Nov 13, 2017

Dr. Gellner: Right now, there is a big concern in the medical community about antibiotic overuse. I'll discuss this as well as potential consequences on today's Scope. I'm Dr. Cindy Gellner.

Announcer: Keep your kids healthy and happy. You are now entering the Healthy Kid Zone with Dr. Cindy Gellner on The Scope.

Dr. Gellner: While antibiotics absolutely have their place, and they've helped transform modern medicine, saving lives and preventing the spread of disease, health officials have been warning that the overuse of antibiotics is helping to breed resistant bacteria. Right now, much of the attention on antibiotic overuse is targeted on doctors who inappropriately prescribe antibiotics for viral illnesses. Overuse and misuse of antibiotics are now creating super bugs. Those are bacteria that used to be able to be killed by certain antibiotics, but now that drug has no effect on them anymore. They are resistant to that antibiotic.

The biggest contributor to antibiotic resistance is when doctors prescribe them for viruses. For example, say your child has a sore throat, but the strep test is negative. If the doctor says, "I'm pretty sure this is still strep," and starts amoxicillin, but then the throat culture comes back negative for strep as well, confirming your child's symptoms were caused by a virus, not bacteria, your child just took an antibiotic for an inappropriate reason. The antibiotic your child is taking is still killing bacteria in their body, even the good bacteria, and that can lead to other problems, like C. difficile diarrhea, which no one wants.

In kids and adults, most coughs, sore throats, sinus issues, and diarrhea, they're mainly caused by viruses. There have even been guidelines set out for when ear infections really need to be treated, because fluid in the ear may not truly need to be treated by an antibiotic and will resolve on its own. Now, again, true ear infections, true bacterial sinus infections, strep throat, lobar pneumonia, these are absolutely appropriate times when a child would need an antibiotic.

Studies done by the University of Utah show that 50% of antibiotic prescriptions for acute respiratory conditions may have been unnecessary. In just 2016, a surprising 30% of outpatient oral antibiotic prescriptions may have been inappropriate. For example, 1 in every 5.4 urgent visits, which is 18.5%, resulted in an antibiotic prescription. Of these, 75% of the antibiotics prescribed during those were for acute respiratory infections, including 5% for sinusitis, 26% for sore throats, 37% for ear infections, and 6% for simple colds, again viruses. Some of those were appropriate, some of those were not.

When antibiotics first came out, they were viewed as wonder drugs. It was great that they worked quickly with relatively few side effects. Now, however, doctors may still prescribe antibiotics before test results come in to identify an actual cause of infection, which means they may have to even change to a different antibiotic after they know what's really going on. I've had many parents ask me for antibiotics when their children are sick because they want their child to get better faster, regardless of whether the illness is caused by a virus or not.

One of the biggest overuse causes is that patients feel better after taking five days of an antibiotic, so they stop taking the antibiotic, put it on a shelf, and then when they're sick again, they will take those antibiotics that were left over from the previous prescription even when the new illness they have may not be bacterial. So why is this such a big deal?

Well, for many years, scientists were able to develop new antibiotics faster than the bacteria were able to become resistant, and now that's flipped. In 2013, a CDC report noted that at least two million people every year develop a serious bacterial infections, and the bacteria is resistant to antibiotics initially diagnosed to treat those infections. At least 23,000 people die annually from antibiotic resistant infections. This is a big deal, especially for kids whose immune systems are still developing and need appropriate and effective antibiotics.

So next time your child's doctor doesn't give you an antibiotic when you think your child needs one, there may be a reason why. I know I'm more than happy to discuss my reasons when I think an antibiotic is needed and not needed with all of my parents. And as parents, you should feel comfortable asking your child's pediatrician their thought process as well. Staying well informed, whether discussing antibiotics or anything else with your child's pediatrician, is one of the best ways you can help keep your child healthy.

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