‘unnecessary antibiotics’

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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 »