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

  1. Avoid using antibacterial soaps: This includes not only liquid soap, but some makeup, plastics and body washes. It’s unlikely these “anti-bacterial” products protect you from any infection better than a bar of soap and it is likely they kill off bacteria in your home and in the water. Simple hand-washing is still the best way to protect the spread of disease after you use the restroom or prepare food or care for someone in your home who is ill. These products may have false claims and can also contain other unwanted ingredients like triclosan. Last year, because of ingredient safety concerns, the FDA put out a proposal for manufacturers to change labels and back up claims that these products were more effective at preventing spread of diseases than typical soaps. Further, a 2012 study from John Hopkins University found children with high levels of triclosan were at a higher risk for developing allergies, both seasonal and food-related and other immune-related sensitivities. So stick with standard soaps and detergents that lack the likely false claim of improved personal protection.
  2. Understand that bacteria do some good: I wrote about this in a post from last year and it’s worth repeating.  We accumulate a lot of bacteria throughout our lifetime and these bacteria help keep our bodies healthy and happy. Bacteria cells outnumber our own cells in our body and may contribute to keeping harmony in our bodies (9 to 1!). The collection of unique bacteria that live on our skin and in our GI tract make up our “microbiome” — keeping that microbiome in check is a part of our wellness. I’ll be writing more about this, with help from Dr Kronman and Dr Weissman this upcoming year. It’s an evolving area of study in health and wellness and we hope to contribute to your insights.
  3. Be explicit. Dr Kronman advises, “Feel free to make your preference explicit! It’s okay to say ‘I’d rather avoid antibiotics unless they are really necessary’ if that’s how you feel. Alternately, you can ask whether it’s reasonable to watch and wait without antibiotics and make a plan with your doctor for what you will do if your child does keep getting sicker off antibiotics.” Your explicitly matters. Dr Kronman notes what research finds, “We recently found that about 1 of every 2 antibiotics given in clinics to children with ear infections, throat infections, and colds were likely unnecessary. That represents more than 10 million extra antibiotic prescriptions for children in the US every year!”
  4. Be an advocate.  Whenever you or your child is prescribed antibiotics, ask why they are necessary. Ask about alternatives. Ask if you can “watch and wait” for 24-48 hours to see if you get better first without antibiotics. If not, use necessary antibiotics as they can be wonder drugs when necessary  There will be some times when antibiotics are your best bet for combating an illness, but often a couple of days of rest can sometimes provide your child’s immune system time to fight off a viral infection. Here are 4 more tips on avoiding antibiotics when unnecessary and ideas for using only when needed.
    1. Ear Infections: The first and most important medication for ear infections immediately are pain relievers like acetaminophen or ibuprofen. If your child is under age 2 years, has a “double ear infection,” or is in extreme pain with fever, it’s likely an antibiotic will help. If your child is over age 2 years and symptoms are controlled with pain relievers, you may want to ask about waiting before starting antibiotics. Studies show well more than 50% of ear infections get better on their own without antibiotics! Also, make sure the doctor or nurse seeing your child confirms there is an infection in the middle ear, not just fluid, to meet requirements for an ear infection. Read more about what you can do for your child with ear infections.
    2. Sinusitis: Sinusitis is difficult to diagnose in children. When going in for a child’s upper respiratory infection or “cold,” ask your doctor why they think your child has sinusitis. Ask about alternatives to treatment with antibiotics. Antibiotics can be necessary when children have severe sinus symptoms, symptoms of dark mucus with fever for 3+ days, daytime cough or infection symptoms that aren’t improving.
    3. Sore throat: If your child has a cold, runny nose, cough, and sore throat, it’s unlikely to be strep throat so antibiotics are unnecessary. However, if your child has been exposed to strep, has fever and an isolated sore throat, head into the doctor for a strep throat swab. If the test is POSITIVE for strep, start the antibiotics. If the strep test is not positive, it’s unlikely you’ll need antibiotics. For sore throat, use ice chips, pain relievers (acetaminophen or ibuprofen), and a humidifier. Smoothies and popsicles, too!
    4. Bronchitis: Bronchitis (inflammation in the airways from a cold) and upper respiratory infections are almost always caused by viruses in kids. Antibiotics won’t help. Discuss with your doctor why your child really needs antibiotics if these are the diagnoses given.