If there is, is there also one for unanticipated consequences to be given with it?

I have a young son who had tubes put in his ears at 10 months. It seemed like he had one big long ear infection from about 3 months (when he entered daycare) until 10, when the tubes went in (and yes, I breastfed). He was constantly on anti’s, and I was sick of it, but didn’t know how sick I should’ve been (and wanted to sleep again), so we went with tubes.

Now he still gets ear infections, but we put drops in, which are combo antibiotic/steroid (ciprodex), after his ears leak.

I try to avoid getting oral antibiotics, but the doctors seem to prescribe them–even if I don’t ask. If they prescribe–should I ask if I could wait? What if my son has been sick for a month? Should I ask for something simpler, like amoxicillian, versus augmenten?

Uh, sorry for all the questions. I’ve just never found a community that questions it like this. I’ve always had doubt in the back of my mind, but I wasn’t sure what to do with it. Would love other opinions.

I also have my AP kids read a great article in the ecology section published in either Scientific America or Natural History which argues that we should treat and manage our antibiotics in the same way as any other natural resource.

Just so you know that I’m trying on my end

I haven’t taken an antibiotic since the 10th grade (and I’m almost 40) either.

A FM resident now doing internal, I am shocked at how the IM people treat levaquin as first line for pneumonia. Erythro, people. It’s 33 cents a dose! And it works!

On the upside, if you check out the stats for MRSA, cultures show it’s quite often sensitive to one of the simpler, older antibiotics.

All you can do is what you can do. There are others working to reduce indiscriminate abx use.

You seem to be in an impossible position, it’s hard to practice good medicine when the only way to keep you job is to practice bad medicine.

As an urgent care physician, I am getting pressure from my employer, the hospital administrator, to prescribe unnecessary antibiotics in order to make patients “happy” and thereby increase volume and revenue in the urgent care. He is also unhappy that I am not prescribing narcotics, thereby losing potential patient revenue and visits from drug seekers. I never expected that I would lose my job because I was trying to practice good medicine. I am being blamed for the decreased volume in our urgent care because of these issues, in spite of having nothing but positive feedback from patients both verbally and on patient surveys.

And I think it’s important to keep it that way. Protocols and guidelines are fine, but I don’t pray to them.

Here’s another consideration: patients in randomized, placebo-controlled studies are at least getting the benefit of a placebo effect. I’d like to see a study comparing outcomes between a Z-pak prescription and a “sorry, you get nothing but a 6 hour wait and a huge bill discussion.”

Like with narcotic-seekers, if a patient is convinced they need some medication to feel better then that’s pretty much what they are going to require.

Maybe we should bring back placebos.

Re sinusitis: per Hardwood-Nuss, antibiotics are reserved only for cases not improving after 7 days duration.

But I feel like we’re nitpicking. It would be foolish to say that patients with bronchitis or sinusitis NEVER need antibiotics, but most of the time it is my opinion that they do not. I think there are practitioners who overprescribe for these conditions, and I think it would be beneficial if they stopped.

Finally, I discuss the watchful waiting thing for otitis in kids (and parents) in which I think it would be appropriate. But for all I know, every single mom could be heading straight from the ER to the pharmacy.

Thanks for your comments, it’s always a good thing to reread and think hard about why I’m doing what I’m doing. I think I remember someone telling me one time that obviously there’s more than one way to do this job

Oh, and just so all of you know, in vet school they do push the public health aspect of antibiotic therapy for animals. We unfortunately have plenty of MRSA and MRSI in the VMTH.