Principles of antibiotic prescribing
Antibiotics should be used only for infections caused by bacteria. In the hospital in severe and life-threatening infectious diseases (e.g. meningitis - inflammation of the membranes of the brain, pneumonia - inflammation of the lungs and other) responsible for the correctness of the choice of medication rests with the physician, which is based on observation of the patient (clinical picture) and on the results of special studies.
When lung infections occurring in the home (outpatient) conditions, the situation is fundamentally different. The physician examines the child and assigns medications, and this is sometimes accompanied by explanations and answers to questions, sometimes not. Often parents ask the doctor to prescribe an antibiotic. In such situations, the pediatrician sometimes psychologically easier to write a prescription than to risk its reputation and to spend time explaining the inappropriateness of such assignment.
In any case, the physician should follow two basic principles of antimicrobial therapy:
- fast assignment of the most effective drugs in cases when their effect is proven;
- minimize the use of antibiotics in all other cases;
Reliable external signs or simple and cheap laboratory methods, allowing to distinguish between viral and bacterial nature of respiratory tract infections, unfortunately, no. At the same time, it is known that acute rhinitis (runny nose) and acute bronchitis (inflammation of the mucous membrane of the bronchi) is almost always caused by viruses, and tonsillitis (inflammation of the tonsils and pharynx), acute otitis media (ear infection) and sinusitis (inflammation of the mucous membrane of the sinuses) in many cases bacteria.
It is natural to assume that the approaches to antibacterial therapy of some acute infections of the upper respiratory tract should be slightly different.
Rhinitis and bronchitis
In acute rhinitis (runny nose) and bronchitis antibiotics are not shown. In practice it happens: one or two days of high temperature and cough, the child's parents, as a rule, do not give the baby antibiotics. But then they begin to fear that bronchitis complicated by pneumonia, and decide to use antibiotics. Here it should be noted that this complication may, but it practically does not depend on previous antibiotics. The main signs of developing pneumonia is the deterioration (further increased body temperature, increased cough, shortness of breath). In this case, you need to immediately call the doctor who will decide whether it is necessary to adjust the treatment.
If the condition is not getting worse, but did not significantly improve, the apparent reasons for the use of antibiotics not. However, during this period, some parents do not stand up and start giving drugs to children "just in case".
It should be noted that a very popular criterion is the use of antibiotics in viral infections - saving high temperature for 3 days - absolutely unsubstantiated. The natural duration of febrile period in viral respiratory tract infections in children varies considerably may vary from 3 to 7 days, sometimes longer. The longer the preserve of the so-called low-grade temperature (37, 0-37, 50C) is not necessarily associated with the development of bacterial complications, and may be due to entirely different reasons. In such situations, the use of antibiotics is doomed to failure.
A typical symptom of viral infection is persistent cough in the background to improve the General condition and the normalization of body temperature. It must be remembered that antibiotics are not antitussive agents. Parents in this situation there are opportunities to use national antitussive funds. Coughing is a natural protective mechanism, and disappears the last of all symptoms. However, if your child has an intense cough lasts for 3-4 weeks or more, it is necessary to search for its cause.
Otitis
In acute otitis media tactics antibiotic therapy is different, because the probability of a bacterial nature of this disease reaches 40-60%. Given that, until recently, antibiotics were prescribed to all cases.
As practice shows, for acute otitis media characterized by intense pain in the first 24-48 hours, then most of the children's condition significantly improved and the disease resolves on its own. After 48 hours the symptoms persist for only a third of young patients. There are some interesting calculations showing that if antibiotics be given to all children with acute otitis media, with a little help (short febrile period and duration of pain), they can provide only those patients whose't there supposed to be independent a quick recovery. This can be only 1 child in 20.
What will happen with the other 19 children? When the reception of modern drugs group of penicillins, such as amoxicillin or Augmentin, nothing really bad is going to happen. 2-3 children may develop diarrhea or skin rashes appear, which will quickly disappear after drug withdrawal, but the recovery will not accelerate. As in the case of bronchitis, the appointment of antibiotics in otitis media does not prevent the development of septic complications. The complicated forms of otitis media with the same frequency are developed as children receiving and not receiving antibiotics.
By now developed a new tactic is the use of antibiotics in acute otitis media. Antibacterial drugs should be given to all children under the age of 6 months even with a questionable diagnosis of acute otitis media (see that little baby it hurts the ear, not so easy).
At the age of 6 months to 2 years with doubtful diagnosis (or slightly over) acute otitis media antibiotics can be set aside only by the observation of the child - the so-called wait-and-see tactics. Naturally, during observation, the children should be given pain medication and, if necessary, fever. If in the next 24-48 hours, his condition does not improve, then you need to start antibiotic therapy.
Of course, in this case, the parents meet the increased requirements. First of all, you need to discuss with your doctor when to give antibiotics, and to clarify which symptoms should be addressed. Most importantly, be able to objectively assess the dynamics of pain, its increase or decrease, and to notice the appearance of new symptoms - cough, rashes and other parents should be able to contact the doctor on the phone, and to have the prescription for an antibiotic.
In children older than 2 years of waiting and observation for 48 hours is the most preferred tactics, except the heavy flow (temperature above C, intense pain) disease.
Pneumonia
When the diagnosis of pneumonia or serious suspicions on this pathology tactics antibiotic therapy differs from the previous two cases.
For individual age groups of children are characterized by several features of the predominant pathogens. So, at the age of 5-6 years, according to some researchers, up to 50% of cases of pneumonia can be caused by viruses. In older age the likelihood of viral pneumonia is significantly reduced and the role of bacteria (pneumococci) in the development of pneumonia. However, in all age groups frequent causative agent of this disease is Streptococcus pneumoniae, which causes severe course of the disease. That is why pneumonia is an absolute indication for antibiotic therapy.
Source:
MedPortal.ru
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