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Monday, December 12, 2011

Top Ten Tips for Positive Parenting in 2012

Number 7.  Just Say No (or Occasionally Yes or Maybe) to Antibiotics for Your Child.   Alexander Fleming's discovery in 1928 that a natural product of the penicillium mold had potent anti-bacterial properties saved millions of lives, created an industry and changed human history.   Some eighty years later, we continue to enjoy the benefits of penicillin and those of dozens of compounds that have been created to mimic its effects.  At the same time, the use of antibiotics for conditions that are unlikely to benefit from these drugs can expose children to unwarranted risk, spread resistant bacteria in the community, and create unnecessary costs for families and the healthcare system overall.

Conditions for which antibiotics are generally not appropriate include nasal discharge for less than 10-14 days, croup, bronchitis and sore throat in children without laboratory evidence of streptococcal infection.  All of these conditions occur commonly in childhood and are typically caused by respiratory viruses.

For other conditions, antibiotic treatment is absolutely appropriate.  Antibiotics are prescribed to treat infections typically caused by bacteria where treatment shortens the course of illness, reduces spread, or prevents complications.   Examples of minor infections for which this holds include streptococcal sore throat, urinary tract infection and some skin infections.  Experts advise that the physician selects the narrowest-spectrum antibiotic known to be effective for the problem at hand.  (The treatment of serious infections in hospitalized children is an important, but separate, topic; more on that another time!)

Finally, there are a few conditions for which antibiotics may or may not be warranted.  In 2004, the American Academy of Pediatrics published a guideline emphasizing that middle ear infections ("acute otitis media") usually cleared without antibiotics and suggested that certain children could be considered for observation and symptomatic treatment alone.  Another such condition is pneumonia in otherwise healthy toddlers.  The majority of lung infections in young children are caused by viruses.  This is especially likely if the onset is gradual, disease severity is mild,  the infection seems to involve both lungs, and certain laboratory findings are present.

Before I sign off, let me try to dispel a couple of myths.  Here's one: "prescribing antibiotics hurts the immune system."  This a one of the medical tough love myths, like "if I don't get Johnny those glasses, his eyes will get stronger."  Both sound good, but neither is true.   And one more, for balance.  Rather than a mythical side effect, here's a mythical benefit:  "Doc, I know you said antibiotics aren't good for a cold, but he has a [football game/school dance/final exam/trip to Sweden] next week and we need him to be over this."  We really do hear this a lot.  I am pretty sure, however, that antibiotics are as ineffective against colds prior to a football game as they are against colds coming on at other times.

With all of this confusion, let me leave you with something simple.  Information is the best medicine.  Ask your trusted pediatrician about prescribing - or not prescribing - antibiotics to your child.

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