Antibiotics and When to Use Them

Hey, my name is Rod Stein I’m a pediatrician
with Westchester Health in Yorktown Heights, NY and i’m just going to talk to you a little
bit about antibiotics. Most people know what antibiotics are and most people know when
you need them but this is just to clarify and I think the most important thing to get
out of this talk is that antibiotics are good for bacterial infections. They don’t work
for viral infections so part of the thing we try to do as doctors is determine which
is a bacterial infection and which is a viral infection and what things antibiotics will
help and what things they won’t. So, I figure let’s start at the top why you might go to
the doctors. So, the first thing you might go to the doctor for would be an upper respiratory
infection. So, and upper respiratory tract infection is a viral infection that comes
with runny nose, cough, maybe fever, and it is almost 100% of the time viral and an antibiotic
won’t help. The exception would be sinusitis. So how do you know you have sinusitis versus
just a regular old upper respiratory tract infection. The difference is duration. The
Academy of Pediatrics says that a sinusitis is defined as an upper respiratory infection
that is lasting for 7-10 days and getting worse, or 10-14 days and not showing any signs
of improvement. That is all you need to know about a sinusitis. You don’t need to get a
CAT scan or an x-ray or an MRI you don’t need a tube stuck up your nose, you just need to
know how long it’s going on for and the symptoms that you have. So moving down, you might wind
up at the doctor with ear pain. So ear infections. Ear infections generally occur 2-3 days into
a cold. The cold blocks up your plumbing, a bacteria comes along, and you get an ear
infection. The caveats of that is that studies, good studies, have shown that 80 to 90 percent
of ear infections will go away on their own without an antibiotic, so what we generally
do is if we see a child who has ear pain and it’s been under 24 hours , we watch, we wait,
you’d take motrin or tylenol and if the pain is persisting for 24-48 hours, we give an
antibiotic. Otherwise it’s just going to go away, which brings us now down to the throat.
Tonsillitis. Tonsillitis is a descriptive word. It means inflammation of your tonsils
and that’s it, it doesn’t tell you the cause. The only bacterial cause of tonsillitis that
we really are concerned about is strep, so if you go to the doctor and they do a strep
test and it’s strep, you need an antibiotic. Otherwise, tonsillitis is viral. It could
be adenovirus, mono, and it’s important sometimes to determine what it is, but if it’s not strep
you don’t need an antibiotic. Bronchitis, one of my favorites. Bronchitis is a cold.
There’s 2, essentially there’s 2 kinds of bronchitis. There’s acute bronchitis, which
is a cold, and then there’s chronic bronchitis. Chronic bronchitis you’ll see in people with
emphysema who are smokers , maybe they have cystic fibrosis. Those people may need an
antibiotic, but acute bronchitis is a cold, you don’t need an antibiotic for it. Pneumonia,
moving further down the respiratory tract. Pneumonia you would need an antibiotic and
a lot of times pneumonia is viral it’s just that we can’t make the determination based
on what we hear or even what you see in an x-ray sometimes and so we wind up treating
everybody with an antibiotic. Some of those people might get better without it but again,
we can’t tell, so we treat. There are a few things you would almost never need an antibiotic
for. One of them is swimmer’s ear. Swimmer’s ear occurs when you get water in your ear
canal, a bacteria comes along, takes hold, and you get an infection it can be terribly
painful but ear drops work better than oral antibiotics. Another thing I can think of
that you would almost never need an antibiotic for would be diarrhea, a stomach virus. Best
to figure out the cause rather than taking an antibiotic, because sometimes you could
take an antibiotic when you have diarrhea and you could make yourself worse and cause
complications. So, that’s about it those would be the conditions you would need an antibiotic
for. Thank you for listening, and call if you have any questions.

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