1. Antibiotic Resistance and our Community Down With Superbugs!

2. What We’ll Cover What is antibiotic resistance? Why should I be concerned? How can we keep our families safe? Green mucus and other exciting topics Your questions

3. Digression #1: “Upper Respiratory Infection” A viral or bacterial invasion of the: Nose (sinusitis) Throat (pharyngitis) Chest/bronchial tubes (bronchitis) Ear (otitis media)

4. Digression #2: “-itis” 1.“-itis” means inflammation. 2. Inflammation of the upper respiratory tract can have many causes: Viruses, allergies, environmental exposures, bacteria 3. “-itis” does not imply bacteria or bacterial infection.

5.  “Strep” throat (scarlet & rheumatic fever)  Chronic sinus infections  Pneumonia  Bladder infections  Chlamydia, syphilis & gonorrhea They treat many bacterial illnesses, including: The Good News: Antibiotics Kill Bacteria

6. ( Adapted from Levin BR, Clin Infect Dis 2001) Antibiotics Kill Bacteria Viruses Bacteria No effect Antibiotics X Break down cell walls Stop replication

7. ( Adapted from Levin BR, Clin Infect Dis 2001) Antibiotics Need Time to Work R Antibiotics prescribed Day 5 R X XX X Medication taken for full course of treatment R X X X X X X X Infection cured! Day 1 Day 10

8. Most upper respiratory infections are caused by viruses. Antibiotics have no effect against colds and the flu. Antibiotics Don’t Help Colds or the Flu

9. When we take antibiotics to treat colds and the flu, they lose their effectiveness against bacteria. This phenomenon is known as antibiotic resistance. Overusing Antibiotics Makes them Ineffective Against Bacteria

10. Antibiotic Resistance Over time, bacteria develop the ability to survive treatment with drugs that used to kill them. Causes of resistance: –Unnecessary use for viral infections –Quitting treatment too soon –Unnecessary use of broad-spectrum medications

11. Scenario #1 Jane has a sore throat. Without testing, her health care provider prescribes penicillin “just in case” it’s strep. Jane’s symptoms are caused by a virus, but she also has bacteria in her sinuses.

12. Unnecessary Antibiotics Cause Resistance Susceptible bacteria are killed off. A few hardy survivors are left behind. X X X X X X X X The survivors can withstand penicillin. R R Jane takes penicillin.

13. The resistant survivors multiply. R R R R R R R R R RR Treatment with penicillin has no effect. X Resistant Bacteria Can Multiply and Spread Jane is now a carrier of penicillin-resistant bacteria.

14. Scenario #2 Ashley comes home from school with a sore throat and fever. After a positive strep test, her pediatrician prescribes penicillin.

15. Her parents decide it’s OK to stop. Ashley takes her medicine for three days. Ashley feels fine. Scenario #2

16. (Adapted from Levin BR, Clin Infect Dis 2001) Incomplete Treatment Causes Resistance R X X X X X Day 3 Symptoms improved, treatment stopped Day 0 R Antibiotics prescribed R R R R R RR Day 10 Resistant infection Meanwhile, the survivors multiply.

17. R R R R R RR Resistant Infections Require Special Treatment Longer treatment Higher dosage More expensive medication Intravenous (IV) medication, hospitalization

18. Resistant Infections are Dangerous Medication toxicity (side effects) Contagious Can pass resistance to other organisms Worst Case Scenario: The infection may become resistant to all medications (untreatable).

19. Why We Overuse Antibiotics Patients: Think green nasal discharge = bacterial infection Need to return to work/school Expect antibiotics if they’ve been given them before Physicians Think patients expect antibiotics Concerned about patient satisfaction Diagnosis is difficult Time pressure (Clin Pediatr. 1998;37:665-672) Antibiotic Prescription

20. What Can Parents Do? Ask your health care provider to explain the diagnosis. Don’t insist on antibiotics. Remember: Most respiratory symptoms are caused by viruses Antibiotics probably won’t make you better any faster Green or yellow mucus doesn’t mean bacterial infection Wash your hands!

21. The Green Mucus Myth Stott BMJ 1976;2:556 012345678910111213 0% 20% 40% 60% 80% 100% Days of illness Patients recording yellow sputum Antibiotics Sugar Pill

22. Don’t ask for a particular brand. When Your Child Takes Antibiotics: Take every dose, unless you’re specifically directed otherwise. NEVER save antibiotics for later illnesses. NEVER share antibiotics between family members.

23. Be Realistic: It Takes Time to Get Over a Virus! Gwaltney JAMA 1967;202:158 fever sore throat cough Runny nose

24. What Can Health Care Providers Do? Take time to explain the diagnosis and suggest ways to feel better. Ask patients about their expectations. Stick to established treatment guidelines. Treat conservatively if possible.

25. Sore Throat Rapid Strep Test if more than one of the following are present: Discharge from tonsils Swollen/sore lymph nodes Fever No cough Antibiotic of choice for confirmed strep: Penicillin 90% of sore throats are caused by viruses!

26. Ear Infections Buildup of fluid in the middle ear is very common in infants and toddlers Treatment: If mild, uncomplicated, no perforated eardrum and >24 mos old, consider “wait-and-see” for 72 hours Antibiotic of choice: amoxicillin No treatment is required unless the following are present: Ear pain, fever, irritability, bulging yellow/red eardrum

27. Sinusitis If nasal discharge > 10 days OR severe symptoms: High/persistent fever, apparent illness Facial pain on one side Postnasal drip Swelling around the eye area Antibiotic of choice: amoxicillin Yellow/green mucus does not mean bacterial infection!

28. Cough Illness Treat only confirmed pertussis (whooping cough) or pneumonia with antibiotics. Most coughs in children are caused by viruses, and may last for 2-3 weeks. Antibiotic treatment will not prevent pneumonia. Yellow/green mucus does not mean bacterial infection.

29. A Community Approach to Appropriate Antibiotic Use Improve diagnosis (train providers and students) Collect information on resistance patterns Work with health plans to monitor prescribing habits Educate medical professionals and the public about appropriate use

30. Help Oregon AWARE Spread the Word! Tell your friends and family about antibiotic resistance Help distribute information at work, in schools and day care centers Join our coalition