Move over Kelly, Cheryl REALLY knows how to save $$$$

[momof2treasures]

I don't know anyone who gets a z pack for the flu, maybe tamiflu. I have never heard of this. Doctors do have a standard of care to follow. Maybe they are prescribing it for something else?

[DGayle]

I don't know anyone who gets a z pack for the flu, maybe tamiflu. I have never heard of this. Doctors do have a standard of care to follow. Maybe they are prescribing it for something else?

I also know people who actually get this for the flu and colds. When it's multiple people saying it's for the same thing, I doubt they're all lying to conceal something else.

[snarkykitty]

I know over-prescription of antibiotics is a problem, but I always thought the problem was people insisting on antibiotics for viral infections or being given antibiotics before testing "just in case." And things like antibacterial handsoap and such when a good hand scrubbing is just as effective.

This is the first time I've heard people say you shouldn't take antibiotics for strep throat because your body could fight it off on it's own.

In many cases, it is biologically better for someone to let their immune system fight bacterial infections versus automatically taking antibiotics. At some point, bacteriae become resistent to enture classes of antibiotics.

Despite my chronic infections of Pseudomonas Aeriginosa (4 strains), non-community acquired MRSA, a strain of Staph Aureus, and one strain of maltophilia, my doctors recommend increased Airway clearance (4-6 HOURS a day and giving my immune system a chance to fight an active infection, before automatically prescribing an antibiotic cocktail. They usually want a sputum culture to see which bugs are overgrowing the most to confirm that we're treating the right strains at the right time. Unfortunately, I still end up in the hospital 2-3 times a year for an antibiotic cocktail of IV meds for 2-3 weeks at a time.

A healthy immune system likely will eradicate a bacterial infection, although most of us don't have time or energy to let nature take its course.

[Deist woman]

If a parent alone has 5 kids in the ER at a time like that, she might not be able to give her undivided attention to the sick kid, and could forget to mention some vital things if she's halfway paying attention to the other kids to make sure they aren't tearing the place apart. So it could be safer for the kid who was sick to wait a little longer.

A better example would be of a friend's toddler whose leg was injured. The dad was swinging the baby around, and whacked the baby's leg into a wall corner on accident. Poor little thing couldn't stand, but his dad would be damned before missing the rest of a sports game because THAT was inconvenient. And since she didn't have a license, she had to wait for him to get his ass out the door. The baby's leg was broken. (All little kids are babies to me when they're sick--this baby in question was 2 years old.)

At least the mom you knew was waiting for childcare because it would be easier to give the sick kid her undivided attention, and in that case, ease could have impacted the appropriate care.

I understand what you are saying, DGayle, and in many situations, that would be fine. A child with a sprained ankle can wait hours, or even a day for treatment. An older child with fever, vomiting, and no symptoms of dehydration can wait. If a parent delayed in bringing in a child with a deep cut that is bleeding profusely, everyone would understand that the parent was being outrageously neglectful if care was delayed by 8 hours for convenience sake. But a very young child, with a very high fever, and signs of dehydration needs care just as quickly as the child with the laceration. The child needs emergency care, which would include IV fluids, and fever reducers, lab work, blood cultures, etc. If he is allergic to some medication, or had a chronic health problem, that would need to be known for the assessment, but the odds of the mother forgetting to mention those things would hopefully be very small, no matter how many kids are ransacking the exam room. The risk is much greater that the child might enter organ failure due to dehydration or sepsis. In a small child, letting dehydration persist for hours longer than necessary is just as irresponsible as ignoring a bleeding wound.

[August]

I've had that hospital/office visit conversation on the phone with the triage nurse several times. It can come in many flavors of urgency, and in my experience they are quite clear when they are telling you to take them in over the next few hours, or whether they need to be seen ASAP. I doubt I'm an unusually smart patient, and I suspect that they are very good at making themselves clear that you do or don't need to wake up everyone to get that kid seen.

In many cases, it is biologically better for someone to let their immune system fight bacterial infections versus automatically taking antibiotics. At some point, bacteriae become resistent to enture classes of antibiotics.

Despite my chronic infections of Pseudomonas Aeriginosa (4 strains), non-community acquired MRSA, a strain of Staph Aureus, and one strain of maltophilia, my doctors recommend increased Airway clearance (4-6 HOURS a day and giving my immune system a chance to fight an active infection, before automatically prescribing an antibiotic cocktail. They usually want a sputum culture to see which bugs are overgrowing the most to confirm that we're treating the right strains at the right time. Unfortunately, I still end up in the hospital 2-3 times a year for an antibiotic cocktail of IV meds for 2-3 weeks at a time.

A healthy immune system likely will eradicate a bacterial infection, although most of us don't have time or energy to let nature take its course.

No offence intended, but it does not sound like you're a typical patient. I assume you have something like cystic fibrosis or are immune compromised? That, plus the fact that these infections are chronic are absolutely going to affect the decision to give you antibiotics. It's a way more complicated decision for you than if I walked in with pneumonia, or even MRSA. I remember hearing somewhere that simply sending a (healthy) person with hospital acquired MRSA home from the hospital usually clears it up.

Firiel, yes, the only reason apart from comfort to give abx for strep throat is to avoid heart problems, and they are vanishingly rare in under 3 and over 15 year olds, so they don't recommend antibiotics for those age groups. And within the middle age group the risk is very different for different populations, hence the European CDC recommendation. There's a lot of interesting research out of NZ on policies and strategies and treatment if you're interested. And it's not just strep A that's being rethought, the current standard of care for ear infections is to wait before prescribing. The problem with ear infections is apparently biofilms, so antibiotics just don't work very well anyway.

Placebo-controlled trials of AOM[ear infection] over the past 30 years have shown consistently that most children do well, without adverse sequelae, even without antibacterial therapy. Between 7 and 20 children must be treated with antibacterial agents for 1 child to derive benefit.34–36 By 24 hours, 61% of children have decreased symptoms whether they receive placebo or antibacterial agents. By 7 days, approximately 75% of children have resolution of symptoms.

[DGayle]

Yes, that child needs to be seen, Deist, but there are other factors that have to weigh in, that have to do with safety. Take in a handful of extra, cranky kids to the ER, and that becomes a safety issue for other people as well as for the kid who is sick. Sometimes you have to try to find a middle-ground, and that won't always mean the exact same action as a person with no other kids.

You HOPE the chances of a mom forgetting which allergies a kid has would be small. When worried about a kid, the chances already are higher than usual, and having a bunch of kids who are probably tired and cranky to haul around from room to room (since you can NOT leave a bunch of young kids unattended in the waiting room!) will VERY much impair a parent's ability to think clearly. When my older daughter went to the ER for a high fever and dehydration, I was so upset that I couldn't remember HER BIRTHDAY. Thank goodness her grandma was there with me until my husband could get there. I'm sure some people can be cool as cucumbers and remember everything like clockwork while telling a bunch of other kids to stay put and be still, but that's not going to be all, or even most, parents.

A deep laceration isn't on par with a fever and starting to get dehydrated. A deep cut can kill within minutes. The chances of a fever and starting dehydration leading to death without immediate medical care is slim. If a situation is bad enough, call 911 to come pick up the kid while you wait at home instead of dragging a handful of kids around to be a safety hazard for other people.

[Mama Mia]

I actually checked in with various administrative folks at my university about that -- antibiotics don't do anything for viruses. The cold/flu are viruses, which is why there are vaccines. I'm not a scientist, but they're different organisms that function differently, and so methods that work for one won't work for the other.

I'm glad you checked in with knowledgable sources to get clarification on viruses vs infections and what antibiotics are useful for. I think that this isn't just common knowledge is why people are talking about how important it is that people become educated on antibiotic use, and overuse. And the primary way they are going to gain that knowledge ( other than random Internet forum side tracks :) ) , is through health professionals. So anytime a Doctor writes a prescription for what is clearly a virus, just to get on with their day, it's really doing a big disservice to not only the patient, but the community.

My kids are all adults, and even 20 years ago I remember hearing about antibiotics being over prescribed and how dangerous that was. It's disheartening that it's still so common.

I had one baby that had recurrent ear infections. He kept being prescribed the same antibiotic over and over. All the antibiotic was doing was wiping out enough of the infection to make him appear well. But a couple of weeks later it would be back again. This went on for months. I finally suggested that a different antibiotic be tried. And it wiped out the infection and he never had another. But the physician would have happily gone on prescribing amoxicillin every month until eventually my kid had tubes in his ears. Im guessing it was a type of infection that had become resistant to common antibiotics.