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

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

3. Taking Antibiotics will…
Increase the risk of antibiotics resistance

4. 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.

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

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

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

8. 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

9. 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.)

10. 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

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

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

13. Acute Sinusitis
Diagnosis
Clinical
X-Ray
Treatment

14. Cough/Illness Bronchitis
Causes Treatment

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

16. Dysuria/Pyuria
Causes Management

17. Harms of Antibiotic Therapy
Adverse Reaction C. Difficile

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

19. Questions & Comments