Insights

Antibiotics – Diligent Restrained Use For A Secure Tomorrow (Part – 1)

Pinterest LinkedIn Tumblr

Antibiotics – A Magic Bullet; But, Not For All!

The word Antibiotics comes from the Greek words ‘anti’, meaning ‘against’, and ‘biotikos’, meaning ‘concerning life’.  Antibiotics are mainly active against bacteria.  They do not cure infections caused by viruses or parasites or fungi, though some antibiotics may act against parasites.  Looking at the second part – “biotikos”, whose life is at concern?  It’s not just the life of bacteria, our lives too!  Antibiotic usage goes with the idiom ‘double edged sword’ – something that can be seen as a benefit and a liability.’ A diligent restrained use of antibiotics is a must for a secure tomorrow!

Antibiotics are one of the most commonly prescribed medicines only next to paracetamol!  There are several reasons for this (ab)use.  To list a few –

  • Parental anxiety/Parental pressure/Parental Misconception– A common scenario found in most of the outpatient clinics.  Any child with high fever, a runny nose, loose stools, vomiting etc., parents’ first remark would be, “Doctor, my child is having an infection, please give him some antibiotics to make him feel better as early as possible!”
  • Physician’s anxiety – Mostly seen with young or newly started physicians.  “What if I don’t write an antibiotic and this child doesn’t get better?  What if the child is taken elsewhere and doesn’t come back?  I may lose more patients because of this one parent who may say to others – ‘this doctor is not good.  He did not prescribe antibiotics and my child’s condition deteriorated’ and so on.”
  • Pharmaceutical companies – They pressurize the health care professionals to meet the target or to move the products in exchange for some incentives.
  • Luxury of insurance coverage This has been trending over the last few years.  It is commonly heard from parents – “Doctor we have insurance.  Please write the best possible antibiotic.”
  • Corporate or Private Health center’s pressure – A pharmacist or the supervisor walking into the doctors’ chambers saying “Doctor, look at this list of antibiotics, not moved at all…expiring in next few months!”
  • Weekend Syndrome – This syndrome owes its origins to the busy life schedules of the modern world. A busy parent may think, “Today is friday/saturday!  Doctor may not be available for the next 1-2 days.  What if my child doesn’t recover?  Better to take an antibiotic.”  A Doctor’s thought, “Let me give them antibiotics, just in case?”  Both these thought processes aid each other – with the end result being an antibiotic prescription.
Living weekend to weekend - causes tremendous pressure among working couple
Living weekend to weekend – causes tremendous pressure among working couple
  • Lengthy Line – Lack of Time Syndrome – This mostly happens with busy practitioners.  To evaluate any child with fever, it takes at least 10-15 minutes.  If there is a line of 60-80 children, the evaluation time can range anywhere between 10-12 hours nonstop.  Practically impossible for a human mind to focus on such extended periods of time.  The easiest option would be to prescribe anti-biotic – thereby saving time.
  • Play safe policy – “Why take chances?”
  • Let’s make others happy attitude!  Quick antibiotic – Parents are happy.  Pharmacists and pharmaceutical companies are happy. It all looks like a win-win situation.  
  •  Lack of forethought – Not thinking of what will happen if the antibiotic becomes useless tomorrow due to development of resistance, which by the way is not a farfetched idea. The devil is just around the corner.
  • “Quack – Quack” Found mostly in sub urban or rural areas.  In many rural areas where there is dearth of qualified doctors, unqualified practitioners prescribe anti-biotics as quick fix – without understanding the consequences. In many cases these “Doctors” acquire their knowledge through internet and through “Medical Representatives’ University”.
  • Working parents’ apprehension: More the number of days lost in taking care of a sick child, more to lose at the workplace.  They end up pestering the doctor for antibiotics.

Myth Busters –Clinical scenarios commonly we come across

  1. Myth: Fever = Bacterial infection.  Many parents believe that fevers are due to bacteria and don’t get cured without antibiotics. 

Buster:  Most of the fevers in pediatrics are viral and don’t need antibiotics.  Good nutrition and hydration, fever control and adequate rest are all that is required.

  1. Myth: Loose stools (diarrhea), vomiting, abdominal pain = Food poisoning due to bacteria and an antibiotic is a must.

Buster: Most of the gastrointestinal symptoms are either due to a virus or preformed toxins or self-limiting bacterial infection.  A good (re)hydration with ORS or tender coconut supported by proper nutrition, adequate rest, probiotics (benefit of doubt) – yoghurt or commercially available probiotics and other micronutrients like Zinc should suffice and/or anti-emetics.

  1. Myth: Runny nose, fever, throat pain = Throat infection due to bacteria.  Better to start antibiotics early!

Buster: Most of the upper respiratory infections are due to viral etiology, unless proved otherwise.  Supportive care should work most of the time.

  1. Myth: Injury/ Wound = Antibiotic is needed to prevent further infection.

Buster: Unless it is case of major or contaminated wounds – proper cleaning and local care should do the trick.

  1. Myth:  Too much cough = Severe bacterial infection.

Buster: Most kids cough either due to a viral infection or some allergy which should be taken care of without anti-biotics.

  1. Myth: Fever has disappeared after 2 days of antibiotic; So why take it for a prescribed number of days?  Let’s save it for the next fever/infection!

Buster: Properly diagnosed and treated bacterial infection usually responds to antibiotics in 48-72 hours.  That doesn’t mean the infection is totally cleared.  It is necessary to complete the prescribed course to eradicate the infection completely.  

  1. Myth: I have the same symptoms as last month – so I bought the same medicines from pharmacy – but it’s not working this time- what’s wrong?

Buster: There are several bacteria which can cause similar symptoms; Let the doctor do his assessment. A doctor is professionally trained to identify these subtle differences and prescribe suitable medicine. Do not try to be a doctor! 

  1. Myth: “Doctor!  The antibiotic you gave worked like magic.  One dose and I’m alright.”

Buster: Effectively treated an infection responds quickly; if the response is so quick with one dose, it is most unlikely a bacterial one.

With an effort to supervise judicious prescription of antibiotics by clinicians and followed adequately by the patient/parents,Antibiotic Stewardship program was brought into existence.  Stewardship program would guide us to use antibiotics diligently, in a restrained manner for securing tomorrow’s concern while treating infections.

To Be Continued…

Disclaimer:  The above article is only to create awareness regarding antibiotic use.  The given information should not be used as a substitute for doctor’s consultation in case of any clinical symptoms mentioned above.

Dr. Mallikarjuna Swamy H P

Practicing Pediatrician and Neonatologist. Originally hailing from Mysuru, he is practicing in Kuwait since 10 years.

62 Comments

  1. Avatar
    Munira Husain Reply

    So well written. Clears all the questions about the use of antibiotics. Briefly explained how much use is advised. 👍

    • Dr. Mallikarjuna Swamy H P
      Dr. Mallikarjuna Swamy H P Reply

      Thanks much. Part 2 shall follow at the earliest.

      Regards

      • Avatar

        Well written, precise,easy to comprehend,genuine points to ponder…

        • Dr. Mallikarjuna Swamy H P
          Dr. Mallikarjuna Swamy H P Reply

          Thanks much Dr. Bibi. Part 2 shall follow at the earliest.

          Regards

    • Avatar
      Kiran pinto Reply

      Sir.. really perfect article for this modern world where people need awareness from professional and honest doctors like you..we are eagerly waiting for Part 2..we know you from past 6 years never seen such doctor like you…we support and share as much, so that it should reach all people..👍👍👍👍

      • Avatar
        Dr Anupama Pujar K Reply

        very well written . Informative and much needed article, as antibiotic resistance is a bigger problem than disease itself.

        • Dr. Mallikarjuna Swamy H P
          Dr. Mallikarjuna Swamy H P Reply

          ಧನ್ಯವಾದಗಳು ಡಾ. ಅನುಪಮ 🙏🏾

      • Avatar
        Dr. Mohammed Asif Ali Reply

        Hi dr. Very true n well presented article. Unfortunately a reality every Dr. is aware of, yet helpless. Perhaps the society and mindset of people has to change to be with patience during illness.

    • Avatar

      Dissecting facts and concerns in the use and abuse of antibiotics go well with simplicity and creating awareness type of article. We have seen in many of our studies on fish related diseases often get worsened if there is a previous history of indescriminate use of antibiotics. Development of drug resistence is one of the worst fall outs of such antibiotic abuses.

      • Dr. Mallikarjuna Swamy H P
        Dr. Mallikarjuna Swamy H P Reply

        ಪ್ರತಿಕ್ರಿಯೆಗೆ ಧನ್ಯವಾದಗಳು 🙏🏾

      • Avatar

        Well Written. Because of the use, misuse and abuse of antibiotics, simple antibiotics don’t work now. Earlier first line drugs now have become obsolete. Strict policies and monitoring is also needed. Finally each one should act responsibly.

        • Dr. Mallikarjuna Swamy H P
          Dr. Mallikarjuna Swamy H P Reply

          Thanks much Dr. Malathi. Part 2 shall be released today.

          Regards.

    • Avatar
      Dr. Hala Habib Reply

      Very nice and informative, Really explained the true story about antibiotics. We are curious about part 2 Thanks Dr Malik

    • Avatar

      Very well written Doctor. Many of the things I was not aware. Nicely analyzed the psychology of parents and the healthcare professionals 😄

      Waiting for part 2

      • Dr. Mallikarjuna Swamy H P
        Dr. Mallikarjuna Swamy H P Reply

        Thanks much. Part 2 shall follow at the earliest.

        Regards

    • Dr. Mallikarjuna Swamy H P
      Dr. Mallikarjuna Swamy H P Reply

      Thanks much ma’am…Part 2 shall follow at the earliest.

      Regards

  2. Avatar

    Well written article.
    Becomes especially relevant during these times where people are hoarding and consuming antibiotics like candy & there is systematic psychology to “push-in” more antibiotics.

  3. Avatar
    Jincy joseph Reply

    It’s a good and useful article, especially during this period as all are back of antibiotics. So it’s a great message to all the people of this generation. Atleast people reduces the usage of the antibiotics. Great swamy, waiting for next article.

  4. Avatar
    Kiran pinto Reply

    Sir.. really perfect article for this modern world where people need awareness from professional and honest doctors like you..we are eagerly waiting for Part 2..we know you from past 6 years never seen such doctor like you…we support and share as much, so that it should reach all people..👍👍👍👍

  5. Avatar

    Sir, it is a very good article which you have written not leaving any stone unturned in the world of myths especially in the most viewed topic in Medicine – “The Antibiotic “.

    Very useful and guiding .👏

    • Dr. Mallikarjuna Swamy H P
      Dr. Mallikarjuna Swamy H P Reply

      Thank much. Part 2 shall follow soon.

      Regards

    • Avatar
      Dr Geetha Ravindran Reply

      Honest write up. Covers all the practical aspects faced by medical professionals.

      • Dr. Mallikarjuna Swamy H P
        Dr. Mallikarjuna Swamy H P Reply

        Thanks much Dr. Geetha…Part 2 shortly…🙏🏾

  6. Avatar
    Dr Ramaswamy A S Reply

    Very well written article on the importance of antibiotics in clinical practice. Seen as magic bullets by most laymen, their abuse is causing more harm than their intended use. Dr Mallikarjun Swamy has hit the nail on the head by baring open the financial pressures and ethical issues involved in their use

    • Dr. Mallikarjuna Swamy H P
      Dr. Mallikarjuna Swamy H P Reply

      Thanks for the encouraging review Dr. Ramaswamy 🙏🏾

  7. Avatar
    Dr Geetha Ravindran Reply

    Honest write up. Covers all the practical aspects faced by medical professionals.

  8. Avatar
    Fahad Farooq Tonse Reply

    Clear,concise,impactful and to the point informative article that gives a wakeup call much needed in todays era of antibiotic abuse and multi drug resistance.

  9. Avatar

    An article, that is the need of the hour. A must read for both the doctors community and general public. Antibiotics abuse has now posed serious threats as drug resistance is a major challenge in treating critically ill patients. The myth – buster series of explanations are very informative, beautifully summarised.

    • Dr. Mallikarjuna Swamy H P
      Dr. Mallikarjuna Swamy H P Reply

      Thanks much Dr. Murli. Your comment on Myth Buster is highly appreciated.

      Regards.

  10. Avatar
    Bijoy Mohammed Reply

    Well said, Dr. Mallikarjun. Very useful and relevant topic too. Expecting more articles like this from you soon.

    • Dr. Mallikarjuna Swamy H P
      Dr. Mallikarjuna Swamy H P Reply

      Thanks much for your encouraging words.

      Regards

  11. Avatar
    Dr Raju Bojja Reply

    Nice article Malli.It creates awareness about antibiotics among public

  12. Avatar
    Dr.Poornima.S Reply

    As a doctor I can relate to all the most common reasons why people ask for antibiotics.
    Very concise way of explaining the intricacies in prescription of Antibiotics.

    Waiting for the next part

  13. Avatar
    Emanuela Rucci Reply

    Very nice article dr. Mallik!
    This is such a fundamental topic in our daily practice and I really hope that the awareness will increase among people.
    Fluent article, easy to read and follow, to the point, with very common practical examples. I think anybody ( doctors, or parents )can recognize themselves in one sentence at least!
    Looking forward to read the second part…

  14. Avatar

    Very very detailed article and in simple language that even layman can understand who doesn’t have medical background. Appreciate the efforts put to spread awareness in society. Waiting for part 2…

  15. Avatar
    B.M.Chandra shekar Reply

    Very Good informative & well Explained about Antibiotics.
    Today Dr’s Prescription to the patients is based on consultant rather than on counselling.
    Most of the points in the Article is reality & fact in this modern marketing era.
    Commercial is in front line rather than life.
    Awaiting for ur next phase -2,Article.
    God bless u.

      • Avatar

        Very well explained, easy to comprehend. Much needed article for present society. Eagerly expecting much more articles from you.

      • Avatar

        Very well explained, easy to comprehend. Much needed article for present society. Expecting much more articles from you.

        • Dr. Mallikarjuna Swamy H P
          Dr. Mallikarjuna Swamy H P Reply

          Thanks much. Part 2 shall follow at the earliest.

          Regards

  16. Avatar

    Very informative. A honest write-up, brave attempt by Dr. Mallikarjunaswamy! Use and abuse of antibiotics explained in a very simple language for everyone to understand, waiting for the next article in the series… Keep writing more, on vaccinations, breastfeeding and so on… Enlighten the anxious young parents…

    • Dr. Mallikarjuna Swamy H P
      Dr. Mallikarjuna Swamy H P Reply

      Thanks much Amu for the encouraging review.

      Part 2 shall follow shortly.

      Regards

  17. Avatar
    Kusuma Rangaswamy Reply

    Very good information.. must read for all .. parents especially… Thank you !!

    • Dr. Mallikarjuna Swamy H P
      Dr. Mallikarjuna Swamy H P Reply

      Thanks much. Part 2 shall follow at the earliest.

      Regards

  18. Pingback: Antibiotics - Diligent Restrained Use For A Secure Tomorrow (Part – 2)

Write A Comment