The Practice of Prescribing Antibiotics Over The Phone

Ok, I admit it, I have done it too…. but only once… and my Lizzie was only 4 years old…and in alot of pain…and I just know she had an ear infection. I am a member of “the club.” I, too, have paged the doctor on-call, after hours asking for an antibiotic prescription, sight unseen, over the phone.

Time has passed, Lizzie is now 18 years old, super infections are on the rise, and the medical community has become more respectful in their use of antibiotics. Fortunately, I was denied an antibiotic back then by a very wise pediatrician.

Antibiotics are wonderful. However, ONLY when used for bacterial infections. Antibiotics are useless against viral infections.

So, how do you know if your child has a bacterial or viral infection? You may have the best doctor in the world, but I can promise you this… no doctor can diagnose a virus versus a bacterial illness over the phone.

Here are some general guidelines on common illnesses:

1. Cold and cough: Colds and coughs typically last 10-14 days, and nasal drainage may even change from clear to thick or discolored -- not to worry, all is still well. If symptoms last beyond 14 days, see your doctor.
2. Sinus infection: Nasal congestion -- mucous may turn thick, yellow or green toward the end of a cold, this can be considered normal. However, if symptoms last beyond 10-14 days, facial pain and swelling or fever develops -- it is time for a doctor’s visit.
3. Sore throat: Many sore throats are viral, but we want to watch for strep infections which are bacterial. Of one thing, I am sure; strep throat can NEVER be diagnosed by looking in the mouth. A throat culture is necessary for a positive identification.
4. Bronchitis or non-specific cough: Coughs are usually part of a cold/viral infection; they serve to help clear the lungs of mucous and debris. If a cough lasts longer than 2-3weeks, see your doctor.
5. Ear infections: All ear infections are not created equally and are classified by doctors differently. Otitis Media with Effusion (OME), fluid in the middle ear, is commonly found in young children with colds -- about half. OME does not require antibiotic treatment. Though fluid is usually present in the middle ear with Acute Otitis Media (AOM) as well, it differs in that additional, specific signs of infection are present -- redness of the eardrum, fever, pus present behind the eardrum, drainage from the ear. Runny noses, ear pulling, changes in feeding or sleep patterns may raise a parent’s suspicions, but does not diagnose an ear infection.

Unfortunately, in the real world of parenting, children sometimes complain of a sore throat over the weekend or wake crying with an earache at 1 am. Surely, it could not hurt to start an antibiotic just this once? What if I promise to bring my child into the office for that strep test Monday morning? Why does my pediatrician have to be so difficult… all my friends’ doctors do it?

Well, let’s take a breath and look at this for a moment. If your pediatrician is “being difficult,” he may actually be following guidelines set up by the American Academy of Pediatrics (AAP), a non-profit group of certified pediatricians and specialists dedicated to the health, safety and well-being of infants, children and adolescents.

Because of antibiotic misuse and overuse, antibiotic resistance has developed over time, and antibiotics have lost their effectiveness in battling some bacteria. Do you know that each time you take an antibiotic, sensitive bacteria are killed, but resistant germs are left to grow and multiply? According to the Center for Diseases Control and Prevention (CDC), repeated and improper use of antibiotics is the main cause for increase in drug-resistant bacteria. So, before you go searching for a new doctor, think again. Declining your request for an antibiotic may not be the answer you are looking for, but rest assured -- your doctor has your child’s best interests at heart.

This article was written by Barb Warner, RN, a nurse at the St. Louis Children’s Hospital Answer Line. For more information, please call the St. Louis Children’s Hospital Answer Line at 314.454.KIDS (5437).