Give Me Antibiotics! No?

Every pediatrician has come to know The Look.  The parent’s face falls.  They are obviously disappointed, sometimes angry.  It happens when the parent came in expecting that the doctor will prescribe an antibiotic for their child’s illness, only to be told an antibiotic will not help.  There are only two times in my 17 year career that I have been yelled at and insulted to my face by a parent.  Were they at times of terrible stress and tragedy, a diagnosis of cancer or a death?  No, they were both when I diagnosed a viral illness in a smiling, obviously not very sick child and told the parent that an antibiotic was not necessary. This October the national Center for Disease Control (CDC) is declaring a Get Smart About Antibiotics week.  From October 5 to 11 they will be having a media campaign to promote better public knowledge about when patients need antibiotics, and when they don’t.  October is a good time for this, given that child illnesses will be rising as kids swap germs at school, and the flu season starts (as if it already hasn’t!).  Many kids will get sick and their parents will be hoping for something to make them better. Most of those illnesses will be caused by a virus, and antibiotics don’t kill viruses.  Viruses are those bugs that cause runny noses (even green runny noses), coughs, vomiting and diarrhea, most sore throats, and most fevers.  These illnesses get better on their own in 3 to 4 days.  Their treatment is to ease the symptoms with vaporizers, fluids, fever and pain medicine, and such.  For more information on these, see the Categories column on the right side of this page. Antibiotics are for treating infections caused by bacteria.  These are the bugs that cause some ear infections, skin infections and boils, Strep throat, certain pneumonias, and bladder infections. So many parents wonder “why not just give an antibiotic, just in case?  What’s the harm?”  Many doctors hate to disappoint parents, give in to this argument, and prescribe unnecessary antibiotics when pressured by families.  Well, here is the harm:  antibiotics are not entirely safe drugs.  Patients can have allergic reactions to antibiotics, sometimes severe reactions.  Sometimes if a patient gets an antibiotic and then stays sick, the antibiotic can negate the ability of later tests to tell the diagnosis. The biggest reason not to give antibiotics is the risk of bacteria developing resistance to antibiotics.  This has been happening for decades and has given rise to bacteria resistant to multiple antibiotics.   Some patients get very sick with these super-resistant bugs like MRSA and VRE.  The newer antibiotics to attack those infections are so strong that the patient can get sick from the antibiotic too. Experts worry that the day may come when all bacteria develop resistance to all antibiotics.  This is why the CDC, the American Academy of Pediatrics, and other expert groups are anxious to get doctors to stop prescribing unnecessary antibiotics; and to get parents to stop pressuring their doctors for them. Next time your doctor says your child has a virus, be patient.  Give it a few days of fever medicine, vaporizers and throat sprays, chicken soup and honey.  If your child is not better then, it is fair then to call your doctor about getting another look. Feel free to comment about your experiences with viruses and antibiotic disappointments!