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Monday, February 19, 2018

Viral vs. bacterial: when to use antibiotics

Father Giving Son Cough Syrup
Millions of prescriptions for antibiotics written each year for children and teens may be unnecessary, according to a new study to be released in the October 2014 issue of Pediatrics, the journal of the American Academy of Pediatrics (AAP).

Researchers looked at data on the treatment of acute respiratory infections in children from 2000 to 2011 to estimate antibiotic prescribing rates.

The researchers estimated that 27.4 percent of U.S. children with infections of the ear, sinus area, throat or upper respiratory system had bacterial illness. Yet antibiotics were prescribed for about 56.95 percent of those visits.

How do physicians determine when to write a prescription and when to hold back? The decision rests on what physicians think is causing the infection in the first place. Is it a virus? Or is it bacteria?

Some respiratory infections are viral, which means they won’t be helped by antibiotics.

There are no practical tools for clinicians to use to distinguish viral from bacterial illness other than the rapid strep test for throat infections. Pediatricians must work hard to prescribe antibiotics judiciously, says Farah Lokey, MD, of Southwestern Pediatrics in Gilbert.

“Overall, most infections are viral and can be watched,” says Lokey, a member of the Arizona Chapter of the AAP (AzAAP).

However, if some viral infections continue for a certain amount of time, they will eventually “seed” bacteria, leading to treatment with antibiotics.

For example, when a cold turns into a sinus infection, or sinusitis, a child may develop a fever and become increasingly uncomfortable. “Then we treat with antibiotics,” says Lokey. “A cold which lasts about seven days is not a reason to treat with antibiotics.”

In her practice, Lokey usually recommends supportive care first: “We tell parents to push lots of fluids and use medicines to help symptoms like congestion and coughs,” also known as the “watchful waiting” approach.

Some illnesses, such as streptococcal sore throat or skin infections, need immediate antibiotic treatment, says Lokey. Pediatricians follow best practices algorithms when they make these treatment decisions. For example, doctors may choose to treat a child under age 2 who has an ear infection — especially if the child has other systemic symptoms, such a fever — because of the risk of complications. With older kids, watchful waiting might be more appropriate since most ear infections are viral.

What about pressure from busy parents? Or schools with policies that require evidence that children are being treated for an infection before they may return to the classroom? Pediatricians need to help educate the public on why overuse of antibiotics can cause problems, says Lokey. According to the Centers for Disease Control, overuse of antibiotics hurts everyone: it can create new strains of bacteria that outsmart the drugs scientists have developed to treat infections.

Lokey has noticed a positive trend in her weekly visits with expectant moms seeking a pediatrician: They are asking questions about the judicious use of antibiotics.

Taking the time to discuss the options is key. “Educating a family goes a long way,” adds Lokey. “Just writing a prescription for an antibiotic is not the best answer, though it may be the quickest. Overall, we doctors need to put education as the priority in our visits with parents and patients.”

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Vicki Louk Balint

Multimedia journalist Vicki Louk Balint specializes in health and safety topics.

Copyrighted material. All rights reserved. This content may not be published, rewritten, broadcast or redistributed without permission of the publisher.

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