Antibiotics

A concerned mother has a question: My pediatrician recently told me that he no longer recommends that patients who are prescribed antibiotics finish their entire dose. He said that recent research shows that finishing the dose may lead to greater antibiotic resistance, not less. He also said that pediatricians are no longer automatically prescribing antibiotics for bacterial ear infections. Could you comment on these two points in one of your columns?

Sure, I can do that. The use of antibiotics and other agents is widespread among humans, animals, in agriculture and other industries. I don’t think there is a person or an animal who has not been prescribed antibiotics. Let us look back in time.

Canadian statistics show that in 1999, about 25 million prescriptions for oral antibiotics were dispensed and that, after cardiovascular and psychiatric drugs, antibiotics were the most commonly prescribed class of agents, says an article in the Canadian Medical Association Journal.

Seventy years ago, sulphonamides (popularly known as sulpha) was the first chemical agent discovered to kill bacteria. Until then molds had been used to fight infection for 2500 years, but its effect was unpredictable and sometimes toxic.

In 1928, a Scottish physician, Alexander Fleming, noticed that a small amount of mold growing on a Staph culture destroyed the bacteria. He named an extract of the mold penicillin. In early 1940s, penicillin was mass-produced by drug companies. Since then many anti-bacterial agents have arrived in the market.

There is no doubt that modern anti-bacterial therapy has considerably decreased illness and deaths from infections, has prevented disease, and has contributed significantly to the development of modern surgery, trauma therapy, and organ transplantation.

“The broad application of antimicrobial agents in modern medicine has not, however, been problem-free. These agents occasionally cause major adverse reactions, interact with other classes of pharmacologic agents, and exert a major selective pressure for widespread antimicrobial resistance among bacteria,” says one textbook of medicine.

So, how long should one take antibiotics for?

Just the right number of days! And there is no magic formula. Short therapy fails to cure the illness. And unnecessarily prolonged therapy leads to undesirable reactions. For most acute infections, it is a good idea to continue therapy for two to three days after the temperature has returned to normal and all signs of infection have gone. If in doubt, then ask your physician.

What about antibiotics for ear infection?

The diagnosis of middle ear infection has the distinction of being the single most common diagnosis reported from pediatric office practices, yet there is no consensus in the literature about optimal methods of diagnosis, prevention, treatment and follow-up, says some medical literature.

Ear infection can be viral or bacterial. Seventy-five percent of children experience at least one episode of middle ear infection by their third birthday. Almost half of these children will have three or more ear infections during their first 3 years.

The majority of uncomplicated cases of ear infection do not require antibiotics as they resolve spontaneously. Since there is so much confusion on how to care for ear infection, a clinician’s experience may be more important than actual scientific knowledge. So, follow your physician’s advice regarding use of antibiotics for this condition.

Finally, here is what Caskie Stinnett said about antibiotics:

“The trouble with being a hypochondriac these days is that antibiotics have cured all the good diseases.”

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