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Ask a Doc Bad Medicine

September 22, 2016

Submitted by Michael R. Jordan, MD, MS-HQSM, FAAP, Chief of Pediatrics Newark-Wayne Community Hospital

Michael R. Jordan, MD, MS-HQSM, CPE, FAAP

Too much of anything can be bad, including healthcare.

All new medical students are taught the ancient Latin adage, “primum non nocere” translated as; “first, do no harm” and meaning that in practice, it is sometimes better to do nothing than to do something and risk more harm. Based on some new knowledge about a child’s immune development, taking an antibiotic for a viral illness is bad medicine and in fact, it does more harm than we first thought. Still, patients sometimes equate leaving the medical office without a prescription as a wasted visit, but when the illness is a community acquired viral infection - and most illnesses are just that - a prescription for antibiotics can leave you and your “community” in worse shape than before.

So here are three reasons you should think twice about running out to the doctor or the urgent care center to quickly get your coughing child on an antibiotic.

  1. We know that a vast majority of childhood illnesses with symptoms of aches or fever, cough or congestion, in a normal child are caused by viruses. These viral illnesses are the expected result of having older siblings or attending day care. These colds are self-limited and do not require any medication. Antibiotics have no influence whatsoever on a virus, they only have an effect on the multiplication of bacteria cells. Most viral illness symptoms will last about seven days. If you take an antibiotic, your child’s symptoms will last about week. Thus, antibiotic treatment for a viral illness, without a secondary bacterial infection, is a total waste of money, time and only adds to our enormous financial burden of inefficient health care expenses. The viruses I know actually think it’s hilarious.

  2. Frequent and sometimes indiscriminant but well-meaning, antibiotic prescribing has turned out to be a selective breeding program for the development of nasty super bacteria. Antibiotic modified resistant bacteria are now causing some new infections, which were rare when I attended medical school. These new maladies like MRSA, cause deep, painful pus-filled boils in children and have been bred by widespread antibiotic use. An invasive gut bacterium called C Diff leads to a bloody colitis, first seen only in hospitals, but is now turning up in ambulatory care patients and occurs mainly in those who have had multiple courses of antibiotics. The real problem with this selective breeding program is that we are running out of reserve medications for these super bugs.

  3. Antibiotics are deadly to our microbiome. This effect on both our normal bacterial flora and the intended disease-causing bacteria should add to the reasons for us to pause before prescribing. It turns out that we are not really singular individuals in the world but live in symbiosis with billions of our own personal microbes: on our skin, in our mouths, and most importantly in our guts. These microbes do not just help with digestion but actually promote immunologic development in infants and guide our immune response so that we will like them but dislike their competitors. New evidence suggests they guide some of our childhood immune response. It turns out we need a diverse, abundant healthy microbiome - especially in children - to program proteins and lymphocyte blood cells that protect us from infections but not to over react to allergens like the dust mite. In 1976, a Canadian pediatrician noted that affluent white children in Saskatoon were much more likely to acquire asthma and hives than the indigenous children who had more early childhood infections. In 1989, a British epidemiologist studied 17,000 children and found that those who had older siblings were less likely to get hay fever…and it was directly related to how many siblings they had to “gift them illness” that improve their immune system! It turns out one of the best immune gifts is breast feeding; the surprise is how it promotes our microbiome. Breast milk has special nutrients to promote unique bacteria, B. Infantis, found only in infants and only available in breast milk and that guides immune programming in newborn infants. The immune advantage of breast milk is best seen in tiny preterm breast fed babies who are much less likely to acquire a life threatening gut infection called Necrotizing Enterocolitis than preemies on formula.

Antibiotics disrupt this symbiotic immune development by altering the healthy diversity of our own community of helpful bacteria. Ed Yong, in his new book, I Contain Multitudes, has called antibiotics “shock and awe weapons…they kill the bacteria we want as well as those we don’t- an approach that’s like nuking a city to deal with the rats.” Imagine the potential effects of antibiotic treatment on the B. Infantis gut population in a breastfed infant who has come down with a new viral illness. We are now learning just how important it is to have an abundant gut microbial population. It turns out the most effective treatment for C. Diff colitis is not more antibiotics but capsules of fecal material packed full of diverse gut microbes or as Mr. Yong delights in saying, “The number one treatment for C. Diff is actually number two!”

So what’s a parent to do for their ill child?

  • Don’t push your medical provider for an antibiotic. They want you to be pleased with your care but good care is achieved by knowledge of your child, clinical experience, careful listening and a careful examination.

  • If an antibiotic is recommended, ask your medical provider to help you understand how they decided the infection was a bacterial one in need of an antibiotic.

  • Antibiotics often take 24 hours to show improvement to child’s illness. If that’s not happening we may have a problem and want parents to call back. The best healthcare teams are not 100 percent correct in every case, but they want the opportunity to review and reassess every case if your child is not showing expected improvement.

  • Take the medicine as prescribed and for the recommended duration. Stopping antibiotics early promotes recurrence and resistant strains of bacteria.

  • Promote their own immune system with vaccines and populate your child’s microbiome with exposure to camping and adventures in the great outdoors, and at farms and public markets, and with animals and pets, and after antibiotic treatment with OTC probiotics or yogurt.

And finally, if at all possible, breast feed your babies!

Michael Jordan, MD, MS-HQSM, CPE, FAAP, Chief of Pediatrics at Newark-Wayne Community Hospital is board-certified in Pediatric Medicine. He attended the College of Human Medicine at Michigan State University and completed his residency training at the University of Rochester. In addition to his leadership role as chief of Pediatrics at Newark-Wayne, he is the medical director of Rochester Regional Medical Group and is also chair of Rochester General Medical Group’s Quality Committee. He works in the Sodus Rochester General Medical Group Pediatric office. To send questions on children’s health, please email Wendy Fisher, Pediatric Practice Manager at [email protected] and write “Ask a Doc” in the subject line. To schedule an appointment, call 315-483-3214.

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