Antibiotic Stewardship

You bring your child into the office to be seen, hoping that there is a quick fix that will make the illness and the suffering it causes go away. You are told that an antibiotic won’t help, and you don’t really understand why. In this blog we will be discussing antibiotic stewardship and why antibiotic stewardship is the responsibility of individuals, as well as providers.

Upwards of 65% of antibiotics prescribed (80 million prescriptions) are done so without medical necessity, including upper respiratory tract infections (common cold), non-strep sore throat, sinus infections that don’t meet diagnostic criteria. Medical necessity is defined by standards set by the CDC and expert panels. These standards often recommend a watchful waiting period to monitor the progression, before starting antibiotics – as most of the time the body can heal the infection on its own.

Antibiotic stewardship “refers to a set of coordinated strategies to improve the use of antimicrobial medications with the goal of enhancing patient health outcomes, reducing resistance to antibiotics, and decreasing unnecessary costs”. These coordinated strategies include education of the public about antibiotics and their impact, as well as creating standards for your healthcare providers for reducing antibiotic usage. In this model patients and communities have responsibility as well as healthcare providers.

Antibiotics have side effects

Antibiotics are not selective in killing just the bacteria that is causing illness, they also kill beneficial bacteria on and within our body. These beneficial bacteria are designed to be in balance with other bacteria, fungi, and viruses (our microbiome) and are essential to creating and maintaining wellness. We know that antibiotics cause diarrhea and yeast infections. One concerning form of diarrhea is caused by Clostridium difficile, which is directly related to antibiotic use and allows for this bacteria to overgrow causing illness. We are now understanding that by impacting the body’s microbiome, we may be increasing the risk of allergies, asthma, bowel diseases, and other chronic illnesses.

Antibiotics contribute to resistant bacteria

Since the discovery of antibiotics, bacteria have evolved defense mechanisms to prevent themselves from being killed by the antibiotic – known as bacterial resistance. You have heard of MRSA, which is bacteria resistant to methicillin class of drugs (penicillin, amoxicillin, ampicillin, etc). This means that these medications are not effective against these bacteria, so other “stronger” antibiotics are required. When a bacteria is resistant to all other antibiotics, death can occur.

What can you do to be an antibiotic steward?

Shift your perspective. Don’t expect an antibiotic will fix what you have.
Understand that there are at least 200 viruses that cause colds and coughs. These viruses (in a healthy individual) may cause symptoms for 1-3 weeks before resolving on their own. Learn more here about common illnesses.
Understand that your provider may recommend a “Watchful Waiting” period to see how an illness progresses before administering antibiotics.
Understand the side effects and impacts of antibiotic use
Be curious if your healthcare provider recommends antibiotics. Advocate for your own wellness to ensure antibiotics are in your best interest.
When taking antibiotics take according to directions for length of time recommended (shortening the time may not treat the bacterial infection and lead to resistance, requiring a second antibiotic).

What can I do during the Watchful Waiting Period?

It is hard to watch a child suffer a cold, let alone an ear infection. Many common infections (colds, sore throats, ear infections) are viral and are self-limiting. Allowing your child’s body to heal infections naturally helps the immune system develop to fight similar infections efficiently in the future. Here are some suggestions for helping to ease the discomforts:

Rest – allow your child to rest. Do not continue regular activities (especially sports or group activities).
Comfort and cuddle your child.
Drink plenty of water. Consider immune boosting teas (can be cooled before drinking)
Use a normal saline spray for congestion. Use a humidifier or mist vaporizer. Breathe in moist, warm vapors (from tea as it brews or steam from shower)
Elevate head for congestion/ear pain
Honey (if >1year old) for cough
Elderberry syrup, tea, or extract.
Zinc can reduce duration and number of infections
Ibuprofen for pain that affects function
For Ear Pain: warm, moist compress for 10-15 minutes; 1-2 drops garlic oil drops (only if intact ear drum)

What have you learned from this and what will you do the next time your child (or yourself) becomes ill? We hope you join us in being Antibiotic Stewards – for yourself, your family, and your community!

Resources –

https://www.cdc.gov/antibiotic-use/community/pdfs/Viruses-or-Bacteria-Factsheet-Eng.pdf

http://aac.asm.org/content/59/7/3848.short

https://www.cdc.gov/antibiotic-use/index.html

https://www.cdc.gov/antibiotic-use/community/pdfs/Viruses-or-Bacteria-Factsheet-Eng.pdf

https://www.cdc.gov/antibiotic-use/community/for-patients/common-illnesses/index.html

https://www.shea-online.org/index.php/practice-resources/priority-topics/antimicrobial-stewardship