community

Report
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

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