Second Opinion: Antibiotics

“But antibiotics taste so good”

It is a hassle to see the doctor.

The first battle typically involves the phone system. With carefully orchestrated options designed to keep you from reaching an actual person, it can be a minor miracle to reach the scheduler. Then, does your schedule match an opening for your doctor, if she or he has one?

Next up: the waiting room.

If your child wasn’t truly sick before arriving there, licking the waiting room toys might cinch the deal. When you are finally called back to the exam room, there is some momentary excitement, until you surmise that this is actually another smaller waiting room.

And don’t get me started on the redundancies of disclaimers and insurance paperwork.

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I know what you’ve been through to get to see me. And I want to try to redeem the experience and make it as positive as possible. That doesn’t necessarily mean I’ll prescribe an antibiotic, however. Sometimes an antibiotic may be harmful rather than helpful.

Let’s take sore throats for example.

What percentage of sore throats are caused by strep bacteria and will benefit from an antibiotic? Only about 20 percent. The remaining are caused by viruses, and an antibiotic will not help.

And what about the color of mucous — is this important? I don’t like that green nasal drainage running down your child’s face either, but it turns out that whether it’s clear or colored does not matter. The color is caused by inflammatory cells, called neutrophils, that are present in both bacterial and viral infections.

Many bacterial infections are going to be self-limited. If a child is found to have an incidental ear infection, but is feeding well and not lethargic, he or she can probably get away with observation. A sinus infection should not be treated with antibiotics unless the patient has severe pain or symptoms have progressed past one week.

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A study that affected how I prescribe was published in The Journal of Family Practice in 2000. It evaluated using a “backup” prescription, instructing families not to fill this unless the patient’s condition deteriorated or failed to improve. I may use this when an ear infection is mild, or if a sinus infection has not progressed beyond a week.

Sometimes people will request another antibiotic because the first one didn’t cure their infection, but it may be that the patient simply has a viral infection that just needs to run its course.

Why are physicians passionate about this topic? Possibly because contrary to the goal of the Hippocratic oath, they have done harm at times with antibiotics. Little Johnny may have had the sniffles before, but now with the help of antibiotics, he’s really got diarrhea and a diaper rash to boot. Antibiotic resistance (think MRSA) has proliferated with overprescribing. If you have a strong stomach, Google “Stevens-Johnson Syndrome” and you can see some of the dangerous rashes (and accompanying trial attorneys) that can rarely result from an antibiotic.

Now don’t get me wrong. I love the great taste of pink amoxicillin suspension as much as the next guy. But these medicines are a double-edged sword that need to be used at the right time in the right situation. So please don’t demand them.

And maybe I’ll see you in the waiting room with my own children, hoping to graduate to the next, smaller waiting room. We’ll try not to lick the toys.

 –David Pommer, M.D. is a family physician at Selah Family Medicine. He is a graduate of Whitworth University and the University of Washington School of Medicine. He is married with three children.

Filed under From the Mag, Second Opinion