Antibiotics: Less is better!

Each year there are about 50 million antibiotic prescriptions written in the US. That’s right- 50 million!  Nobody has any idea how many antibiotics are prescribed in Thailand, but we all know that it is very easy to buy them over the counter.  This should not be allowed but it continues to be legal for now. The bottom line is that the majority of antibiotic prescriptions are not necessary and actually do considerable harm to our individual health and to our communities. In my practice, it is quite common for parents to ask me to prescribe antibiotics when their children have “colds” or upper respiratory tract infections from a virus.  When a parent insists on antibiotics, it is often difficult for the doctor to refuse- even when they know better.  This is a moment when parents need to start to work together with the doctor to help make the use of antibiotics safer and more appropriate. images

To encourage this, the US CDC recently held a “Get Smart About Antibiotics” week and they have posted an excellent website with very good information on this subject.  I encourage you to take 5 minutes to read it carefully.Determining when antibiotics are necessary is the difficult part. A clinical report was recently published in the journal Pediatrics to help pediatricians and parents know when they can avoid antibiotics. I summarize some of the main conclusions of the report below.

Reasons To Avoid Antibiotics Unless Absolutely Necessary

  1. Bacteria are essential for our health and antibiotics kill themWe harbor literally trillions of bacteria inside and on our bodies. The interaction of these bacteria with our immune systems keeps us healthy. They directly assist in digestion of essential nutrients, promote protection against infections, reduce inflammation, influence our behaviors, and may even protect against certain cancers. Taking antibiotics kills huge numbers of our good bacteria and disturbs our natural balance. It can take several months after a single course of antibiotics to regain our natural microbial communities!
  2. Antibiotics often cause side effects. These range from diarrhea, vomiting, rashes, yeast infections, hearing loss, liver damage, to severe skin reactions. You don’t want to put your child at risk of these side effects unless the infection is clearly dangerous and antibiotics are obviously needed.
  3. Using antibiotics changes our environment. Each dose of antibiotics we give to our children, ourselves, or the animals that we eat, changes our community’s health. This is because the more we use antibiotics; the more we “select” bacteria for survival that are resistant. These resistant bacteria or “superbugs” become ever harder to treat.
  4. Unnecessary antibiotics cost money. When an infection is caused by a virus and we treat with antibiotics, it is a waste of money.  There is also a tendency, particularly at private hospitals, to always prescribe the latest and most expensive antibiotics. This increases the wastefulness and means that, in the long term, the most powerful antibiotics will be less effective when we really need them to save lives.

5 Ways To Avoid Antibiotics

  1. Be an advocate: Whenever your child is prescribed antibiotics, ask why they are necessary. Ask about alternatives. Ask if you can “watch and wait” for 1-2 days to see if your child gets better without antibiotics.
  2. Sinusitis: Sinusitis is difficult to diagnose in children. Ask your doctor why they think your child has sinusitis. Ask about alternatives to treatment with antibiotics. Antibiotics can be necessary when children have severe sinus symptoms, symptoms of dark mucus with fever for 3+ days, daytime cough or symptoms that aren’t improving after several days.
  3. Ear Infections: At least 50% of ear infections get better on their own without antibiotics! The first medication for ear infections are pain relievers like acetaminophen or ibuprofen. If your child is under age 2 years, has evidence of infection in both ears, or is in extreme pain with fever, it’s likely an antibiotic will help. If your child is over age 2 years and symptoms are controlled with pain relievers, you should wait before starting antibiotics.
  4. Bronchitis: Bronchitis and upper respiratory infections are almost always caused by viruses. Antibiotics won’t help. Discuss with your doctor why your child really needs antibiotics if these are the diagnoses given
  5. Sore throat: If your child has a cold, runny nose, cough, and sore throat, it’s unlikely to be a streptococcal infection. However, if your child has been exposed to strep, has fever and an isolated sore throat, go see the pediatrician for a strep throat swab. If the test is positive for strep, your child will need antibiotics. If the strep test is negative, antibiotics are rarely required.

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