Albert Z. Holloway MD, FAAP TO TREAT OR NOT TO TREAT Albert Z. Holloway MD, FAAP

Objectives Look at consequences of over use of Antibiotics. Look at common febrile illnesses in pediatrics. Develop parameters for judicious use of Antibiotics.

Taking Antibiotics will… Increase the risk of antibiotics resistance

Overuse of Antibiotics Broad Spectrum Antibiotics use has increased. Overuse of Antibiotics causes avoidable drug related adverse events. Contributes to drug resistance Adds unnecessary medical costs.

The Necessity of Judicious Use of Antibiotics Published in 1999 Updated in 2003 Healthcare Quality Goal

Keys to Judicious Use Determine the likelihood of a bacterial infection Weigh Benefits vs Harm of Antibiotics Implement Judicious prescribing strategies

Most Common Entities Faced URI – Common Cold Pharyngitis and Tonsillitis Acute Otitis Media Acute Sinusitis Cough/Bronchitis Fever without Source Dysuria/Pyuria

Common Cold I. Heals without Antibiotic Treatment II. Acute Viral Illness a. Nasal Discharge & Congestion b. Slight Sore Throat c. Mild Cough d. Fever (usually below 101) III. No Increase in alleviation of symptoms IV. No improvement on preventing complications

Pharyngitis and Tonsillitis Often associated with high fever and white exudates on tonsils. Many causative agents are viruses. Group A Streptococcus Streptococcus 10-15% of Pharyngitis/Tonsillitis Colonized in the tonsil of up to 15% of healthy children (5-12 yrs.)

Pharyngitis and Tonsillitis III. Diagnostic Guidelines Treat after confirming dx with rapid test 18 % of asymptomatic children tested positive Most common in children over 3 years

Group A Strep Main Symptoms Headache Fatigue Stomach ache Nausea Vomiting Conjunctivitis (rare)

AOM AAP and AAFP 2013 update Diagnosis Condition of Diagnosis Categorize Severity of Illness Treatment

Acute Sinusitis Diagnosis Clinical X-Ray Treatment

Cough/Illness Bronchitis Causes Treatment

Fever Without A Source Causes Evaluation Examination Labs Treatment Infants less than 24 mos.

Dysuria/Pyuria Causes Management

Harms of Antibiotic Therapy Adverse Reaction C. Difficile

Judicious Prescribing Strategy Appropriate Antibiotics Appropriate Dosage Treat The Shortest Period of Time Stand Your Ground Watchful Waiting

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