Antimicrobial Stewardship

All Articles in the Category ‘Antimicrobial Stewardship’

Give Children Probiotics When Taking Antibiotics

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.

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No More Antibacterial Soap At Home or School

It’s a clear no-go on those “antibacterial” soaps you see on people’s counters and sometimes in our schools. They are soon to vanish from stores. No good evidence the (typically liquid) soaps actually protect our family from bacterial infections better than washing with regular soap and water and there are some concerns the ingredients used to make the soap may pose risk. Because of this, the Food and Drug Administration (FDA) recently announced a ban on chemicals/pesticides used in antibacterial soaps due to safety concerns, including two of the most commonly used ingredients: triclosan and triclocarban. Some of these antibacterial soaps will still be used in hospitals.

Consumers may think antibacterial washes are more effective at preventing the spread of germs, but we have no scientific evidence that they are any better than plain soap and water.” ~ Dr. Janet Woodcock, director of the FDA’s Center for Drug Evaluation & Research

Some history: Back in 2013 the FDA asked companies that produce antibacterial soaps to prove that their products were more effective than basic soap and water. Turns out, they couldn’t (or didn’t) provide data to show that these products were safe for long-term use nor that they are more effective. We know anytime we add antibiotics into our environment. water, food or agriculture, they kill bacteria off so that bugs that are less treatable with medicines have an easier time surviving. The end result are so-called, “superbugs” or bacteria in our environment and thankfully, rarely in our bodies, that are difficult or impossible to treat. That’s a LOSE-LOSE for humans (and animals). Hence the new ban on these soaps. Companies now must comply with removing the chemicals within 1 year’s time, or take the products off the market. There are 3 chemicals used in some soaps still allowed (not included in the 19 ingredients listed in the FDA ban) that rarely may still be found.

Why We Don’t Want To Use “Antibiotic” Soap

Some bacteria are good (the ones that live in our guts and the ones that live on our skin, for example) and contribute to our microbiome. We want to preserve those as these bacteria protect us, help us break down food, and even support vitamin production. There is also some data that every course of antibiotics we ever take changes this microbiome and may have lasting and long-term effects including susceptibility to chronic disease.

So as part of our wellness relies on these “good” bacteria, part of human wellness also relies on effective antibiotics against the bad ones (for serious infections, surgery, when an immune system is compromised). Clearly, we only want to use antibiotics when necessary; if we overuse them we create environments where resistant bacteria thrive. Once that happens, we won’t be able to cure infections they cause. Read full post »

Flu Season Update & OTC Medicines

2016 flu KYOTCs

The flu season is in full swing across America although thankfully, influenza activity is mild in most states. If you click on this interactive US map you can see where your state fairs with ongoing influenza (hit “play” and you’ll see all weeks reported this season).

It’s certainly NOT too late for your family to get a flu shot  (or nasal spray) since that’s the best way to protect against severe complications from influenza. There is no cure for influenza (antibiotics don’t treat the virus), but there are over-the-counter (OTC) products that do help ease symptoms & side effects from viruses (including influenza) that cause cold symptoms. Some doctors are calling for a “symptomatic prescription pad” that would first suggest simple aids like humidifiers, drinking fluids, and OTC products before antibiotic use. No sense in using antibiotics if the infection you or your child has is from a virus like influenza or one of hundreds that cause the “common cold.”

It’s awful when our children are sick, especially when multiple symptoms like congestion, fever, body aches, sore throat or cough interfere with sleep. Salt in the wound for parents everywhere. Sleep disruption is normal during illness, especially cough and colds, and especially with infants and toddlers who are unaccustomed to moving mucus around while they sleep. So parents often turn to multi-symptom OTC products out of desperation! Sometimes these medicines really reduce symptoms that can make the whole family suffer but there are cautions we have to take.

First off, cough and cold medicines are not typically recommended in children under age 4 to 6 years of age.

In addition, we have to use our smarts with medicines that contain more than 1 ingredient that treat different symptoms. Being aware of the ingredients in the OTC product you’re using is very important because you don’t want to take another product that includes the same ingredients as another (doubling-up). This can happen if you give your child acetaminophen, for example, for fever and then give a cough and cold medicine with that same ingredient. Read full post »

Why To Buy An Antibiotic-Free Turkey This Thanksgiving

Like I said last year, there’s one little thing we can do this month to change our safety and preserve the value of antibiotics. And although not all families can be without antibiotics on Thanksgiving due to chronic or even acute medical problems, we all can eat smarter turkey. This is an easy awesome.

I partnered with Dr. Scott Weissman this week for “Get Smart” week. On Monday we explained that we’re dependent on antibiotics for all sorts of medical miracles (bone marrow transplants, joint replacements, healing from a large cut, routine surgery, and chemotherapy). We when use antibiotics responsibly in the clinic, in the hospital, in raising food and in our agriculture we’ll preserve antibiotics for decades to come. Trends show if we don’t, we’ll contribute to more and more resistant and untreatable infections. Tuesday we explained how antibiotics are used in agriculture, Wednesday how to be a squeaky wheel in the hospital (speak up, ask about antibiotics EVERY day), and yesterday we reviewed 5 tips for avoiding antibiotics in clinic. Today…..drumroll…….we provide something super easy to be smart:

Make an effort to buy an antibiotic-free turkey this Thanksgiving. Animal agriculture uses four times the amount of antibiotics as human medicine, and mostly in healthy animals for growth promotion or disease prevention on crowded farms. It’s also worth noting that safe preparation is also key. Read full post »

5 Ways To Avoid Antibiotics At Clinic When Unnecessary


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

5 Ways To Avoid Antibiotics

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Ask About Antibiotics Every Day In The Hospital


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.
  • Discard any leftover medication once the prescribed course of treatment is completed. There are a variety of safe ways you can do this. No flushies!
  • 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…

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Antibiotics Used In Meat Changes Our Health


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.

Susceptible and resistant animal pathogens can reach humans through the food supply, by direct contact with animals, or through environmental contamination. American Academy of Pediatric Technical Report

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 full post »

This Matters: Getting Smart About Antibiotics


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 full post »

What To Know About Baby Teeth

Image courtesy: American Dental Association

Image courtesy: American Dental Association

Things have changed over the past couple of years regarding how to care for baby teeth. Official recommendations for fluoridated toothpaste begin with the very first sighting of the very first tooth. This is news to many.

What we do early in our child’s life can have lasting consequences. Some quick reminders for new parents, grandparents and anyone out there lucky enough to be hanging out with an infant. Keep their mouth delicious!

5 Things Every Parent Needs To Know About Baby Teeth

  1. Use fluoridated toothpaste at tooth eruption. The minute those baby teeth come in consider it the start of the lifelong brushing habit for your baby. Brushing and rinsing the teeth after breastfeeding or formula, solid meals or snacks will always be recommended.  In minimum, build brushing into everyday, ideally morning and night, with a tiny amount of fluoridated child toothpaste (see image above). This may be most important after the last evening feeding.
  2. Tap water! Brush with tap water twice a day and provide tap water for your infants and children when serving water. After you brush teeth DON’T RINSE with water. Let the tiny amount of fluoride from the brushing sit on the teeth as long as possible to prevent decay.
  3. Use the right amount of toothpaste (image above). This provides protection from bacteria and acid but also avoids concern for too much toothpaste.
    1. < 3 years of age – rice sized smear of toothpaste on the brush.
    2. > 3 years (including adults) pea sized amount of toothpaste is all you need on your brush once you know how to spit.
    3. Don’t rinse after brushing.
  4. Timing: Most infants and toddlers, preschoolers and young children can brush their teeth and tongue in about 1 minute — goal really is to brush at the gumline on all sides of each tooth, paying special attention to back teeth, molars, and lower teeth where bacteria love to reside. For older children, teens and adults the rule of thumb is typically 2 minutes of brush time to brush teeth, tongue and rid mouth of dragon breath!
  5. Bacteria: Baby teeth enamel is thinner than adult (secondary) teeth so the mix of sugar and bacteria in the mouth must be deterred. We unfortunately transfer oral bacteria to babies when we share utensils, kiss them, clean their pacifiers with our mouths (don’t do it!), and drink from shared cups. If you have a history of lots of cavities the American Academy of Pediatrics’ new policy says, “Parents/caregivers, especially those with significant history of dental decay, should be cautioned to avoid sharing with their child items that have been in their own mouths.” I’m all for smooching babies so I say this: get to the dentist yourself to make sure your mouth is in tip-top shape to avoid some bad transfers…

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Is Overuse Of Antibiotics The New Global Warming?

Desinfecting.JH

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

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