Antibiotic Resistance Antibiotic Resistance and our Community and our Community

Down With Down With Superbugs!Superbugs!

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.

“Strep” throat (scarlet & rheumatic fever)

Chronic sinus infections Pneumonia Bladder infections Chlamydia, syphilis & gonorrhea

They treat many bacterial illnesses, including:

The Good News: Antibiotics Kill Bacteria

(Adapted from Levin BR, Clin Infect Dis 2001)

Antibiotics Kill Bacteria

VirusesBacteria

No effect

Antibiotics

X Break down cell wallsStop replication

(Adapted from Levin BR, Clin Infect Dis 2001)

Antibiotics Need Time to WorkR

Antibiotics prescribed

Day 5

R

X XXX

Medication taken for full course of treatment

RX

XXX

X XX

Infection cured!

Day 1

Day 10

Most upper respiratory infections are caused by viruses.

Antibiotics have no effect against colds and the flu.

Antibiotics Don’t Help Colds or the Flu

When we take antibiotics to treat colds and the flu, they lose their effectiveness against bacteria.

This phenomenon is known as antibiotic resistance.

Overusing Antibiotics Makes them Ineffective Against Bacteria

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

Susceptible bacteria are killed off.

A few hardy survivors are left behind.

XXX

XX

XXX

The survivors can withstand penicillin.

R

R

Jane takes penicillin.

The resistant survivors multiply. R

R

RR

R

RR

R

RRRTreatment with penicillin

has no effect. X

Resistant Bacteria Can Multiply and Spread

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.

Her parents decide it’s OK to stop.

Ashley takes her medicine for three days.

Ashley feels fine.

Scenario #2

(Adapted from Levin BR, Clin Infect Dis 2001)

Incomplete Treatment Causes Resistance

RX

XXX

X Day 3

Symptoms improved, treatment stopped

Day 0

R

Antibiotics prescribed

RRR

R

R

RR

Day 10

Resistant

infection

Meanwhile, the survivors multiply.

RRR

RR

RR

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 AntibioticsPatients:• 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

(Clin Pediatr. 1998;37:665-672)

Antibiotic Prescription

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

Stott BMJ 1976;2:556

0 1 2 3 4 5 6 7 8 9 10 11 12 130%

20%

40%

60%

80%

100%

Days of illness

Patients recording yellow sputum

Antibiotics

Sugar Pill

• Don’t ask for a particular brand.

When Your Child Takes Antibiotics:

• 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!

Gwaltney JAMA 1967;202:158

1 2 3 4 5 6 7 8 9 10 11 12 13 140

10

20

30

40

50

60

70

day of illness

% of patients with symptom

fever

sore throat

cough

Runny nose

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

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

90% of sore throats are caused by viruses!

Ear InfectionsBuildup of fluid in the middle ear is very common in

infants and toddlers

Treatment: If mild, uncomplicated, no perforated eardrum and >24 mos old, consider “wait-and-see” for 72 hours

Antibiotic of choice: amoxicillin

No treatment is required unless the following are present: Ear pain, fever, irritability, bulging yellow/red eardrum

Sinusitis

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

Yellow/green mucus does not mean bacterial infection!

Cough Illness

Treat only confirmed pertussis (whooping cough) or pneumonia with antibiotics.

Most coughs in children are caused by viruses, and may last for 2-3 weeks.

Antibiotic treatment will not prevent pneumonia.

Yellow/green mucus does not mean bacterial infection.

A Community Approach to Appropriate

Antibiotic Use

Improve diagnosis (train providers and students)

Collect information on resistance patterns

Work with health plans to monitor prescribing habits

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