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Sometimes the Safest Prescription is “Wait and See”

Categories: Antibiotic use, Antimicrobial Resistance

Adam L. Hersh, MD, PhD

Adam L. Hersh, MD, PhD

Guest Author – Adam L. Hersh, MD, PhD
Assistant Professor of Pediatrics
Division of Pediatric Infectious Diseases
University of Utah

Get Smart About Antibiotics Week is a great opportunity to call attention to a priority that we all share: preserving the effectiveness of antibiotics for the future. Doctors and other practitioners on the front-lines of ambulatory care may become frustrated when they hear the way they practice medicine is partly to blame for the urgent threat of antibiotic resistance.

For those of us working in ambulatory care settings, it is a really busy and demanding job, and for many patients with upper respiratory tract infections (URIs), it’s hard to know who has a bacterial infection and who doesn’t. This year, Get Smart About Antibiotics Week is featuring the publication of Principles of Judicious Antibiotic Prescribing for Pediatric Upper Respiratory Tract Infections in the journal Pediatrics. It discusses the importance of diagnostic certainty and reviews the clinical criteria practitioners should use when determining the likelihood of a bacterial infection.

There are established and stringent clinical criteria that should be applied to justify an antibiotic prescription for the key URIs in pediatrics that are potentially caused by bacteria. Many bacterial URIs will resolve on their own without antibiotic treatment. And the serious and justifiably feared complications of URIs (such as mastoiditis as a complication of otitis media) usually cannot be prevented by early antibiotic therapy anyway. All of this is important to consider as our understanding continues to grow about the harms antibiotics can cause.

Antibiotic overuse not only contributes to increased resistance but also avoidable adverse drug events including serious allergic reactions, cardiovascular problems and chronic conditions such as eczema, asthma, inflammatory bowel disease and obesity. Doctors want to do what is safe and in their patients’ best interests. When there is a considerable degree of uncertainty regarding the diagnosis for patients with URIs, sometimes the safest thing to do is to “wait and see.”

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