Transcript Treatment - Amazon S3

TO TREAT
OR
NOT TO TREAT
Albert Z. Holloway MD, FAAP
Objectives
I.
Look at consequences of over use of Antibiotics.
II.
Look at common febrile illnesses in pediatrics.
III.
Develop parameters for judicious use of
Antibiotics.
Taking Antibiotics will…
Increase the risk of antibiotics
resistance
Overuse of Antibiotics
1.
Broad Spectrum Antibiotics use has increased.
2.
Overuse of Antibiotics causes avoidable drug
related adverse events.
3.
Contributes to drug resistance
4.
Adds unnecessary medical costs.
The Necessity of Judicious Use of
Antibiotics
Published in 1999
Updated in 2003
Healthcare Quality Goal
Keys to Judicious Use

Determine the likelihood of a bacterial infection

Weigh Benefits vs Harm of Antibiotics

Implement Judicious prescribing strategies
Most Common Entities Faced
URI – Common Cold
 Pharyngitis and Tonsillitis
 Acute Otitis Media
 Acute Sinusitis
 Cough/Bronchitis
 Fever without Source
 Dysuria/Pyuria

Common Cold
I. Heals without Antibiotic Treatment
 II. Acute Viral Illness

◦ a. Nasal Discharge & Congestion
◦ b. Slight Sore Throat
◦ c. Mild Cough
◦ d. Fever (usually below 101)
III. No Increase in alleviation of symptoms
IV. No improvement on preventing complications
Pharyngitis and Tonsillitis
I.
Often associated with high fever and white
exudates on tonsils.
II.
Many causative agents are viruses.
III.
Group A Streptococcus
Streptococcus 10-15% of Pharyngitis/Tonsillitis
Colonized in the tonsil of up to 15% of healthy
children (5-12 yrs.)
Pharyngitis and Tonsillitis
III. Diagnostic Guidelines
Treat after confirming dx with rapid test
18 % of asymptomatic children tested positive
Most common in children over 3 years
Group A Strep
Main Symptoms
Headache
Fatigue
Stomach ache
Nausea
Vomiting
Conjunctivitis (rare)
AOM
AAP and AAFP 2013 update
Diagnosis
Condition of Diagnosis
Categorize Severity of Illness
Treatment
Acute Sinusitis
Diagnosis
Clinical
X-Ray
Treatment
Cough/Illness Bronchitis
Causes
Treatment
Fever Without A Source
Causes
Evaluation
Examination
Labs
Treatment
Infants less than 24 mos.
Dysuria/Pyuria
Causes
Management
Harms of Antibiotic Therapy
Adverse Reaction
C. Difficile
Judicious Prescribing Strategy
Appropriate Antibiotics
Appropriate Dosage
Treat The Shortest Period of Time
Stand Your Ground
Watchful Waiting
Questions & Comments