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Antibiotic Resistance Antibiotic Resistance and our Community and our Community
Down With Down With Superbugs!Superbugs!
What We’ll Cover
• What is antibiotic resistance?
• Why should I be concerned?
• How can we keep our families safe?
• Green mucus and other exciting topics
• Your questions
Digression #1: “Upper Respiratory Infection”
A viral or bacterial invasion of the:
• Nose (sinusitis)
• Throat (pharyngitis)
• Chest/bronchial tubes (bronchitis)
• Ear (otitis media)
Digression #2: “-itis”
1. “-itis” means inflammation.
2. Inflammation of the upper respiratory tract can have many causes:
• Viruses, allergies, environmental exposures, bacteria
3. “-itis” does not imply bacteria or bacterial infection.
“Strep” throat (scarlet & rheumatic fever)
Chronic sinus infections Pneumonia Bladder infections Chlamydia, syphilis & gonorrhea
They treat many bacterial illnesses, including:
The Good News: Antibiotics Kill Bacteria
(Adapted from Levin BR, Clin Infect Dis 2001)
Antibiotics Kill Bacteria
VirusesBacteria
No effect
Antibiotics
X Break down cell wallsStop replication
(Adapted from Levin BR, Clin Infect Dis 2001)
Antibiotics Need Time to WorkR
Antibiotics prescribed
Day 5
R
X XXX
Medication taken for full course of treatment
RX
XXX
X XX
Infection cured!
Day 1
Day 10
Most upper respiratory infections are caused by viruses.
Antibiotics have no effect against colds and the flu.
Antibiotics Don’t Help Colds or the Flu
When we take antibiotics to treat colds and the flu, they lose their effectiveness against bacteria.
This phenomenon is known as antibiotic resistance.
Overusing Antibiotics Makes them Ineffective Against Bacteria
Antibiotic Resistance
Over time, bacteria develop the ability to survive treatment with drugs that used to kill them.
Causes of resistance:– Unnecessary use for viral infections– Quitting treatment too soon– Unnecessary use of broad-spectrum
medications
Scenario #1
Jane has a sore throat. Without testing, her health care provider prescribes penicillin “just in case” it’s strep.
Jane’s symptoms are caused by a virus, but
she also has bacteria in her sinuses.
Unnecessary Antibiotics Cause Resistance
Susceptible bacteria are killed off.
A few hardy survivors are left behind.
XXX
XX
XXX
The survivors can withstand penicillin.
R
R
Jane takes penicillin.
The resistant survivors multiply. R
R
RR
R
RR
R
RRRTreatment with penicillin
has no effect. X
Resistant Bacteria Can Multiply and Spread
Jane is now a carrier of penicillin-resistant bacteria.
Scenario #2
Ashley comes home from school with a sore throat and fever.
After a positive strep test, her pediatrician prescribes penicillin.
Her parents decide it’s OK to stop.
Ashley takes her medicine for three days.
Ashley feels fine.
Scenario #2
(Adapted from Levin BR, Clin Infect Dis 2001)
Incomplete Treatment Causes Resistance
RX
XXX
X Day 3
Symptoms improved, treatment stopped
Day 0
R
Antibiotics prescribed
RRR
R
R
RR
Day 10
Resistant
infection
Meanwhile, the survivors multiply.
RRR
RR
RR
Resistant Infections Require Special Treatment
Longer treatment
Higher dosage
More expensive medication
Intravenous (IV) medication,
hospitalization
Resistant Infections are Dangerous
• Medication toxicity (side effects)• Contagious • Can pass resistance to other
organisms
Worst Case Scenario: The infection may become resistant to all medications (untreatable).
Why We Overuse AntibioticsPatients:• Think green nasal discharge
= bacterial infection• Need to return to
work/school• Expect antibiotics if they’ve
been given them before
Physicians• Think patients expect antibiotics • Concerned about patient
satisfaction• Diagnosis is difficult• Time pressure
(Clin Pediatr. 1998;37:665-672)
Antibiotic Prescription
What Can Parents Do?
• Ask your health care provider to explain the diagnosis.
• Don’t insist on antibiotics.
• Remember:• Most respiratory symptoms are caused by viruses• Antibiotics probably won’t make you better any faster• Green or yellow mucus doesn’t mean bacterial infection
• Wash your hands!
The Green Mucus Myth
Stott BMJ 1976;2:556
0 1 2 3 4 5 6 7 8 9 10 11 12 130%
20%
40%
60%
80%
100%
Days of illness
Patients recording yellow sputum
Antibiotics
Sugar Pill
• Don’t ask for a particular brand.
When Your Child Takes Antibiotics:
• Take every dose, unless you’re specifically directed otherwise.
• NEVER save antibiotics for later illnesses.
• NEVER share antibiotics between family members.
Be Realistic: It Takes Time to Get Over a Virus!
Gwaltney JAMA 1967;202:158
1 2 3 4 5 6 7 8 9 10 11 12 13 140
10
20
30
40
50
60
70
day of illness
% of patients with symptom
fever
sore throat
cough
Runny nose
What Can Health Care Providers Do?
• Take time to explain the diagnosis and suggest ways to feel better.
• Ask patients about their expectations.
• Stick to established treatment guidelines.
• Treat conservatively if possible.
Sore Throat
Rapid Strep Test if more than one of the following are present:• Discharge from tonsils• Swollen/sore lymph nodes • Fever• No cough
Antibiotic of choice for confirmed strep: Penicillin
90% of sore throats are caused by viruses!
Ear InfectionsBuildup of fluid in the middle ear is very common in
infants and toddlers
Treatment: If mild, uncomplicated, no perforated eardrum and >24 mos old, consider “wait-and-see” for 72 hours
Antibiotic of choice: amoxicillin
No treatment is required unless the following are present: Ear pain, fever, irritability, bulging yellow/red eardrum
Sinusitis
If nasal discharge > 10 days OR severe symptoms:• High/persistent fever, apparent illness• Facial pain on one side • Postnasal drip• Swelling around the eye area
Antibiotic of choice: amoxicillin
Yellow/green mucus does not mean bacterial infection!
Cough Illness
Treat only confirmed pertussis (whooping cough) or pneumonia with antibiotics.
Most coughs in children are caused by viruses, and may last for 2-3 weeks.
Antibiotic treatment will not prevent pneumonia.
Yellow/green mucus does not mean bacterial infection.
A Community Approach to Appropriate
Antibiotic Use
Improve diagnosis (train providers and students)
Collect information on resistance patterns
Work with health plans to monitor prescribing habits
Educate medical professionals and the public about appropriate use
Help Oregon AWARE Spread the Word!
• Tell your friends and family about antibiotic resistance
• Help distribute information at work, in schools and day care centers
• Join our coalition