‘antibiotics’

All Articles tagged ‘antibiotics’

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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If It Were My Child: A Turkey Without Antibiotics

turkey photoMy 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.

The Case For Antibiotic-Free Turkeys

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Get Smart: 5 Reasons To Avoid Antibiotics

Smiling babyResearch 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

  1. 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.
  2. 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.
  3. 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 full post »

Is It Really An Ear Infection?

Screen Shot 2013-02-26 at 9.46.22 AMEar infections cause significant and sometimes serious ear pain, overnight awakening, missed school, missed work, and lots of parental heartache. For some children, infections in the ear can be a chronic problem and lead to repeated clinic visits, multiple courses of antibiotics, and rarely a need for tube placement by surgery. For most children, ear infections occur more sporadically,  just bad luck after a cold. Fortunately the majority of children recover from ear infections without any intervention. But about 20-30% of the time, they need help fighting the infection.

Ear infections can be caused by viruses or bacteria when excess fluid gets trapped in the middle portion of the ear, behind the eardrum. When that space fills with mucus or pus it is put under pressure and it gets inflamed causing pain. Symptoms of ear infections include pain, fever, difficulty hearing, difficultly sleeping, crankiness, or tugging and pulling at the ear. This typically happens at the time or soon after a cold—therefore the fluid in the ear can either be filled with a virus or bacteria.

The most important medicine you give your child when you first suspect an ear infection is one for pain.

Antibiotics only help if bacteria is the cause. When a true infection is present causing pain and fever, antibiotics are never the wrong choice. Often you’ll need a clinician’s help in diagnosing a true ear infection.

Three’s been a lot of work (and research) over the last 15 years to reduce unnecessary antibiotics prescribed for ear infections. There has been great progress. Less children see the doctor when they have an ear infection (only 634/1000 in 2005 versus 950/1000 back in the 1990’s) and they’re prescribed antibiotics less frequently. Recent data finds that less than half of children with ear infections receive antibiotics (only 434 of every 1000 children with ear infections). However, the far majority who go in to see a doctor do still receive a prescription for antibiotic (76%).

The American Academy of Pediatrics(AAP) just released new guidelines to help physicians do a better job treating ear infections. Sometimes children really benefit from using antibiotics and new research has led to an update on the 2004 previously published recommendations. Over-use of antibiotics can lead to more resistant and aggressive bacteria so we want to use them at the right time. These recommendations may help improve care for children.

In my opinion, NPR published the best article I’ve read covering the new recommendations. I especially liked the balance provided: Read full post »

Antibiotic Use May Increase Risk For IBD

We’re surrounded by bacteria– literally. They live on the surface our skin and set up camp in our intestines immediately after birth. The complexity of the colonies that live there diversifies throughout our lives–many sticking around for the duration. And we’re dependent on the ka-billions of bacteria that co-exist with us to maintain our health. Without them, things can go off-kilter as bacteria really are a part of our wellness–supporting digestion and maintaining harmony on our skin. Of course, some bacteria come in that we’d really rather not have. That’s when we use antibiotics.

As cough and cold season returns, a study published today serves up a needed reminder. Antibiotics can cause significant changes to our body. Because many infections are caused by viruses (not bacteria) antibiotics are often unnecessary. When we take antibiotics by mouth (or IV/injection) they may kill the bacteria causing a troubling or painful infection yes, but they can also kill the desired “good bacteria,” too. This is a side effect all antibiotics carry. Often we witness this in our children by changes in their poop—after a course of antibiotics they get really runny poop or diarrhea or it will smell entirely different. You really are witnessing the change of colonies in their intestines when you see this.

Sometimes antibiotics are absolutely necessary and life-saving. But recent research has found that antibiotics are prescribed in 1 out of 5 pediatric acute-care visits. And of the 49 million prescriptions for antibiotics given annually, some researchers estimate that 10 million of those are unnecessary. Avoiding those unnecessary courses is up to all of us–parents and clinicians.

I really do think the tide is changing in this regard. It’s rare that a family requests or urges for antibiotics in clinic.

New research is looking at how altering bacteria in our bodies may change our life-long health. It’s not just the alteration in our poop immediately after antibiotics that changes. A new study shows antibiotic use may set us up for chronic disease. And this may be especially true when antibiotics are used in infants and young children.

Research Finds Antibiotics May Be Associated With IBD Diagnosis

  • Dr Matthew Kronman and colleagues studied over 1 million patient records in the UK. They evaluated the infant and childhood exposures to certain antibiotics and the later development of Inflammatory Bowel Disease (IBD). The causes of IBD are incompletely understood; Dr Kronman wanted to understand if bacterial changes in the intestines at young ages affected inflammation that could potentially increase the likelihood of being diagnosed with IBD (Crohn’s disease or Ulcerative Colitis). They studied medical charts of a huge group of patients to determine if children prescribed common oral antibiotics in outpatient clinics (penicillin, amoxicillin, Augmentin, clindamycin, metronidazole, for example) had increased rates of IBD later in life. Read full post »

Avoiding Antibiotics Whenever Possible: Less Is 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 full post »

Treating Ear Infections With Antibiotics

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:

  1. Proper inspection
  2. Pain control (Tylenol or Advil, etc). Ear infections hurt!
  3. Observation (waiting for 48-72 hours for relief)
  4. Treatment with high-dose Amoxicillin first and foremost if selected to treat.
  5. Return check after 48-72 hours if no improvement (then moving to treatment with Amoxicillin or changing to Augmentin if child on Amoxicillin)
  6. 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 full post »

Less Is More: 4 Ways To Know

I keep saying less is more. So often, with children, the less we do, the better. Pediatricians often pride themselves on being smart enough to know when to do…..nothing.

Take pink eye, for example. You know, the gnarly ooey-gooey, eyes-sealed-shut-yellow-crusty-“sleep”- in-the-eye that never goes away? The highly contagious infection where your child looks uber-crummy and straight-up, infectious? When it happens, you create a self-imposed lock-down-blinds-drawn-cancel-all-plans-covert-stay-home and watch a movie to hole-up the contagion. You or your child may want to hide from the world until it improves.

In my practice, pinkeye is one of the those infections that inspires me to wash my hands over and over and over again.  It is really contagious. And the best thing you can do when you see a glimpse of it, anywhere, is wash.your.hands.

So you haul in to see your pediatrician. Question is, what does your doc do for your child? School is asking for a note to come back and you’re there for a quick-fix thinking, “Just give me something to make this go away. And fast.” And like always, it depends on a number of things. Read full post »