Knowing When to Prescribe Antibiotics
Runny nose, cough, fever, acting fussy and trouble sleeping at night are some of the common reasons kids come for sick visits in the coming winter months. As a father I five, I can sympathize! As parents, aside from feeling bad when we see our kids’ sad faces, we all have busy schedules that don’t allow for sleepless nights or missed work. And while we all wish for immediate results, unfortunately, when it comes to treating infections, doctors may not have the quick fix parents desire.
Most of the infections that adults and children will experience during the coming months will be caused by viruses. The majority of coughs and runny noses are viral infections, while a much smaller number are caused by bacterial pneumonia or sinus infections. The same statistics apply to sore throats – less than half are actually caused by the bacterial infection known as strep throat. Most are viral.
For patients with one of these viral illnesses, the appropriate treatment will be “supportive care.” This means rest, lots of fluids, acetaminophen or ibuprofen for fever and maybe even some old fashioned chicken soup are the recommended treatment. Note that antibiotics are NOT on that list! Antibiotics kill bacteria but have no effect on viruses. Treating a viral infection with an antibiotic will not help patients get better faster, but they do expose patients to a number of potential adverse drug effects, including the following:
- Up to 25% of patients taking antibiotics will have diarrhea, some will have rashes and a small number will experience more severe reactions. This can lead to even more visits to doctor’s offices and sometimes even a trip to the emergency room where patients are exposed to patients with other infections.
- Perhaps the most pressing issue that has developed during the past several years is the growing problem of antibiotic resistance. It is not just the rare “super bug” that makes the news – but the CDC (Centers for Disease Control and Prevention) reports that many bacterial infections are becoming resistant to the most commonly prescribed antibiotics. Community acquired skin infections are frequently resistant to many antibiotics and some of the most common infections seen in pediatricians’ offices, such as ear infections, now require much higher dosages for treatment. When a patient takes antibiotics, sensitive bacteria are killed – but resistant strains may remain to grow and multiply. Infectious disease experts have clearly established that repeated and improper use of antibiotics are the primary causes of the rising number of resistant bacteria.
The dangers and risks of inappropriate use of antibiotics are clear. Everyday we see parents of kids with viruses, who request antibiotics because others with the same symptoms received a Z-Pak from a quick care clinic. And while it’s true that some of the kids who we see with viral illness will develop symptoms of pneumonia, sinus infections or ear infections, we do not treat viruses with antibiotics as a precaution.
Instead, we strongly believe in the importance of practicing good and safe medicine – and this means getting a detailed history of symptoms, a thorough physical exam and making judicious decisions about the use of antibiotics. Remember that the quick fix is not necessarily the safest or most effective. Indeed, there is STILL no cure for the common cold.