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Down With Superbugs! Antibiotic Resistance and our Community 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. The Good News: Antibiotics Kill Bacteria They treat many bacterial illnesses, including: “Strep” throat (scarlet & rheumatic fever) Chronic sinus infections Pneumonia Bladder infections Chlamydia, syphilis & gonorrhea Antibiotics Kill Bacteria Bacteria Viruses X Break down cell walls Stop replication No effect Antibiotics (Adapted from Levin BR, Clin Infect Dis 2001) Day 1 Antibiotics Need Time to Work Day 5 Day 10 Antibiotics prescribed X X X X Medication taken for full course of treatment (Adapted from Levin BR, Clin Infect Dis 2001) Infection cured! X X X X X X X Antibiotics Don’t Help Colds or the Flu Most upper respiratory infections are caused by viruses. Antibiotics have no effect against colds and the flu. Overusing Antibiotics Makes them Ineffective Against Bacteria When we take antibiotics to treat colds and the flu, they lose their effectiveness against bacteria. This phenomenon is known as antibiotic resistance. 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 X X X X X X X X Jane takes penicillin. Susceptible bacteria are killed off. A few hardy survivors are left behind. R R The survivors can withstand penicillin. Resistant Bacteria Can Multiply and Spread The resistant survivors multiply. R R R R Treatment with penicillin has no effect. X R R R R R R R 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. Scenario #2 Ashley takes her medicine for three days. Ashley feels fine. Her parents decide it’s OK to stop. Day 0 Incomplete Treatment Causes Resistance X Antibiotics prescribed Day 3 X X X X Day 10 Symptoms improved, treatment stopped Meanwhile, the survivors multiply. (Adapted from Levin BR, Clin Infect Dis 2001) Resistant infection 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 Antibiotics Patients: • 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 Antibiotic Prescription (Clin Pediatr. 1998;37:665-672) 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 Patients recording yellow sputum 100% 80% Antibiotics 60% Sugar Pill 40% 20% 0% 0 1 2 3 4 5 6 7 Days of illness Stott BMJ 1976;2:556 8 9 10 11 12 13 When Your Child Takes Antibiotics: • Don’t ask for a particular brand. • 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! % of patients with symptom 70 fever 60 sore throat 50 cough 40 Runny nose 30 20 10 0 1 2 3 4 5 6 7 8 9 day of illness 10 11 12 13 14 Gwaltney JAMA 1967;202:158 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 90% of sore throats are caused by viruses! 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 Ear Infections Buildup of fluid in the middle ear is very common in infants and toddlers No treatment is required unless the following are present: Ear pain, fever, irritability, bulging yellow/red eardrum Treatment: If mild, uncomplicated, no perforated eardrum and >24 mos old, consider “wait-and-see” for 72 hours Antibiotic of choice: amoxicillin Sinusitis Yellow/green mucus does not mean bacterial infection! 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 Cough Illness Most coughs in children are caused by viruses, and may last for 2-3 weeks. Yellow/green mucus does not mean bacterial infection. Antibiotic treatment will not prevent pneumonia. Treat only confirmed pertussis (whooping cough) or pneumonia with antibiotics. A Community Approach to Appropriate Antibiotic Use Work with health plans to monitor prescribing habits Collect information on resistance patterns Improve diagnosis (train providers and students) 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