Antibiotics – When Should We Take Them? Part 2
The fine line between viral and bacterial infection:
There is a fine line between a viral and a bacterial infection. An earache is viral while an ear infection is bacterial. A cough, sore throat, or flu is caused by a virus while pneumonia is a bacterial infection. Bronchitis is viral; sinusitis is bacterial. Therefore, we should wait and see what we are fighting before we run to get an antibiotic.
Here are some good examples of drug resistance already occurring in the U.S.:
* In 1952, almost 100% of Staphylococcus infections could be cured by penicillin.
* In 1982, fewer than 10% of staph cases could be cured by penicillin.
* Today less than 5% of staph cases can be cured by penicillin.
* In the 1960s, doctors switched the resistant staph patients to another antibiotic called methecillin.
* By 1992, at least 40% of these staphylococcus infections were resistant to methecillin, according to the New England Journal of Medicine, 28 Apr 1994.
* By 1993, only one surefire Staphylococcus killer remained: vancomycin.
* Today there are many strains of staphylococcus that are resistant to vancomycin. That means also resistant to penicillin and to methecillin.
Forces spurring the over-prescription of antibiotics:
So now what? A recent study highlights the cultural and economic forces spurring the over-prescription of antibiotic drugs, and the evolution of super-resistant microbes. The report notes that antibiotics cost the U.S. about $15 billion per year. Extra hospital costs associated with drug-resistant hospital-acquired bacterial infections total at least $1.3 billion annually.
Of 51 million visits to physicians for “colds,” upper-respiratory infections and bronchitis, 50% to 66% resulted in an antibiotic prescription, even though these conditions usually do not require antibiotics.
To explain this trend, the study’s authors point to direct-to-consumer advertising, consumer demand, a medical training system that puts the least experienced doctors in charge of prescribing drugs and overloaded hospitals.
It’s so sad that we’ve used antibiotics as a “fix-all” for every ailment. How many times have you been to the doctor and had them prescribe antibiotics just for good measure? In fact the U.S. Centers for Disease Control has announced that they are starting a nationwide campaign “to make antibiotic overuse as unpopular as smoking”.
The CDC will be using radio and television announcements as well as ads in consumer health publications to get the word out about the dangers of excessive antibiotic use. When the CDC gets involved then we know we definitely have a problem.
Research regarding antibiotics and childhood ailments:
Lets look at some of the research involving the effectiveness of antibiotics and the common ailments that effect our children.
American Journal of Medicine:
An article published in the American Journal of Medicine reports:
“Children with otitis media who do not have a high temperature or vomiting during the first three days will most probably not benefit from antibiotics. Family doctors should wait for 24 to 48 hours before prescribing antibiotics for children with otitis as many will settle down on their own, analysis of a randomized controlled trial shows.”
Further, the article indicated the antibiotic tetracycline was shown to inhibit the ability of white cells to engulf and destroy bacteria and to delay the ability of white cells to move to the site of infection. The number of cases requiring surgical intervention was also seen to increase along with an increasing number of resistant Streptococcus Pneumoniae isolates.
Pediatrics:
Antibiotics do not help most children with acute sinusitis, according to a study in Pediatrics. Investigators studied 180 youngsters, aged 1 to 18 years, with acute sinusitis. The children were divided into three treatment groups: 1) amoxicillin, 2) amoxicillin-clavulanate, or 3) placebo.
Treatment lasted 14 days. Seventy-nine percent of the youngsters on amoxicillin improved after 14 days, as did 79% of those taking placebo pills and 81% of those on amoxicillin-clavulanate.
Jane Garbutt, MB, ChB.:
“Our study suggests that, for children with uncomplicated acute sinusitis, it makes sense to delay antibiotic treatment and watch carefully.”
British Medical Journal:
For decades, chiropractors have expressed concern about the aggressive use of antibiotics in children with ear infection. Now, a study in the British Medical Journal validates that concern. A total of 315 children, with acute otitis media were assigned to 1 of 2 cohorts: 1) a 72-hour waiting period with no antibiotic use or 2) immediate antibiotic intervention.
Findings showed that:
“immediate antibiotic prescription provided symptomatic benefit mainly after the first 24 hours, when symptoms were already resolving.”
Although children who were given antibiotics recovered an average of 1 day earlier than children who did not take the medication, no difference was seen in school absence or pain/distress scores.
And, only 9% of children in the watchful waiting group developed diarrhea, compared with 19% of those taking antibiotics. So not only does the child have a greater chance of getting diarrhea with their earache they would have recovered on their own.
Overall, 77% of parents of children in the watchful waiting group expressed satisfaction with the care their youngsters received. In addition, these parents were less likely than parents of children who received antibiotics to predict that their youngsters would require antibiotics for subsequent ear infections.
Another study looked at 240 children, aged 6 months to 2 years, with acute otitis media. The children were prescribed either placebo or 40 mg/kg per day of amoxicillin. There was no significant difference between the two groups in otoscopic findings, pain duration, or crying.
In addition, tympanometric findings in both groups were similar at 6-week follow-up. Investigators again looked at 157 babies less than 3 weeks of age who were treated with erythromycin after being exposed to whooping cough. A total of 5% of the newborns that took erythromycin developed hypertrophic pyloric stenosis, which was treated with surgery. This figure is dramatically higher than the average incidence of the disorder, which only 0.1% to 0.3%.
Southern California/RAND Evidence-based Practice Center:
Finally in a study conducted by the Southern California/RAND Evidence-based Practice Center (EPC) and sponsored by the Agency for Healthcare Research and Quality reveals that nearly two-thirds of children with uncomplicated acute otitis media recover from pain and fever within 24 hours of diagnosis without treatment with antibiotics. And, over 80% recover within 1-7 days. When treated with antibiotics, up to 93% of children recover during the first week.
Part 3 – Natural remedies and bacteria:
Tags: Antibiotics
