To Treat or Not to Treat (with antibiotics )

“Primum non nocere”, Latin translation from the original Greek “do no harm” as in the Hippocratic Oath as recited by all medical students.

Perhaps while you were growing up (much as I did) you heard statements such as:

  • “you’re sick, then go to the Doctor to get an antibiotic”
  • “I love Dr. (insert name here). I just call him/her up and he/she phones in an antibiotic for me. You have to see him/her”
  • “Just swing by the local Urgent Care they will write a prescription for you”

In essence, taking an antibiotic meant getting healthy.

However, in my quest to provide quality care, more often than not I have learned that NOT prescribing antibiotics is the only way to truly follow the Hippocratic oath and do no harm!

 

Why not prescribe antibiotics just in case?

Antibiotic resistance – the CDC sees antibiotic resistance as amongst the greatest public health threats today, leading to an estimated 2 million infections and 23,000 deaths per year in the United States (1). Taking an antibiotic when it is not needed, the wrong antibiotic, the wrong dose, and/or the wrong duration can all increase the likelihood of bacteria developing resistance and becoming ineffective.

Antibiotics upset the balance of good and bad bacteria in your intestinal tract. Antibiotic associated diarrhea is its mildest of forms. Clostridium difficile is its most severe (profuse, often bloody diarrhea with abdominal cramping).

There also is the potential to develop an allergic reaction to your prescribed antibiotic, hives being the mildest form. However, these reactions can progress to a more severe allergic reaction leading to an emergency room visit or even hospitalization.

There are ongoing studies being done on antibiotics and their effects on our microbiome (the genes in the trillion or so symbiotic helpful microbial cells harbored by each person ) and ultimately our overall health

Based on this, I challenge you not to ask your physician why is my child not getting an antibiotic, but why ARE they getting an antibiotic. Don’t get me wrong – there are often times where the benefit outweighs the risk. The development of antibiotics by Alexander Fleming in 1928 was nothing short of a miracle. Having a treatment for Group A strep throat and thus preventing rheumatic fever, treatment for bacterial pneumonia, severe ear infections ( notice the use of severe, as often mild ear infections will resolve on own ), persistent or severe sinus infections ( again, mild ones often will resolve on their own ) has prevented significant morbidity and mortality.

To this end, All Pediatrics has undertaken a quality improvement project with the Virginia AAP and the CDC to improve antibiotic prescribing practices.

There is compelling evidence, as stated above, that often there is no benefit to the use of antibiotics and there are real risks. I sure do wish there was more I can offer as a pediatrician to ease the symptoms of a troubling cough that keeps your child up at night. It would be very rewarding. However, I will take peace in knowing that I have given sound advice that will keep your child from being harmed.

  1. http://www.cdc.gov/drugresistance/threat-report-2013/index.html