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admin | Natural Treatment Bacterial Vag | 20.10.2014
Antibiotic-resistant bacteria has been a growing concern in the United States, leading to thousands of deaths each year. The World Health Organization released a new survey on the risk from overusing antibiotics.
The reasons for so many unnecessary prescriptions vary, but involve both doctors' actions and patients' expectations, experts say."What comes up a lot in studies is that clinicians generally know when an antibiotic is needed and when it's not, at least for these common conditions, but often they will report that they're concerned about patient demand and patient satisfaction," Fleming-Dutra said. To make things even more complicated, the microbes that cause ear infections are changing: Vaccines have shifted the microbial flora blooming in American children, and thanks in part to routine antibiotic overuse, some bugs have become much harder to treat. Common in the wintertime, middle ear infections -- technically called acute otitis media, not to be confused with outer ear infections (swimmer’s ear) or rare inner ear infections -- aren’t a big deal. Even if a doctor is certain of an infection, there’s the problem of knowing what kind of ear infection it is.
Problem is, without knowing what’s causing an infection, it’s very difficult to know how best to treat it.
There’s a good reason for this conservative approach: No matter what their cause, most ear infections go away on their own.
The bottom line is that ear infections are beguiling, yet they are also less common than you might have been led to believe and more innocuous as well. The Kids would like to thank Melinda Pettigrew at Yale University, Tumaini Coker at UCLA, and Itzhak Brook at Georgetown University. Overuse of antibiotics leads to a number of short- and long-term problems, according to Hersh. The increasing resistance of microbes to antibiotics is not new information for public health officials, "but what is alarming is the human cost," Hersh said in an email.
Last year, the Utah Department of Health recorded 90 cases of infection from so-called carbapenem resistant enterobacteriaceae — a particularly dangerous bacteria resistant to almost every known antibiotic. Karen Singson, antimicrobial resistance prevention program manager for the Utah Department of Health, said options "become very limited" with the rise of antibiotic-resistant bacteria. The CDC, Pew Charitable Trusts and other researchers found that doctors and emergency departments gave out 154 million prescriptions for antibiotics between 2010 and 2011.
About 30 percent were deemed unnecessary, according to their findings, which were published in the Journal of the American Medical Association.
Of the unnecessary prescriptions, 44 percent were written for acute respiratory conditions like sinus infections, colds and bronchitis. Doctors often end up prescribing antibiotics unnecessarily because they don't always know whether an infection is viral or bacterial, Hersh said. In other instances, doctors feel that patients won't be satisfied unless they leave the office with a prescription, even if their sickness may be resolved without antibiotics. Research now shows that overuse of antibiotics may also lead to longer term health problems for young children such as allergies and asthma, Hersh said.

The study showed that antibiotics are prescribed to young children under the age of 2 at a higher rate than any other age group. The issue has caught the attention of public health agencies as well as the White House, which released an action plan last year to reduce inappropriate outpatient antibiotic use by half by 2020.
Intermountain Healthcare has also pledged to reduce unnecessary antibiotic use as part of its antimicrobial stewardship program. For the purposes of their study, the researchers defined inappropriate antibiotic use as an instance in which an antibiotic was prescribed for an illness that cannot be treated by one, such as the common cold. We took him to a local pediatrician who quickly diagnosed him with a middle ear infection and prescribed him a 10-day course of antibiotics.
What irked me wasn’t just the misdiagnosis; it was that he had recommended unnecessary drugs that may have upset my baby’s stomach and potentially, research suggests, increased his risk for asthma and irritable bowel disease.
Nearly 80 percent of American kids have had one by the time they turn 3; many seem to battle them constantly -- perhaps yours?
But a 2008 French study reported that one-fifth of ear infections diagnosed by general practitioners are in reality something else, like minor ear inflammation; 7 percent of the time, doctors deem perfectly healthy ears infected.
Some are caused by viruses, which are immune to antibiotics, whereas others arise because a respiratory virus like the cold or flu made it easier for pre-existing bacteria to grow in the middle ear canal.
Since 2004, the American Academy of Pediatrics has advised doctors against giving antibiotics to kids over the age of 2 if their ear infections are not severe. In a 2011 clinical trial, University of Pittsburgh researchers reported that 74 percent of children under 2 who were suffering from ear infections got better after one week when they weren’t given any treatment; 80 percent of those who got antibiotics got better in the same time frame. In a 2010 study, Boston University researchers surveyed 300 pediatricians and found that 85 percent of the time, when infections were minor, doctors ignored the AAP’s guidelines and prescribed drugs.
In 2000, a vaccine called PCV7, which protects kids against seven (out of a total of 93) subtypes of Streptococcus pneumoniae, became part of the standard U.S. This doesn’t mean you shouldn’t take your shrieking, ear-clawing child to the pediatrician. Many of these illnesses are viral, meaning they do not respond to antibiotics and should not be treated with them, researchers said.
Fleming-Dutra said that other circumstances could be deemed inappropriate, such as when the wrong antibiotic is prescribed, but those were not included in the study.In order to determine whether the antibiotics prescribed were necessary, the researchers looked at national guidelines of appropriate levels antibiotic prescribing by age group. Two days later, back home in New York, our pediatrician said our son probably never had an ear infection, and that regardless, he should stop taking the drugs.
No one knows why some kids are more prone to them than others, but some research suggests that genetics plays a role, and environmental factors such as day care, exposure to tobacco smoke, and formula feeding are known to boost the risk as well. Yet half of the kids treated with antibiotics in the study got bouts of diarrhea, compared with only 27 percent of the kids who didn’t take anything. Most of the doctors said they thought that the guidelines made good sense, but they felt pressured by parents to give out drugs anyway.

Antibiotic use is the main driver of resistance, which can lead to harmful consequences ranging from allergic reactions to "superbug" infections like Clostridium difficile, a nasty intestinal bug."Antibiotic resistance is one of the most urgent public health threats of our time," Dr.
When national guidelines weren't available for a particular diagnosis, the regions with the lowest antibiotic prescription rates in the country served as the basis for appropriate prescribing.The results showed that about half of the antibiotics prescribed for acute respiratory infections, including the common cold, bronchitis, and viral sore throat, may have been unnecessary. Ear infections can, however, be more than just a painful, oozing nuisance: They sometimes cause fluid to build up in the middle ear, leading to long-term hearing loss and language and literacy problems (and maybe even picky eating, as I discussed in my last column). Fevers, ear pulling, and ear pain don’t necessarily predict the presence of an infection, so doctors have to examine the middle ear to be sure -- and that’s really hard to do to a sick child.
This reckless overuse of antibiotics isn’t just expensive; it is believed to drive antibiotic resistance, too. As a result of these vaccines, overall ear infection numbers have dropped by 6 percent since 2000, but the types have now shifted in that more infections are now caused by Haemophilus influenzae or Moraxella catarrhalis than they used to be. But don’t pitch a fit while you’re there -- what do you mean you’re not giving Lola antibiotics? Serious infections, left untreated, can also cause meningitis or mastoiditis, an infection of the mastoid bone in the skull, which requires surgery.
Doctors typically have to insert an instrument into the kid’s ear, establish an airtight seal, squeeze a rubber bulb to release several bursts of air, and then watch to see how the child’s eardrum responds. But that could very well have been just because time had passed and his immune system fought the bug off. Doctors disagree about what these changes mean, clinically speaking: On the one hand, the new vaccine protects against 19A and should therefore reduce the number of resistant 19A infections, but on the other hand, some strains of the now more common H. Oh, and if there’s any earwax, the doc has to pluck it out with tweezers and try the whole thing again.
Centers for Disease Control and Prevention identified a new form of Streptococcus pneumoniae called 19A that causes childhood ear infections and is resistant to every FDA-approved antibiotic. First, doctors need to be more cautious about prescribing antibiotics unnecessarily."For clinicians, it's always important that they're prescribing antibiotics only when needed and if they are needed, using them correctly," Fleming-Dutra said.
As you can imagine, this doesn’t always go well, so many pediatricians end up just peering into your kid’s ear, seeing a little redness and guessing at a diagnosis instead.
Then, pick up some pain relievers on the way home -- a bottle of children’s Tylenol for her, and some chardonnay for you. That can be a really helpful technique."Patients can play a role in stopping antibiotic misuse, too.

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