THE VIRGINIAN-PILOT
Copyright (c) 1995, Landmark Communications, Inc.
DATE: Tuesday, January 31, 1995 TAG: 9501310464
SECTION: LOCAL PAGE: B1 EDITION: FINAL
SOURCE: BY DEBRA GORDON, STAFF WRITER
LENGTH: Long : 121 lines
Seven-year-old Dakota Allosso knew what his problem was.
``Strep throat,'' he said confidently as he hopped onto the examining table at Pediatrics at the Beach.
And, after a quick look down his raw, red throat, Dr. Glenn Snyders agreed.
``Your throat is gross,'' he said. ``Looking bad there, man, real bad.''
Join the club, Dakota.
Monday started Week 3 of one of the busiest periods that pediatric offices have seen in a long time.
Strep throat. Colds. Respiratory viruses. Stomach viruses. Ear infections. They've all hit at once, spurred by a mild winter and a sudden, late cold snap, forcing pediatricians to extend their hours, forgo lunch and bring in extra doctors to cope.
``We're busy as a long-tailed cat in a room full of rocking chairs,'' said Dr. Sue Lee of Chesapeake Pediatrics Inc. In one two-hour period Jan. 23, the practice saw 47 patients, more than twice the usual number.
And while most of the illnesses are viral - meaning there's little doctors can do except prescribe rest and fluids - the onslaught has parents asking for, demanding, insisting upon, a prescription for that magic elixir, antibiotics.
But a half-century after antibiotics - the class of drugs that includes penicillin - first began to be viewed as a cure-all, doctors are taking a more cautionary approach to their prescribing.
More bacteria, including those that cause severe ear infections in young children, are resistant to antibiotics, federal disease monitors report. A study in a recent issue of the Journal of the American Medical Association warned that the use of antibiotics in doctors' offices is contributing to this resistance and will ultimately increase health care costs as more expensive drugs are needed.
Antibiotic resistance is a natural phenomenon, notes Dr. David O. Matson, associate professor in pediatrics at the Pediatric Research Center, a joint venture between Children's Hospital of The King's Daughters and Eastern Virginia Medical School. ``But it's made worse by what we do. We treat infections in part to be safe, but many times the infections are caused by things the antibiotic doesn't do anything for, because it's a virus, not a bacteria.''
Using the drugs too often, says Dr. Thomas Rubio, director of infectious diseases at King's Daughters, leads to genetic changes in the bacteria. That, in turn, requires the development of new drugs to kill these new organisms, which in time become more resistant, requiring newer, more expensive, drugs.
Ending this vicious cycle won't be easy.
Today's parents have come to expect instant relief for their children from drugs such as the pink, bubble-gum-flavored amoxicillin.
``I don't know how many times I walk into the room and hear a parent say, `I'm here because I've got to get my kid on something,' '' said Dr. Davis B. Jones, III, who works with Snyders.
Never mind that, as Snyders says, 60 percent of ear infections would clear up without the use of antibiotics.
Today's harried parents want that magic pill so they can tell the day-care center or the school that their children are on the road to recovery and ready to be readmitted.
``If you have an infection and go to the doctor and you don't get an antibiotic, you think there's something wrong with the doctor,'' said Matson. ``Every mom expects her child to get an antibiotic.''
And in some offices they do. A few doctors even prescribe them over the phone after listening to a parent list the child's symptoms.
It's a dangerous game, warns Norfolk pediatrician Robert Lehman.
``I've never yet met a mother who can give an objective opinion about her child. You cannot tell an ear infection by the symptoms. The old adage in medicine says diagnose before you treat; and the doctor that gives antibiotics before diagnosing is going down a road laden with problems.''
Even after diagnosis, some doctors hesitate before prescribing antibiotics. Snyders, for instance, after checking Mackenzie Allosso's ears and finding the 8-month-old had a double ear infection, recommended waiting it out.
``I'll write out a prescription for you,'' he told Janet Allosso as she held Mackenzie in her arms, ``but unless she starts pulling her ear, crying in the night and her appetite really drops, don't fill it.''
But he changed his tune with Dakota. The sight of that inflamed throat convinced Snyders, even without the results from the throat culture, that the 7-year-old's diagnosis was right on.
The prescription - Viaxin, an antibiotic. ILLUSTRATION: Color photos
BILL TIERNAN/Staff
Dr. Glenn C. Snyders of Pediatrics at the Beach examines the ear of
8-month-old Mackenzie Allosso as her mother, Janet, holds her.
Mackenzie was diagnosed with a double ear-infection. The doctor's
recommendation: wait it out.
Dakota Allosso, 7, listens to Snyders after the doctor determined he
had strep throat. Snyders prescribed an antibiotic called Viaxin.
Graphic
SURE SIGNS OF SICKNESS
Should you put your pediatrician's number on the redial button of
your phone and keep punching it for an hour to get through to the
office? When is your child sick enough for the doctor?
Says Dr. Robert Fink, of Pediatric Specialists:
If there's any question about whether the child has the flu,
bring him in. Even if you know it's the flu - fever, headache,
muscle pains, coughing, sore throat - there are some medications now
that can relieve the symptoms and the contagion if started early
enough.
Sore throat and fever without the muscle aches could be strep
throat, and the child needs to be seen.
A virus typically doesn't last longer than seven to 10 days. If
``cold symptoms'' hang on longer, then the child may have a
low-grade sinus infection or allergies and should see the doctor.
Contrary to what most parents think, a child with yellow or green
mucous doesn't necessarily have a sinus infection. Studies have
shown it's not uncommon to have this colored drainage during a viral
illness, like a cold, and that the mucous clears up on its own
without the need for medications.
by CNB