Antibiotics and When to Use Them

30 07 2012

Summer has its share of illnesses, but for most physicians, the “illness season” begins to ramp up in the fall. Colds, sore throats and ear infections, among other illnesses, are much more common.

Patients come to the doctor’s to get better, and for many years that has meant leaving the office with a prescription for antibiotics. Many illnesses were treated unnecessarily, and as a result, antibiotic resistance has increased.

Antibiotics first came into widespread use in the 1940s and revolutionized medical care. Bacterial illnesses, such as pneumonia, strep throat, bladder infections, etc. could now be treated. Within a few years, however, bacteria resistant to penicillin were already present.

Antibiotics kill sensitive bacteria, but resistant ones can survive and multiply. Through the years, antibiotics that used to work for infections become less effective.

While antibiotics work against bacteria, they do not treat viruses. Viruses cause the majority of infections (colds, many sore throats, influenza, most coughs). In many cases, however, antibiotics are prescribed for viruses. This leads to increasing bacterial resistance.

Why are antibiotics overused? The answer is multi-fold. Parents often come to the office with an expectation that they will be given something to make their child better. Doctors want to help people.

In the early years of my practice, it was common to treat for an “early” ear infection, or sometimes, “to head off the illness.” Our knowledge of the natural history of illnesses has advanced. We used to think that if a cold produced yellow or green drainage, this was an indicator of sinus/bacterial infection. Now we know that discolored drainage is a normal part of an illness that may last 10-14 days. Some ear infections will clear up on their own. Sore throats that are not caused by strep do not need an antibiotic.

When antibiotics are needed, the most specific antibiotic is best. Some antibiotics are “broad spectrum.” They kill many bacteria, not just the ones causing the infection. Many of these are newer antibiotics, and while they might be more convenient, taste better, etc, they may be more than is needed, hastening antibiotic resistance.

The advantages of using antibiotics wisely are many. Short term, there will be fewer side effects (diarrhea, rashes, stomach ache), and long term, hopefully, when antibiotics are needed for a serious bacterial infection, they will be more effective.

So, when your doctor says, “Good news, they don’t need an antibiotic,” it really is good news.

By Dr. Katherine Vaughn

Image courtesy of AJC1





Fevers – Not Always a Cause for Alarm

26 07 2012

Few symptoms cause as much confusion and concern as fevers do. Dr. Katherine Vaughn, PKIDs’ medical director, answers questions about this worrisome symptom (check with your child’s doctor to determine what course of action is best for your child):

Why do Fevers Occur?

A fever is a resetting of the body’s thermostat to a higher temperature. This usually occurs in response to an infection, although other conditions can cause fever as well. Fever is an indicator that the immune system is working.

What is a Fever?

We all tend to think of 98.6 as a “normal” temperature, and anything above as a fever. In fact, temperature varies from person to person, and will also fluctuate by about a degree in any given person over the course of a day. We typically run about a degree lower in the morning compared to the evening. A temperature of over 100.4 is considered a fever.

How should a Temperature Be Taken?

Rectal temperature is considered the “gold standard”, and it’s most important to obtain in this way in an infant under 3 months of age. An axillary or ear (tympanic) temperature can be obtained in older infants and children. Forehead and pacifier thermometers are not as reliable a measure of temperature.

When Do I Worry About a Fever?

Always notify your doctor if an infant 3 months of age or younger has a rectal temp of over 100.4. The fever itself isn’t harmful, but babies this age can be quite ill without showing other signs, and will likely need to be seen.

For children over 3 months of age, it’s less likely they will be seriously ill and not have other signs and symptoms. A child’s behavior and activity level are more important clues to the severity of illness. A 6 month old who is playing and happy with a temperature of 103 would be less concerning than a 9 month old with a 101 temp who is listless and lethargic. A fever has to be quite high (generally felt to be greater than 106) for the fever itself to be harmful.

Other symptoms, such as rash, trouble breathing, lethargy, or other indications of a sick-looking child should prompt a call to your physician or visit to the ER. Fevers over 104 degrees, or any fever lasting more than 3 days should prompt a call to your physician to help assess for the need for a visit.

When Should a Fever Be Treated?

The main reason to treat a fever is for comfort. A happy child with a fever does not have to be treated. However, as temperatures rise over 101, many children become uncomfortable, with headache, body aches, increased heart rate, etc.

Treatment can be with acetominophen or ibuprofen at the appropriate doses. Never give your child aspirin for fever. It has been linked to a condition called Reyes’ syndrome.

Lukewarm sponge baths can also be used, as well as offering plenty of fluids. Don’t worry if your child doesn’t want to eat much for a few days, as long as they’re drinking.

Avoid alcohol sponging (it will raise the temperature) or cold water baths (increases discomfort).

Fever Myths

  1. “The temperature came down a few degrees and my child feels better, but the temperature still isn’t normal. My child must be really sick.” A child’s response to acetominophen or ibuprofen (in terms of degrees a fever decreases) is not an indicator of severity of illness. We don’t expect the temperature to come down to normal. Remember, treating the fever is done mainly for the child’s comfort, but it doesn’t make the illness get better any sooner.
  2. “Fever can cause brain damage.” A temperature probably has to be over 106 to cause problems like this, and in a normally healthy person, that doesn’t happen.
  3. “What about febrile (fever) seizures? They can occur at temperatures less than 106.” True. Febrile seizures are frightening. They occur in 3-4 percent of children, usually between 6 months and 5 years of age. They are typically brief and don’t cause any lasting problems. Always notify your child’s doctor if they have a febrile seizure.

Take Home Message

Fevers are rarely harmful. In a child under 3 months of age, call your doctor for any temperature over 100.4 . In older children, you can feel more comfortable evaluating the child, giving medicine to bring the fever down if they are uncomfortable, and calling the doctor if you’re concerned about how they are looking or acting.





Infected Kids and Sports

23 07 2012

While soccer, softball and gymnastics are a joyful rite of passage for many young children, athletic events carry a risk for all children, given the increased chance for mishaps, accidents and blood spills.

For parents of children with viral infectious diseases, including hepatitis B, hepatitis C and HIV/AIDS, these games often present a number of stressful issues.

  • What if my child is hurt and another child is exposed to his or her blood?
  • Should I tell the coach about my child’s infectious disease if it will spur him or her to practice standard (universal) precautions?
  • What if the coach or athletic director doesn’t know or practice standard precautions?
  • Should I attend every game in case there is an accident?
  • Should my child even be playing this sport?

The American Academy of Pediatrics tackled this difficult issue in December, 1999, with a policy statement on HIV and Other BloodBorne Viral Pathogens in the Athletic Setting. (This policy was reaffirmed in 2008.) In it, the Academy made clear, “Because of the low probability of transmission of their infection to other athletes, athletes infected with HIV, hepatitis B or hepatitis C should be allowed to participate in all sports.”

That participation, however, assumes all athletes and coaches will follow standard precautions to prevent and minimize exposure to bloodborne viruses.

The Academy tackled each infectious disease individually.

HIV/AIDS: The risk of HIV infection through skin or mucous membrane exposure to infected blood or other infectious bodily fluids during sports events is very low. The Academy found the risk from damaged skin or mucous membrane exposure was one in 1,007 exposures or 0.1 percent.

Hepatitis B: While hepatitis B is more easily transmitted through exposure to infected blood than HIV, the Academy found only two documented sports transmission. A high school sumo wrestler with chronic hepatitis B was found to have transmitted the infection to a team member. Wrestling is the only sport that raised concern because herpes, impetigo and measles have been transmitted through skin-to-skin contact. However, there is no risk of bloodborne pathogens being contracted through wrestling, the Academy found.

An outbreak of hepatitis B occurred within an outdoor orienteering team in Sweden. Doctors believe the team members used a common cup of warm water to clean wounds caused by branches and thorns.

Hepatitis C: The risk of transmission is greater than for HIV but less than with hepatitis B. The Academy reported no documented cases of transmission in sports.

“There is clearly no basis for excluding any student from sports if they are infected,” said Dr. Steven J. Anderson, who was chair of the Academy’s Committee on Sports Medicine and Fitness when it drafted the Academy’s policy, “and we should also try to protect the confidentiality of each athlete.”

Dr. Anderson, a pediatrics professor at the University of Washington and a team doctor for many high school athletic teams, ballet companies and the U.S. Olympic Diving Team, suggests children should have access to any sport, except boxing, which the Academy opposes for all youths because of its physical risks.

Pediatricians can avoid reporting a student’s infection, the Academy noted, by making it clear on any participation forms that they support the Academy’s position that all students can participate in all sports and that pediatricians must respect an athlete’s right to confidentiality.

“I personally feel parents have no obligation to disclose the infectious status of their children to anyone,” said Dr. Anderson, “that includes their own physicians! While that may seem wrong, it is felt that if standard precautions are used for blood contact or contamination, the risk of contagion is adequately reduced.”

But strict compliance with standard precautions is critical for this open-embrace of all athletes, regardless of their infectious status. “As a parent, I would make sure that there is a plan in place to handle blood spills,” said Dr. Anderson, “including latex gloves, occlusive dressings, appropriate sterilizing solutions, disposal bags and event a printed protocol for coaches, athletes and officials.

“If standard precautions are not followed, I would recommend that the coaches or instructors are queried as to their familiarity with the precautions,” he added. “If they are not familiar with or following procedures, a higher up source needs to be consulted, such as a league office or school administrator.”

Parents should also contact the school or athletic league’s physician so he or she can also act as an advocate to ensure the coaches comply with the department or organization’s safety procedures.

But the Academy’s policy may not lessen the stress some parents feel when their very young children approach a soccer field for the first time. “When children are young, parents should educate their children about the dangers of blood contact,” said Dr. Anderson. “Despite the trauma that can accompany free play, I don’t hear of too many cases where two or more bleeding children mix their blood. I would also hope that an adult would be present when children are playing and would be consulted if there were an injury.”

Dr. Anderson feels it is not necessary to disclose a child’s infectious status to a coach. “Given the low risk of infecting other children, and the high risk of being shunned or ostracized. However, I think a responsible parent would be adamant about standard precautions being in place and followed. I supposed an astute coach might make inferences if a particular parent was a zealot about blood contamination. I would read that as a message that their child was infected and that they wanted their child to participate without creating a risk for others.”

Even when a child has an HIV infection, disclosure is not a requirement, explained Dr. Anderson, stating his personal opinion. “However, if a coach is educated about the risks, the necessary precautions and can be trusted to maintain confidentiality, disclosure may be appropriate. Unfortunately, most youth sports coaches are parent volunteers, non-professionals and are unlikely to have a long-term relationship with the athlete. In such cases, I recommend that standard precautions be followed.”

Dr. Anderson contends active contact sports, such as football, are also not off limits to athletes with infectious viral hepatitis. “However, students with infectious hepatitis A (spread through close physical contact with contaminated food, water or skin) or with liver or spleen enlargement should be restricted from contact or collision sports until the liver or spleen has returned to normal size,” he added, “and the person is no longer contagious.”

One mother whose son has hepatitis B commented, “I used to worry about my son infecting other children, but eventually I decided to make sports decisions based on what my kids risked catching from others.”

This post originates from PKIDs’ website.

Image courtesy of Rugby Pioneers





Whooping Cough Can Happen to You or Your Baby

19 07 2012

Whooping cough comes in waves. It’s not a problem every year, but we’re riding a wave right now.

We were on a telebriefing this morning with Dr. Anne Schuchat, director, National Center for Immunization and Respiratory Diseases (CDC), and Mary Selecky, secretary, Washington State Department of Health.

They reported that Washington state is a reflection of the national picture of this difficult-to-control disease.

Washington is in the midst of an epidemic, with 3,000 cases so far this year and nine infant deaths. Pertussis (whooping cough) is most dangerous for babies, and more than half who become infected are hospitalized.

In the nation, nearly 18,000 cases have been reported to date, with many states seeing higher numbers of infected than normal.

In 2010, there were 27,000 reported cases and 27 deaths, 25 of those who died were infants.

There has been a gradual and sustained increase of reported cases in the US, and the CDC is in the field trying to determine why that is.

Potential causes of increased numbers could be:

  • childhood vaccines provide immunity for a number of years, but that immunity wanes over time
  • there has been increased reporting of disease
  • there has been an increase in diagnosis of pertussis

In this current wave of disease, the highest rates of infection are among babies younger than one. Babies depend on those around to be immunized so that adolescents and adults won’t pass on the infection to the baby, who is too young to be fully protected by immunization.

There are also higher rates of infection in 10-year-olds, because early childhood immunizations have waned. A booster called “Tdap” (tetanus, diphtheria, acellular pertussis) is recommended for children 11 to 12 years old.

One odd thing that’s going on in Washington and elsewhere is that young people ages 13 to 14 years are also experiencing higher rates of infection. A theory as to a possible cause for this is that this group of teenagers is the first to have had acellular pertussis vaccine only as babies and young children, and no whole-cell pertussis vaccine.

In 1997, the switch was made from whole-cell pertussis vaccine to acellular pertussis vaccine in the US.

It’s just a theory. How that might affect immunity, if it does, is being investigated.

Pertussis vaccine is the most effective approach to preventing infection. Unvaccinated kids have an eight times higher risk of infection compared to vaccinated kids.

Vaccinated kids who get pertussis have milder symptoms, shorter illness, and are less infectious.

In 2010, only eight percent of adults in the US had a history of the Tdap booster.

Throughout today’s telebriefing, Dr. Schuchat and Ms. Selecky emphasized the need for pregnant women and all adults and adolescents to be vaccinated to protect not only themselves, but the babies in their lives, as most babies who are infected acquire that infection from adults and teens around them.

This surge in pertussis cases isn’t just in the US. Australia’s rate of pertussis infection right now is even higher than that in the US, and Canada is struggling.

Moms and dads are losing their babies to this disease. Whooping cough is so infectious—you could be infected and pass it on to a co-worker who then takes it home to his newborn daughter.

Because pertussis is underdiagnosed, many people are infected but don’t know it.

Ask your pharmacist, your doctor, or even your employer about getting the pertussis booster shot. Please.

By Trish Parnell

Image courtesy of CDC





HIV + NTDs – the Relationship

16 07 2012

In early April, we wrote a blog post about the END7 Campaign’s work to raise awareness and donations in order to eliminate seven neglected tropical disease (NTDs) by 2020.

We are dedicated to fighting these devastating diseases because they infect more than one billion people around the world. That’s one out of every six people who is likely to suffer from blindness, malnutrition or disfigurement due to these totally preventable diseases.

But in addition to minimizing suffering from these effects, controlling NTDs is also important for success in fighting other diseases notably HIV/AIDS. In many parts of the world, there is quite a bit of geographic overlap between NTDs and HIV/AIDS. In fact, research demonstrates that there are increased odds of having HIV when an individual is co-infected with an NTD. For instance, women with female genital schistosomiasis (FGS) have a three-fold increased risk of contracting HIV/AIDS compared to those not burdened by the disease. Moreover, soil-transmitted helminths (or intestinal worms) can actually worsen the progression of HIV toward AIDS by increasing viral loads.

These high rates of co-infection mean there are a number of opportunities for the NTD and HIV/AIDS communities to join forces to coordinate and collaborate on further research and treatment programs for these diseases.

We’re hosting a workshop at AIDS 2012: XIX International AIDS Conference to begin these discussions. If you’re attending, we hope you’ll join us!

To learn more about NTDs and the links between these diseases and HIV/AIDS, visit END7 on Facebook and tell your friends and family to do the same.

Heena Patel
Communications Department
Sabin Vaccine Institute 
hpatel@sabin.org

Image courtesy of Esther Havens





The Weeder, the Girl, and the Vaccine

12 07 2012

When we were but moppets, Dad paid a nickel for every weed my brothers and I and the neighborhood kids pulled out of our yard on Saturday mornings.

He’d appoint my oldest brother to be in charge, and then he would disappear into the house to watch a game.

One hot day, my best friend stepped on the pointy end of her hand weeder and a spike punctured her foot. I remember lots of yelling and blood and my dad suddenly being there in the yard, picking up Lori, and running with her into the house.

Mostly, though, I remember how afraid we all were that Lori would get tetanus. Well, we called it lockjaw, because most of us were under 10 years of age and didn’t know the word “tetanus.”

Tetanus goes way back in recorded history, all the way to the fifth century BCE, but it wasn’t until the late 1800s that the cause of tetanus was discovered.

By WWII, a tetanus toxoid was available and widely used to prevent tetanus. This toxoid was combined with a pertussis vaccine and a diphtheria toxoid in the mid-1940s to make up the DTP vaccine. Many years and versions later, we have several combination vaccines for use in preventing tetanus.

Tetanus disease happens when certain bacteria usually found in dirt or dust get into a cut on the skin and, once in the body, produce a toxin. It’s the toxin that causes the symptoms we associate with tetanus, including:

  • Headache
  • Tightening or spasms of the jaw
  • Muscle spasms
  • Fever
  • Difficulty swallowing

It can get serious, with spasms strong enough to break a child’s bones, and the fatality rate is high—10 to 20 percent.

Tetanus isn’t something that passes from person to person, and it can be prevented through regular vaccination. Which vaccine you get and when you get it depends on your age and immunization history.

Anyway, that was a thrilling day in our childhood. Lori hobbled around the rest of the summer, free of tetanus but banned from the creek and other of our favorite haunts.

Mom no longer allowed Dad to leave the wee weeders under the care of my brother. Instead, he sat in a lawn chair on our tiny porch and listened to the game on the radio while scanning the yard for potential hazards.

The upside to this was that Dad would overheat from the sun bouncing off that concrete porch, and he’d take us for ice cream after the weed-pulling was done.

To read more about tetanus, visit these links:

http://www.cdc.gov/Features/Tetanus/

http://www.cdc.gov/vaccines/vpd-vac/tetanus/fs-parents.html

http://www.chmkids.org/upload/docs/imed/TETANUS.pdf

http://www.sapj.co.za/index.php/SAPJ/article/view/911/835

http://www.immune.org.nz/diseases/tetanus

http://www.immunize.org/catg.d/p4220.pdf

http://www.immunizationinfo.org/vaccines/tetanus

By Trish Parnell

Image courtesy of Garden Guides





London!

9 07 2012

Are you going to London for the OlympicsI lived in Calgary when the Games were held there. It’s chaos and fun and nothing like you’d expect, if you’ve never been.

You’ll meet people and germs from scores of countries—about 11 million people, to be specific, and each one teeming with his or her own microbes. Olympics health director Brian McCloskey says they’re ready to go and will be on the lookout primarily for GI bugs “and infectious diseases such as measles.”

Want to bring home souvenirs that won’t make you sick? Use this CDC piece as a checklist on staying healthy in London during the Olympics:

Be Up-to-Date on Your Jabs

Some illnesses that are very rare in the United States, such as measles, may be common in other countries. Make sure that you and any children traveling with you have had all shots. Even if you had all routine vaccines as a child, ask your doctor if you need a tetanus/diphtheria/pertussis booster.

Watch Out for that Lorry!

In the United States, you’re taught to look left, look right, and look left again before you cross the road. In England, however, they drive on the left side of the road. That means you should always look right, look left, and look right again to avoid stepping into the path of traffic driving on the left.

Get Thee to an A&E

If you get hit by a lorry, don’t call 911, call 999, and don’t ask to be taken to the ER, ask for the A&E (Accident and Emergency). Only call 999 in the event of a serious illness or injury. For cuts and scrapes, muscle strains, or minor illnesses, visit a pharmacy or walk-in center (no appointment needed). To find a pharmacy or walk-in center, visit www.nhs.uk/London2012  or call 0845-4647.

Note that the health insurance that covers you in the United States probably won’t cover you while you’re overseas, so you may have to pay out-of-pocket for any care you receive in London. Consider purchasing travel health insurance that will reimburse you for any costs you incur.

Go on Holiday (But Not from Healthy Habits)

Have a great time in London, and make sure you take your healthy habits with you:

  • Always wear a seatbelt.
  • Wash hands frequently, or use hand sanitizer.
  • Cough and sneeze into a tissue or your sleeve (not your hand).
  • When outdoors during the day, wear sunscreen, stay hydrated, and seek shade if you get too hot.
  • When indoors or at large events, know where emergency exits are.
  • If you drink alcohol, do so in moderation.
  • Use latex condoms, if you have sex.

Speak Like a Native

Some terms, including health-related terms, differ between British English and American English. Be familiar with these to avoid confusion if you need medical care.

British English/American English

  • A&E (Accident and Emergency)/ER (Emergency Room), ED (Emergency Department)
  • Chemist/Pharmacist
  • Consultant/Attending Physician
  • Giddy/Dizzy, Unbalanced
  • Gip (“My back is giving me gip.”)/Aches, Pains (“My back hurts.”)
  • Holiday/Vacation
  • Jabs/Shots, Vaccinations
  • Lorry/Truck
  • Loo/Restroom
  • Paracetamol/Acetaminophen
  • Plaster, Elastoplast/Elastic Bandage, Band-Aid
  • Surgery/Doctor’s Office
  • Surgical Spirit/Rubbing Alcohol

More Information

Thanks to CDC for excellent info, as always.

Image courtesy of Flickr user kh1234567890