October 14, 2019
What can we do to stem the tide of this mess?
"The rapid emergence of resistant bacteria is occurring worldwide, endangering the efficacy of antibiotics. Implementation of recommended steps, such as the adoption of antibiotic stewardship programs; improving diagnosis, tracking and prescribing practices; optimizing therapeutic regimens; and preventing infection transmission, are expected to be effective in managing this crisis.
Increasing collaboration among concerned stakeholders to establish policies, initiatives, and investments in new agents to battle the antibiotic resistance crisis is also promising. Recently approved antibiotic compounds are expected to help stem this crisis, as are the novel approaches to the treatment of bacterial infections that are currently being studied." (Ventola Part 2, 2015)
Let us list out the do's and don't's for antibiotic stewardship?
1) Avoid using antibiotics when and where possible; This is critical. We need to have providers ONLY prescribe antibiotics when it is a bacterial infection that needs clearance. Consumers of healthcare need to know that pressuring a provider to prescribe antibiotics is NOT in their best interest unless statement one is met. Unfortunately, this still happens all the time in clinic as patients are visibly upset when we tell them that the best course of action is rest, sleep, quality nourishment and time. Unless prescribed by a physician or other licensed provider who believes that the drug is NECESSARY, do not ask for or use them. Antibiotics are drugs with significant side effects including the most dangerous one: disrupting the natural human gut micro biome. Do not be afraid to ask the provider whether the antibiotics are necessary or can a period of watchful waiting be employed with antibiotics on hand in case of worsening. It is your child's health we are talking about.
2) Always throw away antibiotics that are left over from a previous prescription. Using a few doses during a subsequent illness without a full course of treatment, assuming it is necessary at this time, is a recipe for training bacteria to become resistant furthering the problem societally.
3) Stay current with treatment trends. For example, 60-70% of children over the age of 2 years will clear a diagnosed bacterial ear infection without antibiotics. Viral upper respiratory infections can last for a few weeks. Discuss these issues with your provider. Ask your provider to check for strep throat via a rapid test to prove it's presence before treating. There are new, albeit expensive, ways to rapidly test for pathogens in outpatient settings when the cause is in question. Using them can help avoid the use of drugs. Guessing at a tricky infectious disease has been proven to be at times poor even in a great clinicians hands.
4) Along the lines of #1, Be careful with non-pediatric professionals and their liberal prescribing habits. We find that overuse of antibiotics is still rampant in rapid/fast/urgent care type venues. Conventional wisdom is to provide some treatment to keep the consumer happy. This is unfortunately bad for this same person in the long run. Short term happiness traded for long term disease risk.
5) Preventing infections in the first place is critical to avoiding the need to be at risk in the first place. Wash your hands frequently, but especially in any healthcare or food preparation setting. Where a face mask if you are going to be exposed to a sick individual.
6) Assess whether your child has a food allergy or intolerance. If they have a reaction to a food that causes the body to be inflamed, they are at higher risk for infections. For example, milk protein intolerance is a very common problem in America now. Children are chronically irritated by the protein in milk called casein. When they consume it they have reactions in the body ranging from green diarrhea, eczematous dry skin rashes, reflux, congestion and irritability. The chronic milk exposure causes a chronic congestion that plugs up the eustachian tubes that drain the inner ear as well as seeding the sinus cavities with mucous. This leads to a lovely breeding ground for bacteria to grow. This problem, as with many other food reactions, is easily prevented by an elimination diet to the offending food.
7) Try and purchase animal meats that are produced without the use of antibiotics in the feed or for non illness related uses. Use your buying power to sway the consumer market.
8) Raise awareness among the people in your circle to these issues. Spreading the word will help save many lives and also save inordinate amounts of money.
Antibiotic resistance is a serious issue,
Dr. M
Blair Nature Reviews Microbiology Article
Ventola Pharmacy and Therapeutics Article Part 1
CDC 2013 Antibiotic Resistance Report
Ventola Pharmacy and Therapeutics Article Part 2
