Antibiotics: Treading softer nowadays

There’s a time and place for everything.

Pediatrician Perri Klass has an excellent article on antibiotics and children in Tuesday’s New York Times Science Times. She perfectly conveys the dilemma facing pediatricians and others who care for children today. We all have stories of kids whose lives were saved by the timely administration of antibiotics, but we’re also acutely aware–more so with each passing research article–of the consequences of overusing that “magic bullet.”

The physicians who taught me back in the ’70s and early ’80s had good reason to love antibiotics. Many of them had started their careers in the pre-antibiotic era, when infections like pneumonia, meningitis, diphtheria, and others killed a lot of children. Then antibiotics came on the scene and those diseases nearly vanished–until antibiotic resistance kicked in with a vengeance, that is. We’ve been engaged in an escalating arms race with bacteria ever since.

The pro-antibiotic mindset of those times was epitomized by an elderly attending physician in my residency program who, as we were discharging a boy who’d had bad case of pneumonia, quietly said, “When I was an intern that child would already have been dead for a week.”

To his younger self, the boy’s recovery would have been a miracle. Now he believed it was simply a matter of time–and the right antibiotics–and bacterial infectious diseases would disappear entirely. Side effects? Maybe some diarrhea or the occasional allergy, but that was a small price to pay. Right?

It didn’t work out that way, of course. We’re now learning that antibiotics can have far-reaching effects on  children’s health. As Klass points out, there is concern that antibiotic use, particularly in early infancy, may be linked to a variety of chronic health conditions–even obesity, as I wrote about a few months back.

Still, there is a role for antibiotics. Kids still get pneumonia, and meningitis, and any number of infections that may come roaring back if the fear of antibiotics becomes its own epidemic. But not every ear infection needs to be nuked with pharmaceuticals.

So, when to treat and when to let nature take its course? That’s a delicate balance that those of us who learned from doctors who saw antibiotics as a “magic bullet”–which they were, at least at the start–are still working to achieve.

Photo credit: epSos.de

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2 Comments

Filed under Infectious diseases

2 responses to “Antibiotics: Treading softer nowadays

  1. I curious what your thoughts are about antibiotics routinely administered in labor to GBS positive moms and/or antibiotics prophylactically administered to newborns whose mothers either did not get antibiotics in labor and who were either GBS positive or had unknown status.

    I am torn because I am concerned about the consequences of early antibiotic administration, however I know how devastating GBS septicemia can be.

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    • I haven’t looked at that in awhile – time to do so again. Anyone who has seen what GBS can do to a baby has a natural respect/fear of that bug, but the growing evidence about antibiotics and future health issues is concerning. I’ll check into it and post something soon. Thanks for writing!

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