick fix or relief for certain conditions doesn’t work when the medicines won’t help. Although we want to fix our children’s illnesses, antibiotics only help when an infection is caused by a susceptible bacteria.
Antibiotics are used specifically for infections caused by bacteria. In general, most common cold symptoms—such as runny nose, cough, and congestion—are mild and your child will get better without using any medicines. HealthyChildren.org
Antibiotics should be used to treat infections like strep throat, whooping cough (caused by pertussis) and urinary tract infections. We just don’t want to use them for strep culture-negative sore throats, runny nose, most rashes or cold caused by viruses. When we use antibiotics at the wrong time we don’t improve the likelihood of a cure in the short-term and we set ourselves up for more antibiotic-resistant infections. Not only do antibiotics carry short-term side effects (diarrhea, rashes, sometimes allergic reactions) there is some data that early use of antibiotics in life changes long-standing risks for chronic medical conditions (things like Crohn’s disease).
Overprescribing antibiotics affects both individuals and society as a whole. Each time a person is prescribed an antibiotic they risk having a severe reaction to the medicine. These reactions bring approximately 30,000 visitors to emergency rooms across the country every year. Antibiotics can also cause diarrhea or clostridium difficile colitis (C. diff), and early childhood exposure has even been associated with the development of asthma and Crohn’s disease. —Dr Matthew Kronman
Today’s main takeaway: if you or a loved one are at an inpatient setting, ask every day what antibiotics you’re on, why you’re on them, and when you can stop taking them. Every day. Your care team is likely doing the same thing but you bringing it up helps ensure it remains a priority.
How To Be Smart Using Antibiotics:
Take the antibiotic exactly as the doctor prescribes them and take them for the shortest duration.
Try not to skip doses or stop taking an antibiotic early unless your doctor tells you to do so.
Only take antibiotics prescribed for you; do not share or use leftover antibiotics. Do not save antibiotics for the next illness — makes little sense and can contribute to resistance.
Prevent infections by practicing good hand hygiene, cough in your elbow (not your hand), and get recommended vaccines (vaccines don’t contribute to antibiotic resistance).
Remember antibiotics have side effects. When your doctor or nurse says you don’t need an antibiotic, taking one may do more harm than good. Often walking out of the office WITHOUT a prescription is the best outcome…
Using antibiotics on the farm to raise animals contributes to the production of antibiotic–resistant germs or “superbugs.” All animals carry bacteria in their intestines and on their bodies. Giving antibiotics to animals will kill large amounts of bacteria, changing their microbiome (<–good explanation here) and regular “good” bacteria too. Because 60% of the antibiotics used in animals are also used to treat human diseases, with time when antibiotics are used routinely, the bacteria become resistant, survive and multiply. If those resistant bacteria are transmitted to people, we don’t have as many medicines to eradicate them. Therefore, risks develop to humans when these “superbugs” thrive in animals and are transmitted through our food source. Over time, more and more infections carried in the food we eat will lack proper treatments. What we choose to eat will shape our risk.
Antibiotics used for infections in animals should be encouraged but antibiotics used to promote rapid growth and weight gain in animals likely should not (overuse). The majority of tonnage of antibiotics used in raising animals are often used for growth promotion and efficiency meaning they are used to keep meat cheaper, not necessarily safer. Hard to find clear data on exactly what % is used for disease treatment and what % is used for growth. Read more »
Super smartness in the world of health care is always a goal. This week is Get Smart About Antibiotics Week, an annual observance to raise awareness of the threat of antibiotic resistance and the importance of appropriate antibiotic prescribing and use. This isn’t just about NOT begging for antibiotics when our children have a runny nose and this isn’t just about docs and nurses being smarter about using antibiotics only when we need them. If we want antibiotics to be around and useful for generations to come, this will take a multi-prong approach.
Antibiotic resistance — “the rise of deadly germs no longer stopped by the drugs that once controlled them” — will only increase over time if we use continue to use antibiotics at our current pace. At home, in raising the food we eat, and in health care organizations.
Each year in the United States, at least 2 million people become infected with bacteria that are resistant to antibiotics. That means their infections aren’t easily treated, can grow and spread in their bodies without cure and can potentially cause serious harm. Those bacteria can also spread to others. At least 23,000 people die as a direct result of these infections every year. So this stuff matters. What soap we use, what medicines we avoid, what medicines we use, what food we eat and how it’s raised all change the game. I’ll be doing a series of short posts each day this week to share what I’ve learned about the negative effects of antibiotics overuse. Read more »
Antibiotic resistance is like global warming; it feels like it’s someone else’s problem to solve and much bigger than all of us. Yet the simple choices we make – whether or not to use antibiotics and which ones we pick – do affect us and our community. ~Dr Matthew Kronman
This week is Get SMART About Antibiotics Week, aimed at raising awareness of antibiotic resistance and the importance of appropriate use. Dr Kronman’s “inconvenient truth” reminder serves up the importance of our choices; what we do everyday with our food and our medicines changes not only our own health but also the health of others now and in the future. Antibiotics in food, water, and our clinics and hospitals change our environment. Each dose of antibiotics given to our children, ourselves, or the animals we eat change our community’s health in general. The more we use antibiotics that kill off susceptible bacteria, the more we select bacteria for survival that are resistant to known treatments. The consequence over time for us all is that there are more resistant bacteria or “superbugs” around causing harder to treat infections.
4 Things You Can Do Today To Avoid Excess Antibiotics
My coffee arrived in a red cup today so I know the holidays are officially upon us; Thanksgiving will be here before you know it. If you’re ordering a turkey (and/or you’re incredibly organized) you’ll likely be picking out your bird in the next few days. Who are you people? For you prepared and pre-paid types and even those of us who wait until the Thanksgiving week, we have some decisions to make and a great opportunity. What turkey we buy matters.
This year I’ll be making the choice to purchase a turkey raised without antibiotics –when you choose this type of turkey it doesn’t mean “organic” (even some organic meats come from animals fed antibiotics). Antibiotic resistance is a growing problem and I’m taking a new step to keep my kids away from excess antibiotics, like those found in many Thanksgiving turkeys. This is new for me and hasn’t been a priority until the last few years as I’ve tuned into information about the human microbiome and ways that antibiotics in our land, food, water and pharmacies really change our own habitat and potentially our family’s health.
The Problem With Unnecessary Antibiotics
I’ve written several posts on avoiding antibiotics when unnecessary, but here’s the cliff notes version: When you (or your child) take an antibiotic, most of the susceptible bacteria exposed to the drug will die. “Good bacteria” (naturally living on our skin or in your throat or GI tract) and “bad bacteria” (the ones causing the infection) will fail to survive. However, some bacteria will possess genes that allow survival amid the presence of antibiotics. Over time and without competition from other organisms, these bacteria can even thrive. This set-up creates different colonies of bacteria where some will be resistant ‘superbugs’ and changing the bacteria in our environment and our own bodies. Some of these colonies will eventually cause infections that are hard to treat. The more antibiotics are used anywhere, the more possibilities for these ‘superbugs’ to replicate with resistance over time. In fact 97% of doctors are extremely or fairly concerned about the growing problem of antibiotic resistant infections. Most parents are worried, too.
Research shows that about 1 in every 5 pediatric visits for “sick visits” results in an antibiotic prescription. Now not all of those antibiotics are taken; many pediatricians now use the Rx pad for “wait and see” or “delayed prescribing” antibiotics. They give a prescription and allow the family to watch and wait — if a child is not getting better, they advise parents to start taking them. However, in total there are nearly 50 million antibiotic prescriptions written annually in the US. It’s not uncommon that prescriptions for antibiotics are written when children have “colds” or upper respiratory tract infections from a virus. That’s where we all have an opportunity to improve our children’s health. Nearly all of us know it’s good to avoid antibiotics when unnecessary. It’s the end of Get Smart About Antibiotics Week.
Studies indicate that nearly 50% of antimicrobial use in hospitals is unnecessary or inappropriate. ~CDC
In my experience, this issue really isn’t a tug-of-war between parents wanting drugs and doctors wanting to restrict them. Most parents I talk with in clinic don’t want an antibiotic if they can avoid it. However, recent survey data on adults found that 38% expressed a desire for antibiotics when seeking health care for the common cold. Determining when antibiotics are necessary is the tough part. This week, a clinical report was published to help pediatricians and parents know when they can avoid antibiotics given unnecessarily. Some of the data from the report included here:
5 Reasons To Avoid Antibiotics When Unnecessary
Antibiotics can cause side effects. The reason: while you may be giving antibiotics to treat a possible ear infection, once ingested the antibiotics go to every organ in your body thus killing off some of the “good bacteria” living there. Some new research even suggests that bacteria that live in our gut affect our brain activity, mood, and behavior.
Bacteria do good. Throughout our lifetime we accumulate a lot of bacteria to the point that of all the cells in and on our body, 90% of our cells are bacterial! These bacteria help keep our bodies happy – assisting in digestion and keeping a good balance of colonies for healthy skin and intestines.
Every dose of antibiotics changes us. Each dose of antibiotics kills the normal bacteria that live in our body. The risk of taking antibiotics is not only the side effects (diarrhea, rash, or upset stomach, for example) but the risk that each dose changes who we are. Previous research from 2012 found that antibiotics, particularly when given to infants, may increase risk for chronic disease later on (inflammatory bowel disease). Read more »
I work hard (as do most doctors) to avoid prescribing antibiotics when unnecessary. The reason? I’m concerned about both the short term effects (diarrhea, rash, allergies) and long term effects (drug resistance, altered normal bacteria and microbes on our bodies) of antibiotic use in children. As we learn more about health and about the role of “good” bacteria in wellness preservation, I suspect we will feel more and more compelled to avoid antibiotics in children. Less is often more.
There are certain medical conditions that benefit greatly from antibiotics (Strep throat, pneumonia from bacteria, kidney infections, some severe skin infections, for example). Hands down, antibiotics save lives and prevent terrible infections when bacteria are to blame. But antibiotics are not without risk. And, we know that antibiotics do no good for children when viruses are the cause of the infection. The use of antibiotics when unnecessary, contributes to “unnecessary [health care] costs, avoidable adverse events, and the development of antibiotic-resistant infections” a study published today reminds.
The hard part for parents (and pediatricians) is knowing when bacteria are to blame and when they are not. Read more »
New research on ear infections confronts a challenging conundrum: What should pediatricians do for a toddler with a real-deal ear infection? Treat with antibiotics or “watch and wait?” New research and a nice editorial published in The New England Journal of Medicine this week add to the stew of information about how to manage ear infections in young children. The new research confers benefit to using antibiotics at initial diagnosis of a true ear infection in children under age 2 or 3.
But wait. Seemingly simple, treatment decisions for ear infections are far from it. It can be easy for a pediatrician to prescribe antibiotics, yes. But those of us working hard to perfect how we care for children think long and hard prior to writing a prescription for the pink stuff. Current guidelines from the AAP (published in 2004) make us pause. The AAP recommendations embody the “watch and wait” approach in most children with uncomplicated, acute, middle ear infections between 2 months to 12 years of age. The AAP recommendations include:
Pain control (Tylenol or Advil, etc). Ear infections hurt!
Observation (waiting for 48-72 hours for relief)
Treatment with high-dose Amoxicillin first and foremost if selected to treat.
Return check after 48-72 hours if no improvement (then moving to treatment with Amoxicillin or changing to Augmentin if child on Amoxicillin)
Prevention efforts (encouraging breast feeding, no bottle propping, working to decrease exposure to cigarette smoke)
But the “watch and wait” approach can be challenging for parents, pediatricians and family practitioners alike. Particularly with a child in pain, a gnarly looking eardrum, and/or a fever. Because of this, studies have found that the majority of physicians who see ear infections in the US don’t necessarily subscribe to these recommendations; we all really like to do something to make our kids feel better… Read more »
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