We've had long-standing concerns about a phenomenon called antibiotic resistance.

This is a serious public health problem caused by the overuse and inappropriate use of antibiotics. Antibiotics are excellent medications when used appropriately; they fight bacterial infections and have saved many lives. The problem occurs when bacteria that have previously responded to a particular antibiotic get over-exposed to it. Those bacteria can actually change their structure and become invincible against the antibiotics that previously controlled them. This is called "antibiotic resistance", and it can affect an individual person or an entire community.

The potential danger of antibiotic resistance is that the more our current antibiotics are used (especially if used inappropriately), the less effective they will be when we really need them to treat serious and life-threatening illnesses. Until now, the primary response to the problem has been the development of new antibiotics, a strategy that is expensive and temporary. There is a limit to this potential, and we close in on it every day.

The most common antibiotic overuse or misuse situations occur with viral infections. Viral illnesses, while bothersome, will not get better any more quickly if an antibiotic is used. They will run their course in the time it takes the body's immune system to clear the infection. Sometimes it is assumed that if no antibiotic is advised there is "nothing wrong" or "nothing we can do." Viruses do indeed cause illnesses; our job is to keep a child with a viral illness comfortable, hydrated, and nourished, and to watch for signs of more serious illness.

Examples of Common Infections

Colds
Characterized by runny nose, sneezing, low-grade fever, achy muscles, headache, fatigue, and cough, the common cold usually lasts from 3 to 14 days. The runny nose usually goes from clear to thick green/yellow in the middle of the cold. This is normal and does not indicate a sinus infection. The average child has 3-8 colds a year (up to 12 if in daycare), which can mean one cold after another, with no break in symptoms in between.

Sinus disease
Most colds involve sinus disease (congestion and pressure in the sinus area). A sinus infection is more likely if a child's cold symptoms persist more than 14 days without any signs of improvement, or if the symptoms worsen (high fever, increasing headaches, facial pain or swelling).

Sore Throats
Most sore throats are caused by viruses (70-90%). Strep throat is bacterial, and is usually the only type of sore throat that needs an antibiotic. A throat culture is the only way to know for sure; if it is negative, then your child does not need an antibiotic.

Ear Infections
Believe it or not, many ear infections (50-80%) will heal completely with observation alone and without antibiotics. This is especially true for those described as middle ear fluid without signs of other disease (redness, inflammation, fever). Sometimes children complain of ear pain but do not actually have an infection. This is the reason we see all children with symptoms of an ear infection.

Coughs
Most coughs are viral, even ones that last a week or so after a cold goes away. Some are dry and hacky, some are loose and congested. The diagnosis of "bronchitis" means "inflammation of the bronchi" (the large airways to the lungs). This is usually caused by a virus, as is most illness-related wheezing and even pneumonia. It is wise to have a worsening or chronic cough evaluated, but an antibiotic may not be needed.

Influenza
The symptoms of this winter virus include fever, cough, chills, fatigue, head and muscle aches, crankiness, and a sore throat. Unless there are complications no treatment is needed except fluids, comfort and time. The yearly vaccine usually prevents it.

Pink Eye
This itchy, red, mattery eye infection is occasionally caused by a virus and therefore may not respond to antibiotic eye drops. It frequently comes along with a cold, and, whether it is bacterial or viral, it is contagious so good hygiene is important. The best treatment is warm packs and vigilance (seek an evaluation at the clinic if it worsens).

Antibiotic Resistance

We are often asked if an antibiotic will prevent a secondary infection (such as an ear infection from a cold). While there is a select group of children considered high risk for developing secondary infections, most children are not at risk and antibiotics will probably not help. We are also sometimes confronted with the statement, "That antibiotic didn't work last time." If a child has a current infection, and cleared a previous infection more than two or three months ago (regardless of what antibiotic was used last), it is highly unlikely that the current infection is caused by the same past germ. Using a broad-spectrum ("stronger") antibiotic when a first-line antibiotic is likely to achieve the same results is another way of promoting antibiotic resistance. Bacteria develop resistance more easily against broad-spectrum antibiotics.

For the reasons mentioned above we are finding it more critical to examine why and how we use antibiotics. To slow the emergence of resistant bacteria, we need to preserve the antibiotics we have by using them more sensibly. Studies show that reducing the use of an antibiotic is generally followed by a decrease in antibiotic resistance community-wide. We realize that recommending symptomatic versus antibiotic treatments for our patients is sometimes stressful for parents. We are well aware that it is hard to have a sick child, especially just before or during a vacation or special event, or when you really need to be at work. We also know it is never easy to come in for an appointment. But we value your child's health and feel an accurate diagnosis is important. This usually cannot be done over the phone. If you have any questions or concerns about your child's diagnosis or treatment, please ask.

To prevent illnesses and the need for antibiotics, we can all help:

Be realistic and rational about infections and their treatments; let's all avoid using or requesting antibiotics when they are neither indicated nor proven beneficial.
Never start antibiotics on your own ("leftovers" from a previous illness). This increases the risk of resistance and can affect the outcome of laboratory tests if they are needed.
Wash your hands, and your child's hands, frequently.
Encourage immunizations.
Work with daycare centers and schools to improve infection control practices.

We vow to do our part, by educating ourselves, our patients and families, and by resisting the casual antibiotic attitude so prevalent in our society.