Diplomate, Board Certification of Emergency Medicine
More letters. If I am against the random use of antibiotics, so what conditions really do and do not need them?
Otitis media -- an ear infection -- is a situation which generally is viral and in the Netherlands they never use antibiotics. Most physicians make this diagnosis randomly without truly knowing how to tell if it is viral or bacterial. If no air is blown in the ear with a special instrument than the diagnosis is in doubt.
Sore throat with cough is probably not strep. In the USA many physicians do not use antibiotics even for strep. In Israel, complications do occur, so we do use them, but penicillin is enough.
Sinusitis is generally viral; unless they look very sick, pass on the antibiotics. Bronchitis and upper respiratory infections do not need antibiotics.
Most diarrheas do not need antibiotics. They may help if there is bleeding and fever, but they only reduce the symptoms for a day. Mastitis after birth needs antibiotics, but nursing should be continued. Urinary tract infections can cause scarring, so antibiotics are used there. Skin infections do need antibiotics, and erysipelas, known as shoshana here in Israel, needs antibiotics.
Bee stings rarely get infected and do not need antibiotics. Bites of cats, dogs and humans do need, but children who bite usually do not need antibiotics. Abscesses need to be opened and antibiotics will not help here.
Diabetics are special cases and do need antibiotics although that may not be enough.
I do not use antibiotics in conjunctivitis of the eye in allergic reactions. For teeth I prefer to treat rather than use these, but many do not.
Patients with gallbladders that are infected and with appendicitis will get antibiotics, as well as women with fever after birth and a possibility of infected womb. Meningitis, which is due to bacteria, needs urgent antibiotics, but often they are not enough.
In general, the antibiotic with the narrowest spectrum should be used. Using a high-powered antibiotic that kills everything can kill the good bacteria in the body. It is like killing a mosquito with artillery. And remember: most patients want their doctor just to listen while many physicians think their patients just want antibiotics. Write me in care of the Yated.
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