ANTIBIOTIC RESISTANCE

Bugs, microbes, pus, and things that ooze.

Bacteria are single-celled organisms that can live without a host.  Some bacteria are beneficial and are found in and on the body.  Others have the potential to cause illness, both mild (e.g. strep throat) and severe (e.g. meningitis).  Viruses can be many times smaller and cannot survive or reproduce without a host.  Viruses can also cause illness (e.g. the common cold virus, chickenpox, and polio).

Antibiotics are chemical compounds that destroy or prevent the growth of bacteria.  They have no effect on viruses.  Different antibiotics are effective against different types of bacteria.  While antibiotics generally have no direct effect on the host, they can have some undesirable side-effects such as diarrhea and sensitivity reactions such as anaphylaxis.

So my child doesn’t need an antibiotic?

If your child is diagnosed with a cold, the flu, bronchitis, or most sore throats, s/he does not need an antibiotic; unless there is a secondary infection, such as a bacterial ear infection or pneumonia.  All colds are caused by viruses.  The course of a viral respiratory infection is generally between 3 and 10 days and often starts with a fever which can last 1 to 4 days.  With influenza, the duration of fever and illness may be much longer.  Viral infections get better only with time and stimulation of the body’s immune system. 

But the mucus is now yellow-green…

As the body’s immune system is stimulated in response to a viral infection, many inflammatory chemicals are produced.  The inflammatory fluid (or mucus) is often yellow-green in color and does not indicate a bacterial infection.  Everyone’s “snot” is  yellow!  I often tell parents that it is the duration of illness, rather than the color of the mucus, that determines whether or not an infection may be bacterial.  I am more impressed with clear discharge on day twelve than I am with green mucus on day three.

My doctor put me on antibiotics for bronchitis and my child has the same illness…

The majority of children with persistent coughs and tightness in the chest (often categorized as bronchitis) are suffering from a viral infection.  In some instances, such as in smokers or persistent asthmatics, a secondary bacterial bronchitis may develop which would require an antibiotic.

I had a bad case of Lyme Disease, and I pulled a tick off of my child yesterday…

Lyme disease is caused by a bacteria (spirochete) that is transmitted by the deer tick.  Most experts agree that the tick needs to be attached for 2-3 days or more for transmission to occur.  I often tell concerned parents that the ticks we find are often not as dangerous as the ticks we don’t find.  Tick bites (with a known short-duration of attachment) do not require prophylaxis or preventative antibiotics.  If the tick has been attached for a longer period of time, and if the parents are sufficiently anxious and are unwilling to “watch and wait,” a short course of antibiotics may be considered.

Why don’t you treat everyone with middle ear fluid?

A viral infection produces a whole host of inflammatory and immune responses which may include secretion of middle ear fluid.  Typically this fluid is clear and will drain internally through the Eustachian tube which connects to the back of the nose and throat.  The persistence of this fluid may be related more to a child’s anatomy than due to a bacterial infection.  Unless the eardrum is immobile, bulging, red, or distorted by the build-up of pus, it is unlikely that an antibiotic will be of use.

What doesn’t kill them only makes them stronger.

With many infections, there is a need for antibiotics.  Most ear infections, bacterial pneumonias, sinusitis, urinary tract infections, etc., will require treatment with an antibiotic to prevent progression of an illness.  Antibiotics generally require 3-4 days before signs of improvement are noticed.  The course of antibiotics should be long enough to fully eradicate the bacteria, usually 10-14 days.  Failure to complete the course of antibiotics, switching from one antibiotic to another, and inappropriate use of antibiotics all lead to the emergence of resistant bacteria.

Antibiotic resistance is, perhaps, one of the greatest public health threats world-wide.  There are bacteria which are resistant to multiple antibiotics and the most common bacteria are becoming increasingly resistant.

Amoxicillin doesn’t work for my child.

Children are among the largest group to use antibiotics.  The rate of resistance is directly proportional to the use of antibiotics.  As a result, children often have antibiotic-resistant infections.  It is important to realize that an adequate dose and course of antibiotics is required to eradicate even the most simple bacterial infection.  A shortened or interrupted course of an antibiotic, while destroying the weaker bacteria, may allow the more resistant bacteria to proliferate.  Stronger and stronger antibiotics are then required.  Additionally, starting an antibiotic too early—in the absence of a bacterial infection—may contribute to the development of resistant bacteria.

My child has been on azithromycin (Zithromax) for 3 months for Lyme Disease.

Many infections require long-term therapy with antibiotics.  Some infections, such as osteomyelitis (a bone infection), require intravenous antibiotics for 4-6 weeks.  Most experts believe that, with these rare exceptions, most common infections can be adequately treated with more standard courses of antibiotics.  If used inappropriately and without evidence for its use, long-term antibiotics quickly lead to the development of increasingly resistant bacteria.  Antibiotic resistance can cause significant danger for people who may have otherwise had a treatable illness.  The consequences of antibiotic resistance include longer duration of illness, hospital admissions, the need for more potent and toxic medications, and even death.

My older child uses oral antibiotics for acne.  Why aren’t you concerned?

Any antibiotic use, warranted or not, can lead to antibiotic resistance.  An antibiotic with the narrowest spectrum of coverage should be used for a specific infection.  The shortest (but effective) duration of therapy should be used.  The only clear way of decreasing antibiotic resistance is to decrease the use of antibiotics.

I really don’t like to use antibiotics, anyway.

Despite the increasing resistance of bacteria to antibiotics, there are appropriate and necessary uses for them.  Lyme disease, meningitis, pneumonia, some ear and sinus infections, skin infections, kidney infections, and most other definitive bacterial infections will not improve and can progress to more serious conditions if left untreated.  In order to do what is best for your child, you need to know as much about his/her condition, its treatment, and possible alternatives.  Only then can you and your child’s doctor determine the best course of action.

Any last words?

Please don’t share antibiotics.  Please don’t horde antibiotics.  Don’t stop taking the antibiotic because you feel better.   Try not to skip doses.  Please don’t demand or take antibiotics for the flu or for a cold.  Talk to your doctor.