Words of Wisdom from Dr. Weiss about Antibiotics…the good, the bad, and the ugly.

Practicing Pediatric medicine is an exciting, rewarding, and challenging profession.  It is also an art form.

We are tasked with the health and well being of children in our care, while often finding ourselves competing with parental expectations, fears, and ‘home’ research (Dr. Google) in our efforts to educate.  We are faced with daily reminders of how fragile the human body is and how many things in our environment can subject us to harm.

When we, or our children become ill, we want to fix it quickly. Fear and panic are not far behind.  As a Pediatrician, it is important to maintain empathy for the situation, while also translating the facts into a convincing argument that can be reassuring.

Often, treatment is not needed or indicated.  This can be a bitter pill to swallow.  How often have we as parents been faced with an infant or young child with a high fever, cough, green runny nose, and fussiness who we bring to the doctor to be cured, only to be told it’s a virus and will get better by itself? Or worse yet, it seems that every visit ends up with another antibiotic and over the counter medications.

This is where the facts and the art of listening to fears and taking the time to teach make all the difference.

In children under 2, most illnesses tend to be viral. Antibiotics don’t work in those situations. Viruses attack the body by entering the cells. Antibiotics only work on bacteria that remain in the spaces between cells.

The common cold is a virus. Most cases of bronchitis, sore throat, and sinusitis are caused by viral infections If headache or ‘sinus’ symptoms have been present less than 10 days, it is probably not bacterial. Influenza is a virus that is treated with anti-viral medication that helps stop its replication within the cell…but doesn’t kill it. It sometimes can lead to secondary bacterial infections that can be treated with antibiotics.

So what problems are more suggestive of bacterial illness that might require antibiotics? Strep throat, which can be tested for rapidly in most offices; pneumonia (lung infections); bladder infections; many ear infections; and, in older patients, sexually transmitted diseases. The physical examination is critical in determining which we are dealing with –  a viral infection or bacterial infection.  That is why prescribing antibiotics over the phone is not only poor medicine, but dangerous. Hearing that an illness doesn’t require treatment is actually a good thing.

Antibiotics are a wonderful tool to fight disease, but they can also prove harmful. Our body is made up of ‘good’ bacteria…our microbiome. Whenever we use an antibiotic, it disrupts, and kills many of those helpful bacteria. This can lead to secondary infections particularly in the GI tract and can take a long time to repair. Our immune system can be depressed leading to yeast/thrush infections, and exposure to frequent antibiotics that are not needed teaches our resident bacteria how to become resistant. These bacterial like MRSA (staph) infections become difficult if not impossible to treat.  Antibiotics can cause nausea, vomiting, diarrhea, rashes, and even allergic, life-threatening reactions.

Physicians train for many years to learn when to treat, how to identify the best antibiotic for a particular problem, and when cautious observation is the best approach. Develop a good relationship with your doctor, ask questions, allow them to guide you and reassure you. Don’t push for an antibiotic that isn’t needed, don’t use left-over medicine or medicine prescribed to another family member, and always finish the entire course of treatment as prescribed. Different bacterial infections take different periods of time to fully heal.  The human body is much stronger and smarter than you think.