How to use antibiotics safely and wisely

Since the first discovery of penicillin, antibiotics have been a useful and beneficial tool in fighting a wide variety of bacterial infections. But antibiotics must be used wisely and safely and only used when medically necessary in order to get the most benefit from them. For the last decade or more, health care professionals have been concerned because antibiotics have been over-prescribed, overused and misused for so long that many of them are losing their ability to fight illnesses. Many types of bacteria have already become resistant to some of the older “first-generation” antibiotics making them almost useless against some illnesses. New antibiotics are being developed but bacteria can adapt and become resistant to them to them too, if they are not used carefully. Doctors are trying to their part to stop antibiotics from being overused by not prescribing them unnecessarily. We can help, too, by learning more about these “miracle drugs” and how to use them properly and safely.

What Do Antibiotics Do?

Antibiotics fight bacteria. (Think of them as “bacteria-busters”!) There are many different kinds of bacteria that cause many different illnesses. Because of the wide variety of bacteria, there is also a wide variety of antibiotics that have been developed to treat them. When your doctor diagnoses a bacterial infection she will determine which antibiotic is appropriate for that particular infection.

If your doctor diagnoses a bacterial infection, ask her if it is absolutely necessary to use an antibiotic. Some bacterial infections can be cleared up without antibiotics when under a doctor’s supervision. For example, antibiotics used to be routinely and automatically prescribed for ear infections in young children. However, research has shown that many of these infections can heal on their own without antibiotics as long as a doctor is monitoring the infection. Talk with your doctor about the necessity of using an antibiotic, the pro’s and con’s of using one versus not using it, then follow her advice and directions.

Not all infections are bacterial. Most common, minor illnesses are caused by viruses. Viral and bacterial infections may share some of the same symptoms but they are very different infections and must be treated differently. If your doctor diagnoses a viral infection, it is unwise to pressure her into giving you a prescription for an antibiotic because antibiotics are useless against viruses. It would be a waste of money and would contribute to the problem of resistant bacteria due to antibiotic misuse.

When You or Your child is Prescribed an Antibiotic

The questions that you need to ask your doctor include:

• The name of the medicine (both brand name and generic name)
• The amount to be given (dosage)
• The times to be given (schedule)
• Possible side effects
• Potential drug interactions with any other medicine you are taking
• When to call or come back in if symptoms have not improved

Be sure that the doctor is aware of any other medications (including over-the-counter medications and herbal supplements) that are being used. If the antibiotic is for your child, ask about the taste and if it can be mixed with juice or food to disguise a bad taste. (We have been blessed with a pediatrician who tastes tests medicines so he can be honest with his patients about whether they are yucky or not. And if he has a choice of what to prescribe, he gives them the best tasting one.)

When You Go to the Pharmacy

Ask the pharmacist to give you written instructions on:

• When to take the medicine (schedule)
• How long you need to take it for (most of the time you will continue until all of the antibiotic is gone)
• How much to take (dosage)
• Side effects

Also ask whether or not the medicine:

• Can be taken with or without food
• Needs to be refrigerated
• Needs to be shaken well (if a liquid)
• Can be mixed with food or liquid to disguise a bad taste

Make sure the name of the medicine and the amount and times to be given on the label match what your doctor told you. Liquid medications need to be measured precisely, ask for a measuring device if you don’t have one. If other medications/supplements are being used, tell the pharmacist and ask about drug interactions. Some medications can be dangerous when mixed.

Taking or Giving the Antibiotic at Home

When giving or taking the antibiotic at home, make sure to stick as closely as possible to the scheduled times. If a dose is missed, do not double dose. If it is almost time for the next dose, then do not take the skipped dose, just take the next one on time. If it is still a few hours until the next dose, take the skipped one and then adjust the time to take the next one accordingly. If two or more doses have been skipped, call your doctor for instructions. Always call the doctor or pharmacist if you have questions.

Be sure to use a medication measuring cup, dropper, or oral syringe for liquid medications. Kitchen teaspoons and tablespoons can vary widely so don’t use them to measure medicine. (I wonder how many times we got the wrong dose when our moms gave us medicine using kitchen spoons?) Do not cut pills in half or crush them unless you have been told to or have checked with the pharmacist first because it could alter the effectiveness. Do not mix the antibiotic with juice, milk, or anything else to make it taste better unless the pharmacist says that it is okay to do so because certain antibiotics have to be taken on an empty stomach. Also, calcium and vitamin C can lessen the effectiveness of some antibiotics.

Always finish all of the prescribed antibiotic unless the doctor has instructed otherwise. Just because the symptoms may be alleviated after a few doses and you feel better, it does not mean that the infection is completely gone. Not finishing an antibiotic allows the remaining bacteria to learn how to adapt to the antibiotic and become resistant against it.

Side Effects

Common side effects of most antibiotics include: mild diarrhea, nausea, abdominal discomfort, and headaches. All antibiotics have the potential for side effects but that does not mean that every person will have the same ones. Most of the time, side effects are mild. If you have side effects that are moderate to severe, contact your doctor or pharmacist. Don’t stop using the medication without checking first. If your doctor instructs you to stop taking the medicine before it is finished, throw out the remaining amount. Do not save it for another illness.

Storing Antibiotics

Keep antibiotics (and, of course, all other medications) out of the reach of children. Put them in a cool, dry, dark, safe place or if it needs refrigeration, put it on the highest refrigerator shelf. Bathroom medicine cabinets are exposed to too much humidity which can lessen the effectiveness of some antibiotics.

If you have leftover antibiotics in your medicine cabinet, do not use them. Using or giving an antibiotic to one person that has been prescribed for another person can be very dangerous, even life-threatening. You would not have a full course of treatment and the antibiotic may not even be effective against the specific bacteria causing your illness. Instead, ask your pharmacist how to properly dispose of any leftover antibiotic. Do not throw any medicine in the trash because small children and pets could have access to them there.

When All the Medicine is Gone

Hopefully you will be feeling much better by the time you have finished all of your antibiotic. If, however, your symptoms haven’t cleared up and you are still feeling sick, call your doctor. She may want you to come back in for a re-check visit or she may call in a different, stronger antibiotic for you.

These guidelines are of a general nature and not intended to replace the advice and supervision of your physician or pharmacist.

Pediatricians urge food manufacturers to reduce choking hazards

In a policy statement published in the March issue of Pediatrics, the American Academy of Pediatrics (AAP) calls upon food manufacturers to reduce choking risks for children. Pediatricians want manufacturers to make foods that are known choking hazards safer by changing the size, shape, and/or texture of high risk foods. They also request labeling of such foods with a warning about the potential for choking. Foods such as hot dogs, carrot sticks, grapes, peanut butter, and many others fall into the high risk category because of the frequency of choking incidents among young children involving them.

Hot dogs can be especially dangerous for young children under the age of 3. The size and shape, along with the ability to compress easily can cause the complete blockage of a child’s airway and can be lodged in too tightly to remove, even with proper medical equipment. According to the AAP policy statement Choking on food causes the death of approximately 1 child every 5 days in the United States. Hot dogs accounted for 17% of food-related asphyxiations among children younger than 10 years of age in a 41-state study.

Whether food manufacturers heed the call to re-design high risk foods or not, parents and child care providers must take responsibility for protecting children against choking on any food. Here are some recommended tips for helping your child eat safely:

• Cut up food into small pieces, no more than 1/2 inch in diameter.
• Do not feed children under the age of 4 any hard, smooth, round or firm foods that have to be chewed with a grinding motion without cutting them up into small pieces. Peanuts, grapes, hot dogs, and carrot sticks must be cut up first.
• Do not let children eat while playing, laughing, walking, or running around.
• Teach your child to chew food thoroughly and to swallow before talking.
• Do not feed popcorn, nuts, or hard candy to children under the age of 4.
• Learn CPR and how to appropriately and safely assist someone who is choking.

Summer’s Lifeguard

On October 13, 2006, at just 21 months old, my daughter, Summer was diagnosed with acute myelogenous leukemia (AML). Because AML is fatal without treatment (and even with treatment the overall survivor rate is low), Summer began intensive chemotherapy within hours of the diagnosis. The treatment process lasted over six months, with the majority of the time spent in-house at Children’s Medical Center in Dallas, Texas.

As part of her treatment, Summer had a central venous catheter (CVC) surgically implanted in her chest, through which, she received her medicine and treatment. Less than a month into treatment, my husband Brad discovered that part of Summer’s CVC was twisting, which could cause the tube to break, and bring about serious complications including the need for additional surgery.

After several unsuccessful attempts by the caring pediatric oncology nurses at Children’s Medical Center Dallas, to find a remedy, Brad and I realized we needed to design our own solution. During this time, Summer’s CVC broke twice within two days. (After three breaks surgery is required to implant a new central line catheter!) I contacted a family friend, Karen, a retired nurse who is also a sewer, and together we developed Summer’s Lifeguard™, a Central Line/Port Wrap.

The primary concerns were minimizing the risk of infection (due to no immune system) and avoiding additional surgery, by ensuring Summer’s (CVC) was out of her reach. The unique design literally wrapped the lines of the CVC around her body, with padding and soft fabric that cushioned Summer to make her more comfortable and allowed for her mobility. Karen, as a nurse, added some unique features that provided easy access to the lumens for administration of medicine, and color coded tabs that matched the lumens for easy identification by hospital staff and caregivers. Four drafts later, we finally settled on a design that met all of Summer’s needs. And now we have designed a version that is universal enough to fit any child regardless of where their CVC is implanted on their chest.

Although Summer reached remission in May of 2007 and enjoyed a wonderful summer, she relapsed in November 2007. Summer completed a bone marrow transplant in January 2008. She is facing many challenges, specifically chronic graft versus host disease (GVHD), but today I am blessed to say she is a happy, active pre-schooler.

When Summer was originally diagnosed, I would tell her that she was a soldier of God, and her “armor” included her entire family and friends, her medicine, and all the doctors, nurses, and specialists treating her. Summer’s Lifeguard is an important part of this soldier’s armor in her fight against cancer.

Due to the interest by other parent’s of critically-ill children and through the encouragement of the nurses and doctors at Children’s Medical Center, Karen and I have formed a company called SIYA, Inc, located in Texas. The mission of this company is to provide medical protection with safety garments and other devices for patients, while providing peace of mind for families. After three attempts, Summer’s Lifeguard received clearance from the FDA in May of 2009 as a class I exempt medical device which means that hospitals can carry Summer’s Lifeguard and nurses can determine if a patient needs the device.

We’re thrilled to know that through our efforts, we can now give other parents of critically-ill children a little peace of mind and comfort to their child.

HEALTHFUL HINTS

If your child has a central line or portacath, here are some things to consider:

• Have your nurse use a Biopatch on the exit site of the central line or port as another precaution. (According to Ethicon 360’s website: “Catheter-Related Blood Stream Infections (CRBSI) are the 10th leading cause of death in the United States.”
• Have the dressing changed weekly around the exit site of the catheter.
• If your child develops a rash, examine what kind of tape is being used for the dressing, many children develop sensitivities to the tape.
• When using Summer’s Lifeguard:
  • Have your child lay down on their back to put on the wrap.
  • If your child is a transplant patient, you will want to put on a clean wrap daily (…therefore, it may make sense to have at least one extra wrap available).

Signs of Leukemia:

Believe it or not, it is different for everybody, and it sometimes may seem minor, like a cold that just won’t go away. To that note- if your child is experiencing symptoms of illness or a cut/scrape, or unusual and a lot of bruising, that won’t go away- have a Complete Blood Culture (CBC) done right away.

Dear Santa…Please Keep My Family Safe

Every year children all across the country and the world make lists to Santa. Wishes for new bikes and dolls and don’t forget the very latest toy. Childhood wishes and childhood dreams. Every year though children are poisoned by holiday plants; are electrocuted by holiday decorations. Parents die in drunk-driving collisions.

As a paramedic my partner and I responded one Christmas morning to an unknown medical. When we arrived we walked past a Christmas tree completely surrounded by presents as well as two young children eagerly awaiting both parents arrival so the day’s festivities could begin. The husband met us and led us to the master bedroom. Mom was dead- had died several hours earlier. The holidays are hard times for many people even people with love, and family and friends. Some people make choices during the holiday they might not make during other times of the year. There was nothing we could do and not a more helpless feeling we could feel.

What’s amazing to me is that this call was over 20 years ago. I had no other involvement that what I stated yet I still remember it- every Christmas season. The children would be grown by now. I bet that they too still remember. I bet they still feel different about Christmas than do many of their friends.

I bet if those kids could go back in time their wishes would simply be to have Mom with them for many more years to come. So please place safety at the very top of your Santa list. As adults we need to assure the health and safety of our kids and we can’t afford a break over the holiday season.

The lyrics of one of my favorite holiday songs perhaps say it best.

My Grown Up Christmas List

….”As children we believed
The grandest sight to see
Was something shiny
Wrapped beneath the tree

But heaven only knows
That packages and bows
Can never heal
A hurting human soul

No more lives torn apart
That wars would never start
And time would heal all hearts
And everyone would have a friend
And right would always win
And love would never end

Oh, This is my grown up Christmas list”

Keeping Kids Safe: Common (and Not So Common) Choking Hazards

Keeping kids safe is top on the minds of most parents, but sometimes hazards are just not that obvious. Introducing foods to infants and toddlers can be great fun, but it also brings opportunities for danger. A little knowledge about how to avoid choking can go a long way in avoiding serious emergencies.

I wrote in a previous post about using pixie stix to get kids to take their medicine. I am going to co-opt this old favorite treat for our lesson about choking hazards. What does a powdered candy have to do with choking hazards, you might ask?

The text and photo from this blog demonstrates that kids can make nearly anything into a choking hazard:

“Looks like fun, right? Probably. But a tube of powdered candy of that size might as well be a loaded gun. It’s frickin dangerous. I know.

When I was thirteen and tried putting the whole mega-Pixie Stick worth of flavored sugar in my mouth, I laughed and inhaled and the moisture in my throat hardened the sugar into a moist sugar ball lodged squarely in my trachea.

One my friends knew the Heimlich maneuver and managed to dislodge the bright blue coagulation into a psychedelic pool of vibrantly scarlet regurgitated Big Red Cola. It was the [last] time I touched either Pixie Stix or Big Red.

It wasn’t my time but I think, when I’m ready, that is exactly how I want to go.”

I love this post for several reasons…

1. This photo is a pediatrician’s nightmare.
2. That someone could avoid impaling himself with the sharp plastic tube but instead manage to obstruct his trachea with powdered candy is a mark of real talent. It’s amazing that we have any children left unharmed.
3. I love the word “frickin” and will try to use it as often as possible in this blog and in my real life. Not to worry, I will avoid using it around kids.
4. Speaking of near-death-by-food, I almost poked my eye out with a loaf of bread once. That story will probably never make it into this blog, so contact me directly if you’re interested. It is as embarrassing as it sounds….
5. Though the Olympics was more than a year ago, swimming boys still make me think of Michael Phelps. I love Michael Phelps. I’m not the only one.

Seriously though, while pixie stix are not usually cited as top choking hazards, choking is a real hazard for children, and food is the number one culprit.

It’s amazing what a mostly-toothless little one can manage to eat. Starting at about 9 months of age, babies can begin to manage foods of a variety of textures and shapes. But remember, kids less than 4 years old may not chew, grind, or gum food well and are at great risk for choking. The most common choking hazards are round firm foods (hot dogs, grapes, nuts, popcorn), and sticky/gooey foods like peanut butter or sticky snacks and candies. Chunks of uncooked vegetables and fruits can also make their way down the wrong tube. Candy and gum top the list of foods that send choking children to the emergency room.

Tips for Parents:

How can you prevent choking? Here are a few tips…

• Take an infant and child CPR class: if you did not take one before your child was born, try to do so by 6 months of age, before your little one starts solids. If you have taken the class, review the course materials as a little refresher.
• To avert the need to perform these life-saving maneuvers on your child, avoid potentially hazardous food until your child is four to five years old. Cook foods well or cut firm foods into pieces less than 1/2 inch in size.
• Give your child small portions, adding to his plate as he finishes.
• Make (and enforce) a household rule that all food is eaten at the table. In a chair. And no eating while running (with scissors). Or playing. Or lying down. Or in a car (or a bus or a taxicab or hot air balloon).
• Limit distractions (tv, pets, games, clowns) at mealtime.
• Watch out for “chipmunking”: hoarding food in the cheeks of an eager eater. Kids really do this.
• Keep helpful older sibs from feeding the little one. They will not provide the same level of supervision that you will.
• And most importantly, NEVER leave a young child alone while eating.

Useful Links:

• For more ideas on avoiding choking on foods and other objects, check out this tip sheet from the AAP
• And since food is not the only thing that your kids can choke on, the Consumer Products Safety Commission gives good information about recalls on toys and tips for avoiding choking on toys.

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