Antibiotics

ANTIBIOTICS: MISUSED AND MISUNDERSTOOD

Antibiotics InfantsMost parents feel relieved when an antibiotic is prescribed for their sick child. That’s why it’s hard to convince worried parents that antibiotics are sometimes not a good idea and, in fact, may be harmful! Some physicians, when dealing with anxious parents, feel pressured to prescribe antibiotics even when they’re sure that such treatment is unwarranted. The doctor may worry that he will be perceived as incompetent when he explains that the illness should be allowed to run its course. But unnecessary treatment, although tempting to both parents and physicians, is not a good choice and can lead to unwanted results.

Where in the world did you hear?

Children with fever, cough or sore throats always recover more quickly with antibiotics.

Sound Advice

Not true. Most common illnesses in children are infections caused by viruses, microscopic particles that multiply inside our cells. Viruses are unaffected by antibiotics. The vast majority of childhood illnesses, the common cold, bronchitis, sore throats (except “strep”) and the ubiquitous flu, among others are caused by viruses. Using antibiotics for those illnesses is the wrong treatment. When antibiotics are used against viruses (say, taking Penicillin for a virus cold) we end up destroying the harmless germs that live in our body and, as a result, stronger, antibiotic-resistant germs move in. The next time we get a sinus infection or an earache or, perhaps, pneumonia we may have to deal with monster bacteria that we have allowed to grow freely.

The Conclusion

Antibiotics are not a panacea for all infectious illnesses. They should be carefully selected to treat only appropriate bacterial infections, never a viral illness.

Where in the world did you hear?

All antibiotics have to be taken for ten days.

Sound Advice

Why ten days? Not much science to support that assumption. Recent studies have suggested that shorter treatment periods for many infections are as effective as longer durations and may lessen our chances of cultivating resistant germs and dealing with side effects. Some urinary and genital tract infections are effectively treated with a single dose of antibiotic. A strep throat can be successfully eradicated with three to five days of selected antibiotics. Ear infections may be successfully treated with only a few days of antibiotic or, according to our European medical colleagues, with no treatment at all!

The Conclusion

Check with your doctor after getting a prescription filled. Some pharmacists automatically write ten days on the label. Those instructions may be incorrect.

Where in the world did you hear?

Green, thick mucus means infection.

Sound Advice

There’s no relationship between the color or thickness of mucus and the presence of infectious bacteria. Surprised? Studies have shown that mucus color results from lymphoctes and inflammatory proteins in the mucus, not to any harmful bacteria. In fact, the longer mucus is produced, the greener and thicker it becomes. That’s why a common cold lasting more than three or four days produces green mucus. Almost always, we’re dealing with viruses, no antibiotic required. Unless the mucus is mixed with purulent material (called pus,) antibiotics are usually worthless and, in fact, may do harm. Antibiotics should be used only when bacteria are causing the illness, based on evidence such as frankly purulent material, blood counts, cultures when possible, and, most important, the clinical appearance of the patient. Experience counts.

The Conclusion

Although it’s a universal belief that discolored mucus is a signal to start antibiotic treatment, antibiotics should be withheld unless the patient’s clinical condition or a culture indicates a bacterial infection. Inappropriate use of antibiotics can only cause harm.

Where in the world did you hear?

I never give my child amoxicillin. He’s immune to it. It doesn’t work for him.

Sound Advice

Except for allergies, we don’t develop an immunity to antibiotics. It’s a myth. You may have heard someone say, “that antibiotic doesn’t work for them.” Not true. Most previous treatment failures happen because the antibiotic was used for a viral infection, worthless. Or it was given to treat a resistant germ or the dose wasn’t correct. There are no people in whom antibiotics don’t work. There are, however, germs which are, indeed, antibiotic proof. Doctors shouldn’t prescribe antibiotics automatically. Doing so without considering the most likely germ involved and the recommended dose based on the child’s weight will cause treatment failure. If these questions are addressed properly, all appropriate antibiotics should be effective. But don’t forget, most times, it’s not appropriate to give any antibiotic.

The Conclusion

All correctly chosen antibiotics should work equally well in every patient, regardless of previous experiences with that medicine.

Where in the world did you hear?

Don’t give your child too many antibiotics, they’ll lower his immunity and discolor his teeth.

Sound Advice

Antibiotics have no adverse effect on immunity. Our bodies produce antibodies (immunity) in response to an infection. When antibiotics eliminate that infection, production slows down but never stops. That’s not a problem. The immune system is still fully capable of producing antibodies when they’re needed.

Teeth are safe from all antibiotics except for a class rarely used for children nowadays, tetracyclines. Tetracycylines enter growing teeth, discoloring them, and are therefore never prescribed in children less than 12. There are some children, however, who are born with faulty enamel. Their teeth are often dark and occasionally malformed. Nothing related to antibiotics.

The Conclusion

Antibiotics are extremely safe in children. Unless the child has demonstrated an allergic reaction such as hives, wheezing or swelling there are very few side effects. The most common mild reaction to any medicine is vomiting and diarrhea, antibiotics being no exception.

Sinusitis and Bronchitis, over diagnosed and over treated: a commentary

There are probably no medical conditions more inappropriately treated with antibiotics than “sinusitis” and “bronchitis.” Not a day goes by when parents declare they (or their children) have “sinusitis” because of persistent nasal congestion, pressure in the face, and a post-nasal drip. But probably fewer than five percent of these patients actually have a bacterial infection in their sinuses, ie sinusitis. The vast majority of these symptoms are caused by viruses, allergies and environmental irritants. Even CT scans are not conclusive evidence of bacterial sinus infections, some physicians finding that allergy and colds can result in “positive” scans. According to most researchers, true sinusitis causes a prolonged daytime cough usually lasting more than two to three weeks. In the absence of a chronic cough and purulent (pus in the mucus) nasal discharge, many of the symptoms of congestion, pressure and difficult nasal breathing can be completely relieved by the frequent use of nasal saline sprays. Even thick, discolored mucus can often be dispatched with nasal saline washes along with nasal steroid sprays, and some of the newer anti-inflammatory medications which block leukotrienes.

Bronchitis is another winner in the antibiotics-for-nothing sweepstakes. This may be the most abused diagnostic word in the medical dictionary, a label applied liberally by physicians and patients for almost any loud, annoying or persistent cough. Once the diagnosis of bronchitis is mentioned, the patient is usually treated with antibiotics. This treatment is ill advised since viruses, allergy or reactive airways cause almost every episode of bronchitis. The medical literature is full of studies that fail to show bacteria as the cause of bronchitis. Patients who are treated with expectorants and bronchodilators recover as quickly as those who take antibiotics, avoiding the pitfalls of unnecessary medication.

Have any questions? Please contact Dr. Mesibov

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