2. 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
3. Digression #1:
“Upper Respiratory Infection”
A viral or bacterial invasion of the:
• Nose (sinusitis)
• Throat (pharyngitis)
• Chest/bronchial tubes (bronchitis)
• Ear (otitis media)
4. 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.
5. “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
6. (Adapted from Levin BR, Clin Infect Dis 2001)
Antibiotics Kill Bacteria
Viruses
Bacteria
No effect
Antibiotics
X
Break down cell walls
Stop replication
7. (Adapted from Levin BR, Clin Infect Dis 2001)
Antibiotics Need Time
to Work
Antibiotics
prescribed
Day 5
X X
X
X
Medication taken for full
course of treatment
X
X
X
X
X X
X
Infection
cured!
Day 1
Day 10
8. 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
9. 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
10. 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
11. 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.
13. The resistant survivors
multiply. R
R
R
R
R
R
R
R
R
R
R
Treatment with penicillin
has no effect. X
Resistant Bacteria Can
Multiply and Spread
Jane is now a carrier of
penicillin-resistant bacteria.
14. Scenario #2
Ashley comes home from school with a sore
throat and fever.
After a positive strep test, her pediatrician
prescribes penicillin.
15. Her parents decide it’s OK to stop.
Ashley takes her medicine for
three days.
Ashley feels fine.
Scenario #2
16. (Adapted from Levin BR, Clin Infect Dis 2001)
Incomplete Treatment
Causes Resistance
X
X
X
X
X Day 3
Symptoms improved,
treatment stopped
Day 0
Antibiotics
prescribed
Day 10
Resistant
infection
Meanwhile, the
survivors multiply.
17. Resistant Infections
Require Special Treatment
Longer
treatment
Higher
dosage
More
expensive
medication
Intravenous (IV)
medication,
hospitalization
18. 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).
19. 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
(Clin Pediatr.
1998;37:665-672)
Antibiotic Prescription
20. 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!
21. The Green Mucus Myth
Stott BMJ 1976;2:556
0 1 2 3 4 5 6 7 8 9 10 11 12 13
0%
20%
40%
60%
80%
100%
Days of illness
Patients recording yellow sputum
Antibiotics
Sugar Pill
22. • 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.
23. 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 14
0
10
20
30
40
50
60
70
day of illness
% of patients with symptom
fever
sore throat
cough
Runny nose
24. 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.
25. 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!
26. Ear Infections
Buildup 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
27. 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!
28. 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.
29. 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
30. 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
