Down With Superbugs!. Antibiotic Resistance and our Community. What We’ll Cover. What is antibiotic resistance? Why should I be concerned? How can we keep our families safe? Green mucus and other exciting topics Your questions. Digression #1: “Upper Respiratory Infection”.
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Down With Superbugs! Antibiotic Resistance and our Community
What We’ll Cover • What is antibiotic resistance? • Why should I be concerned? • How can we keep our families safe? • Green mucus and other exciting topics • Your questions
Digression #1: “Upper Respiratory Infection” A viral or bacterial invasion of the: • Nose (sinusitis) • Throat (pharyngitis) • Chest/bronchial tubes (bronchitis) • Ear (otitis media)
Digression #2: “-itis” • “-itis” means inflammation. • 2. Inflammation of the upper respiratory tract can have many causes: • Viruses, allergies, environmental exposures, bacteria 3. “-itis” does not imply bacteria or bacterial infection.
The Good News: Antibiotics Kill Bacteria • “Strep” throat (scarlet & rheumatic fever) • Chronic sinus infections • Pneumonia • Bladder infections • Chlamydia, syphilis & gonorrhea They treat many bacterial illnesses, including:
X Break down cell wallsStop replication No effect Antibiotics Antibiotics Kill Bacteria Bacteria Viruses (Adapted from Levin BR, Clin Infect Dis 2001)
Antibiotics prescribed R R R Infection cured! X X X X X X X X Medication taken for full course of treatment X X X Day 1 Antibiotics Need Time to Work Day 5 Day 10 (Adapted from Levin BR, Clin Infect Dis 2001)
Antibiotics Don’t Help Colds or the Flu Most upper respiratory infections are caused by viruses. Antibiotics have no effect against colds and the flu.
Overusing Antibiotics Makes them Ineffective Against Bacteria When we take antibiotics to treat colds and the flu, they lose their effectiveness against bacteria. This phenomenon is known as antibiotic resistance.
Antibiotic Resistance Over time, bacteria develop the ability to survive treatment with drugs that used to kill them. • Causes of resistance: • Unnecessary use for viral infections • Quitting treatment too soon • Unnecessary use of broad-spectrum medications
Jane’s symptoms are caused by a virus, but she also has bacteria in her sinuses. Scenario #1 Jane has a sore throat. Without testing, her health care provider prescribes penicillin “just in case” it’s strep.
X X X X X X X X R Susceptible bacteria are killed off. A few hardy survivors are left behind. The survivors can withstand penicillin. Jane takes penicillin. R Unnecessary Antibiotics Cause Resistance
The resistant survivors multiply. R R R R R X Treatment with penicillin has no effect. R R R R R R Resistant Bacteria Can Multiply and Spread Jane is now a carrier of penicillin-resistant bacteria.
After a positive strep test, her pediatrician prescribes penicillin. Scenario #2 Ashley comes home from school with a sore throat and fever.
Scenario #2 Ashley takes her medicine for three days. Her parents decide it’s OK to stop. Ashley feels fine.
Day 0 X Day 3 X X R R R R R R R R R X X Antibiotics prescribed Day 10 Symptoms improved, treatment stopped Meanwhile, the survivors multiply. Resistant infection Incomplete Treatment Causes Resistance (Adapted from Levin BR, Clin Infect Dis 2001)
Longer treatment More expensive medication Higher dosage R R R R R R R Intravenous (IV) medication,hospitalization Resistant Infections Require Special Treatment
Resistant Infections are Dangerous • Medication toxicity (side effects) • Contagious • Can pass resistance to other organisms Worst Case Scenario: The infection may become resistant to all medications (untreatable).
Patients: Think green nasal discharge = bacterial infection Need to return to work/school Expect antibiotics if they’ve been given them before Antibiotic Prescription Why We Overuse Antibiotics • Physicians • Think patients expect antibiotics • Concerned about patientsatisfaction • Diagnosis is difficult • Time pressure (Clin Pediatr. 1998;37:665-672)
What Can Parents Do? • Ask your health care provider to explain the diagnosis. • Don’t insist on antibiotics. • Remember: • Most respiratory symptoms are caused by viruses • Antibiotics probably won’t make you better any faster • Green or yellow mucus doesn’t mean bacterial infection • Wash your hands!
The Green Mucus Myth Patients recording yellow sputum 100% 80% Antibiotics 60% Sugar Pill 40% 20% 0% 0 1 2 3 4 5 6 7 8 9 10 11 12 13 Days of illness Stott BMJ 1976;2:556
When Your Child Takes Antibiotics: • Don’t ask for a particular brand. • Take every dose, unless you’re specifically directed otherwise. • NEVER save antibiotics for later illnesses. • NEVER share antibiotics between family members.
% of patients with symptom 70 60 50 40 30 20 10 0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 day of illness Be Realistic: It Takes Time to Get Over a Virus! fever sore throat cough Runny nose Gwaltney JAMA 1967;202:158
What Can Health Care Providers Do? • Take time to explain the diagnosis and suggest ways to feel better. • Ask patients about their expectations. • Stick to established treatment guidelines. • Treat conservatively if possible.
Sore Throat 90% of sore throats are caused by viruses! Rapid Strep Test if more than one of the following are present: • Discharge from tonsils • Swollen/sore lymph nodes • Fever • No cough Antibiotic of choice for confirmed strep: Penicillin
Ear Infections Buildup of fluid in the middle ear is very common in infants and toddlers No treatment is required unless the following are present: Ear pain, fever, irritability, bulging yellow/red eardrum Treatment: If mild, uncomplicated, no perforated eardrum and >24 mos old, consider “wait-and-see” for 72 hours Antibiotic of choice: amoxicillin
Sinusitis Yellow/green mucus does not mean bacterial infection! If nasal discharge > 10 days OR severe symptoms: • High/persistent fever, apparent illness • Facial pain on one side • Postnasal drip • Swelling around the eye area Antibiotic of choice: amoxicillin
Cough Illness Most coughs in children are caused by viruses, and may last for 2-3 weeks. Treat only confirmed pertussis (whooping cough) or pneumonia with antibiotics. Yellow/green mucus does not mean bacterial infection. Antibiotic treatment will not prevent pneumonia.
A Community Approach to AppropriateAntibiotic Use Work with health plans to monitor prescribing habits Collect information on resistance patterns Improve diagnosis (train providers and students) Educate medical professionals and the public about appropriate use
Help Oregon AWARE Spread the Word! • Tell your friends and family about antibiotic resistance • Help distribute information at work, in schools and day care centers • Join our coalition