Antibiotics: More Complicated Every Day

You’ve all faced it. The crying child comes into the exam room with an earache, classic acute otitis media. The exhausted parent wants you to do something, anything, to make the child feel better.

You may feel pressure to prescribe an antibiotic, even if the case appears appropriate for “watchful waiting.” In the era of antibiotic stewardship paired with a strong emphasis on family satisfaction, what’s a primary care pediatrician to do?

Research indicates the parental pressure you’re feeling might not necessarily be to give the child medication. Instead, after receiving a diagnosis, parents crave to know: 1) What can I do to help my child now? 2) What can we expect the disease course to be? 3) What is the contingency plan if the illness doesn’t follow expectations?

I’m co-investigator on a study led by Rita Mangione-Smith, MD, MPH, of Seattle Children’s Hospital, that is exploring communication strategies and training, aiming to uncover how to best get the message to parents. The need to reduce antibiotic use is well documented and multidimensional. The very real problem of antibiotic resistance has led to data-driven recommendations to avoid antibiotic prescribing when safe, or, when they are indicated, prescribe narrow spectrum antibiotics for shorter durations.

Another factor to consider is side effects. Statistics that show antibiotics account for more Emergency Department visits for adverse side effects than any other medication. And even common, less serious side effects like diarrhea occur in up to 25% of patients.

New concerns involve dysbiosis of the gut microbiome. Early-stage research suggests an association between dysbiosis and a variety of chronic diseases. A current study at CHOP is enrolling 400 newborns and will track the effect of antibiotics on the microbiome.

Some of these data might help inform what can be a complicated risk-benefit analysis, especially when you perceive parents are demanding antibiotics.

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