MEDICATIONS: ANTIBIOTIC ANSWERS

Column by Medem's Editor-in-Chief Nancy W. Dickey, M.D.

Every year and every season I have parents call my office asking for antibiotics for their child. Usually, there is sniffling, sneezing and coughing going on in their house —and they believe that a trip to the pharmacy can take care of it all. Often, their child is suffering from a cold, flu or allergies, and the only thing an antibiotic would add to the mix is potentially unpleasant and even dangerous side effects.

These are good-intentioned parents who want everyone in their household to get well —and get well fast. They are right to believe that antibiotics are an incredible drug, and under certain circumstances, a lifesaving drug. But anything awesome is also powerful, and the misuse of a powerful drug can cause harm.

It is frustrating as a parent to watch a child be sick. It is natural to want to help. We like the idea that there is a magic pill out there that can take care of all the aches and pains. Who wouldn't? But that idea is fiction rather than fact. The truth of the matter is, taking a pill is not always the answer. Sometimes old-fashioned advice is good advice, and rest, fluids and time are the best medicines.

When Antibiotics Are the Answer

Antibiotics can help kill bacterial infections, and bacteria are the culprit to several common childhood illnesses, including ear infections, some sinus infections, strep throat and urinary tract infections. These are all illnesses that need to be diagnosed with a trip to your family physician or pediatrician, so be sure to bring your child in for an appointment if symptoms appear.

When it comes to the flu and common cold, and many times coughs and sore throats, a virus is causing the harm rather than a bacterium. In such cases, antibiotics are powerless.

More Harm Than Good

The issue of antibiotics misuse is not just one of ineffectiveness or medication side effects. We only have a certain number of antibiotics available to treat infection. When antibiotics are overused, bacteria can mutate and become immune or resistant to treatment; in other words, they "learn" to get around the antibiotic. This is called antibiotic resistance. Resistant bacteria often require treatment with more powerful drugs —and in some cases lead to untreatable infections, such as super bugs, which survive and thrive even when the most powerful antibiotics are used.

Another cause of antibiotic resistance is only taking part of the prescribed treatment when antibiotics are needed. If you start a prescription but do not finish it, the bacteria might not have been exposed to enough antibiotic to be killed. Along the lines of the old saying, "What doesn't kill you makes you stronger," the weakened bacteria can then mutate to be more resistant to future treatment with the antibiotic.

So, both misuse and overuse of antibiotics cause problems. Not asking for unnecessary antibiotics and finishing everything in the bottle when prescribed antibiotics are the best ways to keep the antibiotics we have effective in treating illness. The Centers for Disease Control and Prevention have estimated that 50 million of the 150 million outpatient prescriptions for antibiotics every year are unneeded. The problem of antibiotic resistance is alive and well. For the first time in the United States since antibiotics were discovered, there are five strains of bacteria that are resistant to all antibiotics.

Antibiotics on Our Dinner Table

Antibiotics aren't just in the medicine cabinet; they can be found in and on everything from cows to apples. More than 40 percent of antibiotics in the United States are used with livestock and other foodstuffs. While some of these antibiotics are used for infections, the majority is used to promote growth or ward off infections that aren't present. According to the World Health Organization, this perpetual use of antibiotics contributes to antibiotic resistance in or around the animal being treated; another fear of this overuse is resistant bacteria in livestock being spread to other species, such as humans.

When Antibiotics Aren't the Answer

While colds and flu can't be helped by antibiotics, there are some over-the-counter preparations that can keep your child more comfortable. But there are safety issues to keep in mind here as well. Proper dosing and drug interactions are at the top of this list.

Fever Control

I have distinct memories of receiving small pink baby aspirin as a child, but today, baby or children's aspirin should never be used. Aspirin use in children who have certain viruses, such as flu and chicken pox, has been linked to Reye Syndrome (a serious condition that can cause brain damage and even death). Always be on the safe side and use acetaminophen (Tylenol®, Tempra®, Liquiprin®, Panadol®) or ibuprofen (Motrin®, Advil®).

Make sure the acetaminophen or ibuprofen you use is in a children's formula, not adult, and follow dosing instructions. (I have included links to dosing charts below.) Also be sure to use the recommended dosing device. A kitchen teaspoon is not accurate enough for giving medicine. Use the dropper or dosing spoon that comes with the product. While these medicines are generally safe and effective, the main concern is overdosing. Many times, multi-symptom preparations (such as cold medicine) already include a fever reducer. If you are giving your child more than one medication, make sure to check labels so that you do not accidentally double dose.

Final Notes

Children learn from our behaviors; part of teaching them good health is the lesson that pill popping is not always the cure. A physician survey showed 95 percent of physicians had on average seen seven patients within six months who had requested prescription drugs they saw advertised. Seventy percent admitted feeling pressure from patients to prescribe. If your family physician or pediatrician tells you antibiotics aren't necessary, listen to him or her. If you have additional concerns, bring them up. It is always okay to ask, "Why?"