Thanksgiving this year is likely to become one of my favorite holiday memories. My husband’s niece, her husband, sister and fifteen-month-old daughter visited from Mississippi. We had a nice time showing them our pretty Louisville Zoo where Emma got a new hat to protect her ears. We ate a delicious turkey dinner, checked out some restaurants and explored Christmas lights in the “MegaCavern” which was an old crushed-stone mine now used for rentable storage and zip-lining. My daughters stayed up late with their cousins while Tim took to his job as great uncle with enthusiasm.
This year I was on call for our office which is usually quiet but a long weekend can be busier especially since we elected to keep the office closed on Friday. Typically the calls concern respiratory infections and urinary tract issues.
As I explained the normal symptomatology of an upper viral infection (or cold) to the patient on the phone Thanksgiving day, I noticed my husband’s niece listening. When I got off the phone I said, “Everyone thinks a Z-pack is going to make them better. Typically the request for an antibiotic is about halfway through the process and in a few days, they feel better. They assume it’s from the antibiotic but in reality, they were going to get better anyway.” I could see the wheels turning in her head. “My doctor always gives me an antibiotic.” So we talked about the negative aspects of getting an antibiotic every time she has a respiratory infection. The virus won’t respond to it but the bacteria that live in and on her can become resistant to antibiotics. She will be at increased risk of developing MRSA–methicillin resistant staph infection, a skin infection that is difficult to treat. If she does develop a bacterial-caused illness such as a true bacterial sinus infection (usually one-sided sinus pain, purulent nasal drainage AND a fever), a skin infection, urinary tract infection or pneumonia, it may take stronger and more toxic antibiotics to kill the organisms. It is even possible that the infection could be fatal. A good over-view of this topic is here.
She was pleased that the pediatrician had not given her daughter antibiotics, even though Emma has been seen several times for various upper respiratory infections and stomach bugs. She commented that most of her friends’ children were frequently treated with them. Obviously she can’t control what the doctor prescribes for her but maybe next time she will ask, “Is the antibiotic really necessary?” Sometimes that is just the opportunity a provider needs to say “No, it probably isn’t. Let’s just try a little symptomatic relief and lots of fluid and rest!” Maybe another participatory patient was born this holiday.