PEDIATRIC NEWS UPDATE
Updates from December 2001
ANTIBIOTICS MAY NOT BE NEEDED FOR SOME EAR INFECTIONS
A recent study at Children's Hospital Los Angeles questioned the
need to treat uncomplicated ear infections with antibiotics.
Doctors reviewed 74 research trials done between 1966 and 1999.
After re-examining all the data, they concluded that 78% of children
in the studies would have experienced resolution of their ear
infections within 4 to 7 days if not treated with antibiotics.
It is common practice in the Netherlands and some other European
countries to not treat ear infections with antibiotics unless
symptoms persists or worsen after 24 to 48 hours. The study also
pointed out the risks of side effects from antibiotics such as
allergic reactions and diarrhea. Avoiding overuse of antibiotics
will also slow down the growing problem of resistant bacteria.
It has always been my general practice to prescribe antibiotics for
moderate to severe ear infections when the child is experiencing
significant ear pain, fever, and is looking fairly ill. For mild
ear infections, I generally like to delay starting antibiotics
unless the child's symptoms worsen or persist. I also usually do
not use antibiotics when the ear looks bad, but the child is acting
fine. This thorough review of the research goes even one step further
- it gives legitimacy to the "wait and see" approach for even moderate
and initially severe ear infections, and avoids antibiotic side
effects and bacterial resistance. Many children will improve
eventually without antibiotics. The key word here is eventually.
Antibiotics will often shorten the duration of infection, and
therefore eliminate the pain and fever. However, since the eventual
outcome appears to be the same with or without antibiotics, parents
can choose to support their kids with anesthetic ear drops
(Auralgan - by prescription) and pain relievers like acetaminophen
or ibuprofen until the infection subsides on its own. If symptoms
worsen and become unbearable in the meantime, then start the antibiotic.
No harm done (except for an unhappy child for a few days). So
when you take your child to urgent care or the ER for fever and fussiness,
and the doctor says "oh, the ear looks a little red, we better
treat it" (I can't tell you how many "red ears" are over-treated),
you can delay the antibiotic and see how your child does over the
next few days.
One last note - numerous research studies have shown that using
antibiotics does decrease the occurrence of complications such as
ear drum rupture (not rare), meningitis (extremely rare), and
mastoiditis (very rare - the infection spreads into the bone
surrounding the ear, causing pain, redness, and swelling behind the
ear). This is why antibiotics are generally recommended when
moderate to severe symptoms persist.
STUDENTS CAN NOW WEAR HATS IN CALIFORNIA SCHOOLS
A new law was just signed by the Governor of California that allows
students to wear hats at school. The law goes into effect January
1, 2002. Previous dress codes in many school districts did not
allow students to wear hats. The bill was initiated by a mother
whose 22-year old boy died of malignant melanoma. Schools may
still prohibit hats that appear inappropriate or gang related.
It's about time. Every preschool checkup and older that I do, I
remind parents about the importance of sun protection. I tell them
to make sure their child has a hat on whenever he or she goes
outside. This includes playground time at school. Many parents
have told me that their school does not allow hats. Well now, in
California anyway, kids are allowed to protect themselves from the
cancer-causing ultraviolet rays from the sun. Hopefully other
states will follow suit.
Get your kids used to wearing hats at an early age. I started
this with my kids, and now, years later, you won't find one of my
kids outside without a hat on.
ONE-DOSE ZITHROMAX IS ON THE WAY
Everyone is familiar with this "once-a-day for only five days"
antibiotic. Well, how does only one dose sound? The FDA has
approved two new ways to give this medication - 1. one large dose
on the first day only, and 2. once a day for 3 days (instead of the
current once a day for five days. How does this antibiotic work
with just one dose? Most antibiotics are broken down and
eliminated by the liver and kidneys within 6 to 12 hours. That is
why many doses are needed. Well, Zithromax is NOT broken down
quickly. It stays around in the blood stream and body tissues for
days. That is why only one dose will continue to work for 7 to 10
days. The FDA advisory panel has approved the new dosing. There
is, however, one bit of controversy in the FDA that not all panel
members agreed on. The blood levels of the one-time dose were NOT
yet studied in children under age two years. Therefore, 4 out of 10
panel members did not agree with the approval of this dose for children
under two. The 3-day course was studied, and 7 out of the 10 members
did approve this dose. The FDA final review board, however, has
approved both doses now.
If you thought once-a-day for five days was convenient, wail until
you get your hands on this once-a-day for three days, or even
better, the one dose, one time only form. Many parents have begged
me for Zithromax. "It is so hard to give my baby the pink stuff 2
or 3 times a day. He spits it out all over. Can't I
pllllleeeeeaaaaassssseeee have that once-a-day stuff?" Now this
popular antibiotic will be even more convenient and tempting.
Here is the problem. Zithromax is NOT a first-line antibiotic for
ear, sinus, throat and most lung infections. It is only supposed
to be used when other (less convenient) antibiotics fail, or when
someone is allergic to the penicillin class of antibiotics. Now
even more people will be wanting to use this drug as a first-line
antibiotic. Because of the overuse of Zithromax, some bacteria are
already resistant to it. This resistance will only increase the
more Zithromax is over-used. So if your doctor prescribes "the pink
stuff", be responsible and do not ask for an upgrade unless there
is a legitimate medical reason.
NEW AAP GUIDELINES FOR NOT TREATING SINUS INFECTIONS
The American Academy of Pediatrics has released new guidelines for
treating sinus infections with antibiotics. Research has shown
that 50% of sinus infections will resolved without antibiotic treatment.
The AAP is urging doctors to educate patients of this issue.
I can't tell you how many times I have tried to explain to a parent
that a green nose, cough and fever for a few days does NOT need
antibiotics. Decades ago, we thought that anything "green" oozing
out from anywhere meant there must be a bacterial infection. We
now know this is not true. New research has now shown that even
when there IS a bacterial sinus infection present, half the time
it will resolve without antibiotics. I urge parents to do the
following to help mild sinus infections resolve without antibiotics:
- Hose the nose - have older children gently blow
their nose repeatedly throughout the day. For infants and younger
children, spray nasal saline into the nose, then suck out the mucus
with a bulb syringe. Steam treatments (in the bathroom with the
hot shower on, or with a steam vaporizer) can also help.
- Decongestants - if the nasal congestion or sinus
pressure is bothersome, use a nasal decongestant. What brand is
best? They are all exactly the same. There is only ONE
over-the-counter decongestant ingredient that is used in all of
them - pseudoephedrine.
- Eucalyptus or lavender oils - put these into a facial
steamer or vaporizer. They can help.
Following this regimen religiously can help you or your child get
over a sinus infection without antibiotics. You SHOULD be seen by
your doctor if the symptoms are severe or prolonged.
Click here
for our complete guide to treating coughs, colds, and sinus infections.
STUDY SHOWS ANTIBIOTIC USE DOWN 25% IN 1990s
A recent survey by the CDC shows that the rate at which doctors are
prescribing antibiotics has fallen by 25% over the past 10 years.
The rate fell from 166 prescriptions per 1000 patient visits to 127
prescriptions per 1000 visits. While this was the case in doctor's
offices, it was not true for urgent care clinics and emergency
rooms where the rate has stayed the same. The survey also revealed
an alarming increase in prescriptions for broad spectrum
(in other words, stronger) antibiotics like Cipro, Biaxin, and
Zithromax. In fact, prescriptions for the popular "one-a-day for
five days" Zithromax rose by 400% from 1992 to 1999. Two reasons
for the increase are convenience and the fact that these drugs are
heavily marketed to doctors and the general public.
The decrease in antibiotic use is an encouraging trend. The increase
in broad spectrum antibiotics, however, is something the public
should take very seriously.
Why is using these more convenient antibiotics so dangerous?
Every time someone takes a course of antibiotics, there is a chance
that a few of the bacteria will learn to become resistant to the
antibiotic. These bacteria multiply and "teach" what they have
learned to their offspring. The resistant bacteria get spread to
the general public. When someone gets the same antibiotic, the
infection persists, and an even stronger antibiotic is needed.
Well, there are only so many "stronger" lines of antibiotics.
This is a battle that the human race will eventually lose unless
more appropriate antibiotic use in instituted.
So the next time your doctor prescribes you or your child
"the pink stuff", don't argue unless there is a legitimate reason.
MOST KIDS WHO HAVE NOT HAD CHICKENPOX BY AGE 10 ARE IMMUNE TO THE VIRUS
A recent Canadian study of over 2000 fourth-graders showed that 92%
had had chickenpox already. Among kids without a known history of
the illness, 63% showed immunity on blood testing. One purpose of
the study was to determine the need for "catch-up" vaccinations for
older children. Based on these results, if all older children
without a history of chickenpox got the shot, two-thirds of these
shots would be given needlessly.
This is a very interesting finding. I have often recommended that
kids over age 10 who have not yet had the disease get vaccinated
(due to the fact that chickenpox is much more severe in teenagers
and adults). This study suggests that these kids instead get a
blood test to see if they picked up immunity either from a mild
unrecognized case or from exposure to the illness. I think this
approach is valid and will consider adopting this in my office.
APPLES AND SELENIUM MAY HELP PREVENT ASTHMA
A recent study in the UK revealed that people who ate at least two
apples per week had a 30% lower chance of asthma versus people who
ate less than 2 per week. In addition, people who ate more selenium
(an anti-oxidant mineral) in their diet were about half as likely
to suffer from asthma. The RDA for selenium is 55 micrograms.
The study showed that people who ate 50 to 90 micrograms were
protected most from asthma. The theory behind this is the anti-oxidants
in apples and many other fruits can help protect people from
chronic diseases. Foods rich in selenium include walnuts, Brazil
nuts, tuna, beef, enriched grains and pasta.
So an apple-a-day really may keep the doctor away. This is another
confirmation that good nutrition really is important.
FISH MAY DECREASE HEART DISEASE
Researchers in Denmark studied 270 patients with heart disease
(narrowing of the arteries). They tested blood levels of CRP
(a protein that indicates inflammation in the bloodstream) and DHA
(an omega-3 healthy fat found in fish). They found that people
with the narrowest arteries had the highest CRP levels. Previous
studies have also correlated high CRP levels with high risk of
heart attacks. The study also found that people with the lowest
CRP levels also had higher levels of DHA. It is thought that DHA
and other healthy omega-3 fats may protect against inflammation in
the blood stream, which is thought to be one cause of the build-up
of plague inside the arteries.
I have been promoting the benefits of DHA for several years now.
It is nice to see another benefit confirmed by research. Click
here for
a full discussion on how to get enough of it in your diet.
NEW GUIDELINES FOR PREGNANT WOMEN AND FLYING
ACOG (the American College of Obstetrics and Gynecology) released
new guidelines that state it is safe for women to fly up to 36 weeks
for uncomplicated pregnancies. Complications that may prohibit
women from flying this late in pregnancy include those with risk of
preterm labor, poorly controlled diabetes, and placental abnormalities.
NUMBER OF OVERWEIGHT U.S. KIDS INCREASING
The number of obese children age 4 to 12 has increased by 120% in
Hispanics and African-Americans and by 50% in Caucasians in a study
from 1986 to 1998. This correlates with an increase in obesity
among adults by 50%.
This trend poses a serious national health risk by creating more
diabetes, heart disease and other health problems when this young
generation grows up. Good nutrition and an active lifestyle are
important. It is easier to say this than it is to actually do it
however. Click here
to read about my L.E.A.N. program and how it can dramatically
benefit you and your family's health.
ACTIVATED CHARCOAL EFFECTIVE HOME TREATMENT FOR POISONING
Activated charcoal has been used for many years in emergency rooms
to treat poisoning or accidental overdose patients. It works by
soaking up poisons and medications in the stomach before they can
be absorbed into the bloodstream. If given in time (usually within
one hour of poison ingestion), it is extremely effective. The
problem is that many victims don't reach the ER in time for this to
work. Also, it has always been thought to be too messy and too
difficult to give at home.
This study followed 138 children who ingested poison and were
advised to give activated charcoal at home. 83% of the children
did receive the treatment at home, within 40 minutes of poisoning
on average. The 17% of children who were NOT given charcoal at
home received charcoal in the ER on average of 75 minutes after
poisoning. None of the 115 families who administered the treatment
at home reported any major difficulties in doing so.
I too have always thought giving charcoal at home would be way too
messy (after seeing the black stuff smeared all over an ER room
during my training). However, giving this treatment at home has
become more popular recently, and it does prevent much of the
poison from being absorbed if given at home versus in the ER.
It is an alternative to syrup of Ipecac, which has long been used
to induce vomiting after someone ingests poison. I will start
recommending activated charcoal to my patients. You can buy it in
any drugstore. You should only give this remedy if advised to by
your doctor or a poison control center counselor.
