06/05/2025
Bacteria are becoming resistant to antibiotics faster than we can develop new ones. 🦠 The more we use antibiotics, the less effective they become, which is a huge threat to public health.
Research shows that at least HALF of the antibiotics prescribed are NOT necessary – that is, the illness did not require a prescription antibiotic! 😳 Why is this happening? The literature suggests several reasons:
First, when a patient comes in sick, many doctors feel as though families expect tangible actions to address their concerns. In other words, parents don’t want to leave the office “empty handed.” 👐 I've seen families become upset after hearing that their child's illness is due to a virus and therefore they do not need antibiotics. A family’s angst is often expressed in the form of low patient satisfaction scores used to measure physician "performance." 📝 This is just an unfortunate set-up all around. It does NOT inspire medical professionals to stand their ground.
Secondly, bacterial and viral infections often have overlapping symptoms. Physicians admit that uncertainty surrounding the diagnosis can lead to antibiotic prescribing as the perceived “safe choice.” While it is often harmless to “wait and see” how an illness will pan out (with good return precautions), parents may perceive delayed antibiotic treatment as an inconvenience or even a “missed diagnosis."
Lastly, some would argue that doctors are pressed to see too many patients in wayyy too short of time. It is exhausting, if not impossible due to time constraints, to convince 30 families per day that their cough/fever/sore throat is viral and therefore does not require antibiotics. Even when the appropriate reassurance IS provided, some parents (who are rightfully desperate to make their child feel better) will seek out additional opinions until they get the prescription that they are yearning for. 😞 The child will then receive an unnecessary antibiotic and their symptoms will begin to subside – not because the antibiotic is “working” - but because that’s the natural course of a viral illness. I call this the "confirmation bias virus." Misperceptions are reinforced, and the cycle of unnecessary antibiotic treatment ensues.
So what can you do to help fight antibiotic resistance? Educate and empower yourself just like you are doing right now. 🙌 Try to resist the urge to rush to the doctor every time that your child has symptoms of cough, cold, congestion, and fever. It may bring revenue to the doctor’s office, but it wastes YOUR time and resources. If you feel as though your child's illness warrants a trip to the emergency room, try to select a Pediatric ER, as adult ER physicians may not feel as comfortable providing you with the reassurance that you need.
Remember, the common cold (cough, congestion, runny nose, fever, sore throat, and/or poor appetite) is caused by a viral infection. Antibiotics will not help. 💊 Antibiotics only treat bacterial infections.
Fever is NOT the enemy – dehydration and breathing difficulties are the enemies. As long as your child doesn’t appear ill and is otherwise healthy above the age of 3 months, you can try at-home techniques such as nasal saline, bulb suction, humidifiers, salt water gargles, Tylenol, Vicks v***r rub, etc.
Nursing lines can sometimes be helpful. Some lines are fantastic whereas some seem to tell nearly everyone to come into the office. This is just one example of how liability issues ruin everything. 🙄 If you express concern over the phone, you will likely be told to “come on in.” Instead, try to specifically ask for AT-HOME tips and suggestions for the symptoms that are bothering your child the most. This way, the person on the other line may feel comfortable giving you advice from afar.
Yes, this is me telling you how it is. I’m a medical minimalist at heart – a lot of pediatricians are. ⚕️ Find a doctor that saves you from unnecessary testing and treatment as often as possible.
PLEASE don’t get me wrong: It is ultimately 100% your doctor's job to limit the number of antibiotic scripts that they write. ‼️ I'm just encouraging you to be open-minded when your doc takes the time to explain the difference between a viral infection (that will get better on its own) versus a bacterial infection that requires the use of antibiotics. Hopefully what you've read here will make the process go a little bit smoother.
Sources:
Same R and Tamma P. Antibiotic Stewardship. Pediatrics in Review April 2021, 42 (4) 218-220
Zetts R, Stoesz A, Smith B, and Hyun D. Outpatient Antibiotic Use and the Need for Increased Antibiotic Stewardship Efforts. Pediatrics June 2018, 141 (6)
