How many parents, when they take their child to the doctor because of an ear infection or a cold, expect to get antibiotics? I’ve seen a fascinating variety of patients and illnesses during my ten years as a family medicine doctor, but the issue of antibiotic overuse never seems to end. Time after time, I have patients come in with common illnesses, and I often conclude that the patient has an infection from a virus and not a bacteria. Thus, I would not prescribe antibiotics and would give them mostly over-the-counter medicines to help their symptoms. Many people are reassured by my exam and explanation, but quite a few are disappointed or even angry because I didn’t fulfill their expectations of needing antibiotics. This is a very common cause of patient-doctor friction, especially among pediatricians and family medicine doctors when dealing with children.
The question is: When does a child really need antibiotics? The simple answer is: not as often as you think. Let’s take the common cold for example. The common cold symptoms of a low fever, wet cough and runny nose are usually caused by a family of viruses and not bacteria. Symptoms normally last three to four days and the cough is usually the last to resolve itself many days later.
The commonly assumed “warning sign” of a colored or greenish runny nose does not mean this infection is bacterial – it only means your body’s white cells are fighting an infection, which again, is most likely viral. So in most of these cases, the antibiotic doesn’t help fight infection at all.
Antibiotic overuse is a serious problem not only because the medicine isn’t properly treating your child – it can also cause side effects such as diarrhea, rashes, or more serious allergic reactions such as allergic shock and even death. Your child’s body may also become resistant to this antibiotic in the future, when they may actually need the medicine to fight a real bacterial infection. This issue is a major problem in China’s hospitals and clinics, where antibiotic use, especially for intravenous drips, is very common.
The American Academy of Pediatrics and the American Academy of Family Medicine both agree that children are dangerously over-prescribed antibiotics for simple illnesses – especially for ear infections. Many times in this scenario, the infection is again caused by a virus, and thus a week on antibiotics is not helpful at all for the patient. Fortunately, thanks to these Academies’ public education campaigns, doctors have been much more aggressive in cutting back on prescribing antibiotics for ear infections.
So what can we do? I think one major fault lies with the doctors – we really need to do a much better job convincing our patients or their parents that antibiotics are only for serious bacterial infections. Perhaps doctors should even rename “antibiotics” to “antibacterials” to help patients distinguish the difference; after all, there is a class of “antivirals” for specific viruses such as HIV, influenza and hepatitis.
Parents can also try waiting 24 to 48 hours – if the child is clearly worsening, then you can choose to fill the prescription. This can be a win-win for doctor and patient, as it gives the parents a bit more control, while giving the child time to recover without antibiotics.
Parents can find helpful information, including handouts in Chinese about this important issue at dobugsneeddrugs.org.
Need more info? Dr. Richard Saint Cyr is a family doctor at Beijing United Family Hospital, and the Director of Clinical Marketing and Communications.He runs the blog www.myhealthbeijing.com.