Before I settled here in Las Vegas, my wife and I did a year of locums
accross the country in various settings from rural Georgia, Kentucky, and
North Dakota, to New Orleans, Atlanta and Los Angeles. I can assure you the
problem of folks treating viral illness with antibiotics occurs everywhere.
When I arrived, I saw many "overflow" patients from my busiest partner who
treated every uri with antibiotics. I had to experiment with what words to
use to convince them that this time we would withhold antibiotics. I explain
the difference between virus and bacteria and give examples of the type of
infections that need antibiotics. I say something like : " if he had an ear
infection, strep throat or bronchitis, then he certainly would be helped with
antibiotcs, but unfortunately, with viruses it will only potentially hurt by
causeing possible side effects like diarrhea or upset tummy; and unnecessary
antibiotics will only make future infections more difficult to treat by
helping bacteria become more resistant to the simple antibiotics. You call me
Thursday if the fever isn't gone or the symptoms are not starting to improve.
Then we will talk about the possible need for antibiotics or getting more
information by, for example, getting an X Ray of his sinuses." (of coarse I
rarely do sinus films). If they are really freaked out, I have a nurse do a
progress call the next day. I have to admit, I also will give an Rx for a
decongestant/cougn med for those who I sense need an Rx in hand. It takes
more time, but it works. My partner now prescribes fewer antibiotics, I
think because the patients now have different expectations. I wonder how
others out there deal with the child whose parents both got antibiotics and
expect them for their child with the same symptoms? I usually say something
like "in adult medicine, they give a lot more antibiotics"
Blair Duddy, gen peds