Antibiotics and Medicine

May 13th 2017

Yesterday my daughter returned from school complaining of a “pounding headache”. She’d had the headache since the morning, and all day at school. I gave her some Ibuprofen, and then she went with her father – who was waiting outside in his car. I advised my daughter that ‘if the headache is still there tomorrow, go to the doctors’.

I texted my daughter’s father this morning, saying that I was worried about her after I received this from my daughter last night:

_20170513_203959

I didn’t see that text until about 1am so I didn’t text her back as she would have been sleeping. And she was with her father, I assumed that he would know if she was unwell and needing to go to the doctors or hospital. I texted him at 1.30am and sent him the above screenshot and said, ‘Worried about her after this text how is she she’d had this headache since this morning.’ He texted me back at 2am, ‘Seems OK went to bed fine’.

I spoke with my daughter this morning when I woke up at 10.30am and she told me that her head was still pounding. So I texted my daughter’s father and said ‘She’s saying she ain’t fine and she went to bed with banging head and now it’s still banging. Can u take her Dr pls.’ He didn’t reply.

I called my daughter at 1.30pm and asked her how she was. Her head was still banging. I asked her to give the phone to her father, he said he would call me back in 5 minutes, I said no I wanted to speak to him now (because he never calls or texts back when he says he will). I asked him to please take our daughter to see a doctor as her having a headache for 2 days is out of the ordinary. He said he would. I texted him the phone number for my daughter’s doctor’s surgery. It was closed. He said he would take her to the Walk-In Centre.

I called my daughter again at 3.30 to see what the doctor had said, but she hadn’t gone there yet.

My daughter’s father phoned me at 5.30pm. They had been to see the doctor. He told me that the doctor gave our daughter a throat inspection and did a temperature reading. She had a red throat and a temperature of 37.7 Degrees C.

My daughter was diagnosed with a “Viral Infection” and prescribed Antibiotics – Clarithtromycin.

I was not at all happy with this because I do not give my daughter antibiotics or other medicines unless it is absolutely necessary. I expressed this to my daughter’s father.

I asked my daughter’s father, ‘what Viral Infection has she got?’. He didn’t know – “a viral infection is just a viral infection” He said.

I asked ‘what Antibiotics has she got?’. He didn’t know.

I asked ‘What natural treatments can she have instead of antibiotics?’. He didn’t ask. And then he told me (in a dismissive manner) – ‘If I had so many questions then I should have taken her to the Walk-In Centre’… I hung up the phone. Our daughter was with him (as she is every weekend), so why would I have taken her? Unless it was an emergency, why would I also go? Why can’t he just ask these questions and let me know (and speak to me with a bit of decency)?! They are very basic questions that many parents do not even ask the doctors. They, like my daughter’s father today agree with whatever drugs prescribed to their children, without reviewing it properly. I always ask those questions and I always review medicine before giving it to my child (or myself). I want to know exactly what I am putting into my child’s body.

I asked my daughter’s father not to give the antibiotics to her. I said that I would prefer it if he didn’t give her them, and I sent him a few screenshots of information including the ones below:

Screenshot_20170513-175307

https://www.cdc.gov/getsmart/community/for-patients/common-illnesses/sore-throat.html

Screenshot_20170513-194229

Screen Shot 2017-05-13 at 21.14.18

https://patient.info/doctor/sore-throat-pro

……….

Why was my daughter given antibiotics – (drugs)?

Antibiotics target bacterial cells. They do not differentiate between the “good” bacteria and “bad” bacteria. They kill off our body’s good bacteria that is in our body’s gut and elsewhere. This can cause issues. Taking them too regularly can cause resistance, this will of course vary from person to person. Antibiotics, like any other medicine / drug should be used only when absolutely necessary. Giving children medication for ailments that they could otherwise fight naturally inhibits their natural ability to launch their ‘immune response’. When the immune response is launched the body produces antibodies – white blood cells. When the body is infected again with the same illness, the body makes the antibodies faster. I can only logically conclude that the bodies’ ability to launch it’s immune response is compromised with the misuse of antibiotics. I prefer not to interfere with the body’s natural cycles. I am a purist in that respect. There is also evidence that antibiotics cause and effect autoimmune diseases: Can antibiotics cause autoimmunity?

My daughter’s symptoms are headache (which is relieved with pain relief – Paracetamol / Ibuprofen), and a red sore throat. She also had a temperature (just about). Other than that she seems OK.

Below is some information regarding body temperature:

‘A temperature over 38°C (100.4°F) most often means you have a fever caused by infection or illness.

It is generally medically accepted that normal body temperature ranges between 36.5°C (97.7°F) to 37.5°C (99.5°F).

The average normal body temperature for children is about 37°C (98.6°F). A child’s temperature usually averages from around 36.3°C (97.4°F) in the morning to 37.6°C (99.6°F) in the afternoon.’

https://www.disabled-world.com/calculators-charts/degrees.php

 

I give my daughter pain relief medicine – paracetamol or ibuprofen, when her temperature reaches 39°C I do not give it to her before that. I regularly take her temperature when she is ill, and if it doesn’t reach 39°C, then we ride it out with plenty of rest and fluids. This is of course dependant on the situation and I am referring to every-day illness. It takes my daughter around 5 days to recover from the flu symptoms of fever, chills, tiredness / fatigue, loss of appetite, tummy ache, aching muscles, headache, coughing, sore throat, heavy chest, running or blocked nose. Flu sucks. She does not get flu often, she’s maybe had it three times (if that) in her whole life. I can remember having it a few times, not many. The last time that I had the flu I was very ill. Ah it was harsh. My throat was so sore that I found it difficult to drink water and talk, my voice was low and raspy as well. My chest was so heavy it felt like someone was sitting on top of me. I couldn’t smoke. After 5 days of being that ill, and with the onset of struggling to breath and a horrible chest pain, I went to the doctors. I suspected that I had a chest infection and I thought that I would need antibiotics. The doctor examined me. I did not have a chest infection. It was just a very harsh round of the flu. Perhaps I did have an infection but it had cleared up by the time the doctor examined me. I have not been that ill with flu before. My daughter does not receive the yearly flu nasal spray vaccination that is offered at the school. She doesn’t need it as she is in good health, she gets enough sunlight and eats healthy, freshly cooked meals. Plus I have my own opinions on the vaccine’s merits. I have read up on the flu vaccine spray, the Black Triangle Drug. It is in it’s clinical trial stages and I’d rather my daughter did not take part in clinical trials. Long-term side effects are unknown. According to the Department of Health, the flu vaccine has had a typical effectiveness of 50%. However, in 2015 it was shown to be only 3% effective in a study conducted on 1,314 patients in primary care across the UK. But the vaccine was already in rotation by 2015. It may cause flu like symptoms in as many as 1 in 10 people as it contains live influenza, albeit a weaker strain. There is a lot of misinformation that is fed to the public, to parents regarding issues such as this. Some parents will get their children vaccinated because ‘they are advised to do so’, or because ‘everyone else is doing it’, or because a governing body such as a school is promoting it. For many parents, the information is produced and given to them and they do not go and research it, they trust that the school knows what is best. The schools are no doubt pressured by other governing bodies (for health, education, etc) to promote it. I have read one head teacher’s description of the flu vaccine – ‘Annual immunisation provides important protection to individual children and also reduces the spread of flu to families and the wider community, protecting younger siblings, grandparents and others who are at increased risk of becoming seriously ill from flu.’ Which is exactly how the healthcare community describe the flu vaccine. Fair enough, some people do need protecting against influenza. But don’t those people have an annual flu shot anyway?

Perhaps the overuse of medication is the reason that we feel the need for extra protection against influenza. Perhaps if the schools were not allowing children with contagious illnesses into the school in the first place, healthy children would not be needing to have regular flu vaccines… Maybe.

Public schools say to still take your children into school if they suffer with a cold, a minor bout of the flu and other contagious ailments. I do not agree with this, and I never do take my child in when I know what is best for her. Practically none of the days that my daughter has had off due to her being ill have been authorised. Because I don’t take her to the doctors / dentist and bring in some evidence. This has gone on for years. Regulations!

Would my daughter get plenty of rest, fluids and the TLC that she needs, and has at home if I sent her to school while she is under the weather? Well…

My daughter was ill a while back with flu. I took her into school after a few days while she was not yet recovered – due to pressure from the school, and against my better judgement. The school phoned me to collect her again after a couple of hours. They did not take her temperature or administer medication. When I got her home her temperature was 39.2°C  So nowadays I most definitely will keep her home when I know that she is not well.

I am not a doctor but I am also not stupid. I don’t take her to the doctors often because I myself can diagnose a cold or the flu, thrush, worms, and other minor every-day ailments. If there are any other symptoms not relating to the every-day illnesses that I have knowledge of or it the ailment is persistent, then I will always take her to the doctor. And if I am not happy with one opinion then I get another.

It is good practise to let a fever take it’s course and to let the body fight infection without intervention of medicine. And it is a child’s right to fight illness without medical intervention and it is a parents right to make that call.

‘Advice for managing child fever:

“Parents should not give children with a mild fever regular spoonfuls of paracetamol and ibuprofen, doctors advise today, as they warn that doing so could extend their illness or put their health at risk,” reported The Daily Telegraph.

The newspaper report is based on an opinion piece written by expert paediatricians. The article is aimed at discouraging ‘fever phobia’ in parents, doctors and nurses by reminding them that there is little evidence that fever itself causes harm, and that a more important aspect of fever management is to be vigilant for signs of serious illness. The experts sensibly call for the judicious use of medications, and they highlight the greater risk of dosing problems when combined drugs are given.

The National Institute for Health and Clinical Excellence (NICE) advises against combining  ibuprofen and paracetamol to treat fever in children. It says either paracetamol or ibuprofen can be used to reduce temperature. They should not be administered at the same time or routinely given alternately. However, use of the alternate drug may be considered if the child does not respond to the first drug.

It is important that parents read dosing information carefully. With over-the-counter medicines, it is also important that the ingredients are studied to ensure that children do not receive two doses of the same drug from different preparations.

Where did the story come from?

The article was prepared by the American Academy of Pediatrics and published in the Academy’s official, peer-reviewed medical journal Pediatrics. There is no mention of external funding or support.

Although the newspaper articles are generally accurate, the headlines may give the wrong impression that current guidance for parents is incorrect or has been changed. The main aim of the AAP article was to bring attention to this issue and to challenge the current emphasis on treating fever to normalise a child’s body temperature rather than focusing on improving their comfort and being vigilant for signs of serious disease.

What kind of research was this?

This is an expert commentary prepared by the American Academy of Pediatrics. The authors, who are paediatricians (children’s doctors) discuss the issue of fever and its management in children. It is not a systematic review, which would have involved searching the global literature to identify all studies relating to the harms and benefits of antipyretics (medication to reduce fever, such as ibuprofen and paracetamol) in children. The commentary discusses when antipyretics should be used; it talks about the physiology of fever and the goals of treatment with both paracetamol and ibuprofen. It also looks at what the guidance says about the alternate use and combined use of these drugs.

What does the article discuss?

The authors introduce the topic by explaining that fever is one of the most common clinical symptoms managed by paediatricians and that it results in many unscheduled visits to the doctor, as well as telephone calls by parents for advice and widespread use of over-the-counter antipyretics. They raise their concern that as many as half of parents give the incorrect dosages of these drugs, some giving too much paracetamol or ibuprofen. They say that nurses and doctors are the most common sources of information about when to give anti-fever medicines, and that this is usually recommended when the temperature is greater than 38.3°C and to improve the child’s comfort.

What is Fever?

Normal body temperature is approximately 37°C but it can vary between individuals and it depends on where the temperature is measured. It is generally defined as an elevation of body temperature above that of normal daily variation. In research studies, it is usually more precisely defined as a temperature of 38°C or higher. Body temperature often rises in response to an infection with bacteria and viruses.

The authors of this article discuss the physiology of fever. They emphasise that fever is not an illness but a normal physiological response to infection, which in fact helps to fight infection. Fevers are often short-lived, and the severity of fever does not always correlate with how serious the illness is.

They say that there is no evidence that fever increases the risk of negative outcomes, such as brain damage. They say there is concern among some people that the effects on the body may be the same as those seen in cases of hyperthermia (severe overheating). But the authors believe that the two processes are completely different. They say that a child ‘with a temperature of 40°C (104°F) attributable to a simple febrile illness is quite different from a child with a temperature of 40°C (104°F) attributable to heat stroke’.

When to use antipyretics (such as ibuprofen and paracetamol)

The authors say that when doctors discuss the goals of treatment with parents, they should place the most emphasis on the child’s comfort and being aware of signs of serious illness, rather than focusing on normalising body temperature. The authors say there is not much evidence to suggest that using these drugs improves a child’s comfort levels, but it is likely that they do.

Paracetamol and ibuprofen are the most commonly used antipyretics. The reviewers discuss potential harms associated with higher doses. They also talk about the different practices relating to taking the drugs either alternately or in combination. They discuss research that has compared the two strategies, which suggests that combination treatment is better in terms of reducing fever but that ‘questions remain regarding the safety of this practice’. This is in line with their belief that fever reduction should not be the primary aim in treating children with fever.

What is the authors’ take-home message?

In general, the authors are highlighting ‘fever phobia’, i.e. the significant concerns of parents, doctors and nurses about the adverse effects of a fever. They say that there is no clearly established relationship between a high temperature and an increased risk of brain damage, seizures and death, which are often a major concern of parents. They say there is also no evidence that temperature reduction in and of itself should be the primary goal of antipyretic therapy.

The authors add that it is ‘critical’ to give a safe dosage of ibuprofen and paracetamol. They say that ‘there is insufficient evidence to support or refute the routine use of combination treatment with both acetaminophen [paracetamol] and ibuprofen’. Overall, they call for better advice to be given to parents, better labelling on medications and the development of simplified dosing methods and standardised drug concentrations.

Conclusion

This article was written by expert paediatricians, and its intended audience is other health professionals. The aim is to encourage a change in the thinking about fever, i.e. away from focusing on normalisation of body temperature, towards a focus on the comfort of the child, attention to signs of serious illness and avoiding dehydration. Paracetamol and ibuprofen are safe and effective for children when used at the appropriate doses. They must be used judiciously to avoid negative effects.

Although the Telegraph reports that reducing fever with drugs can actually prolong a child’s illness, such a claim is not made in this article. It is likely to have originated from one of the author’s comments, i.e. ‘limited data have revealed that fever actually helps the body recover more quickly from viral infections, although the fever may result in discomfort in children’.

Overall, the observations within this article are sensible, as are the authors’ calls to give parents better information and to shift priorities in fever management. The newspaper headlines may give the wrong impression that recommendations for fever management, or specifically for the use of particular drugs, have changed. Importantly, no new research has been conducted. Nor does the article focus on new harms or a lack of effectiveness of paracetamol or ibuprofen.

NICE recommends

  • Antipyretic agents should be considered in children with fever who appear distressed or unwell. They should not routinely be used with the sole aim of reducing body temperature in children with fever who are otherwise well. 
  • Either paracetamol or ibuprofen can be used to reduce temperature in children with fever. They should not be administered at the same time. 
  • Paracetamol and ibuprofen should not routinely be given alternately to children with fever. However, use of the other drug may be considered if the child does not respond to the first agent.’

http://www.nhs.uk/news/2011/03March/Pages/advice-for-managing-child-fever.aspx

http://www.telegraph.co.uk/news/health/news/8351085/Parents-warned-against-giving-paracetamol-and-ibuprofen-for-mild-fever.html

Quite clearly, at the moment my daughter does have an infection. Her symptoms show that. As I said, I’m not a doctor but with the knowledge that I do have, I would say that she doesn’t have an infection that requires antibiotics. And even if she does actually require antibiotics, I would not have given her any kind in the first instance (on only the second day of the infection). I would, as I did, administer pain relief for her headache. I would have given her ice lollies and throat sweets, and probably some honey and lemon for her throat. We use honey as a cough syrup, it works better than cough sweets as it contains antibacterial properties and coats the throat. Unless she has got glandular fever or another viral infection that has been identified then I would not have give her antibiotics. But as her father took her and agreed on the medicine, I will have to see it through. Not happy about it. But I will do it. His call on this one as I wasn’t there at the appointment. I have advised him, whether or not he chooses to listen to my advice is up to him isn’t it. I’m not going to go against his decision once he has made it and already given my daughter the antibiotics. That would be irresponsible of me as her parent to do that and I do not want to see me completely undermining her father like that.

The reasons that I would not give my daughter antibiotics in this instance are:

  • Her temperature is only slightly higher than her base temperature. She’d had paracetamol some time earlier, but still 37.7°C is almost normal. I advised her to ask her father for some ibuprofen as it is better than paracetamol at bringing down a temperature. And is has anti-inflamitary properties (for her throat). Paracetamol or Ibuprofen?
  • She is not having problems swallowing or drinking and eating.
  • Her tonsils are not enlarged.
  • Her glands are not swollen. Even if they were, I would still not give her antibiotics without other relating symptoms / possible diagnosis. Glands swell even with a common cold.
  • There are no white spots on her throat.
  • She does not have a rash.
  • She is not being sick.
  • She seems generally well in herself and OK.

I know myself when my daughter needs to go to the doctor and when she doesn’t. I know what to look out for and the signs of serious ill health. I do not put my child’s health at risk by using my own common sense. I have a lot of it, along with actual knowledge. I have read a lot about children’s ailments and I always read about any illness that my daughter has, and any medication that she is prescribed. So far up-to-date I have known when she needed antibiotics and when she hasn’t. I am not against using antibiotics. I am against using them all of the time for every minor ailment. I am against the over-prescribing of medication that happens all of the time.

Below is the care / management / advice that I think that the doctor at the Walk-In Centre should have given instead of antibiotics:

General Management of Sore Throat

  • Reassure people that a sore throat is usually a self-limiting condition and usually resolves with or without antibiotic treatment within a week.
  • Advise the use of paracetamol and/or ibuprofen to relieve symptoms of pain and fever as required.
  • Advise fluid intake should be adequate to avoid dehydration.
  • Advise that some people find throat lozenges, hard boiled sweets, ice, or flavoured frozen desserts (such as ice lollies) provide symptomatic relief. There is some evidence for use of some lozenges but little for benzydamine gargles and none for zinc lozenges, herbal remedies or acupuncture[8910].
  • Give safety-netting advice, advising the person to return if symptoms do not improve or are getting worse, and to seek urgent medical advice if they:
    • Develop difficulty breathing or stridor.
    • Start to drool.
    • Develop a muffled voice.
    • Develop severe pain.
    • Develop dysphagia.
    • Become unable to swallow adequate fluids.
    • Become systemically very unwell.

https://patient.info/doctor/sore-throat-pro

……….

Last month I took my daughter to the doctors because she gets constipation sometimes. I had taken her to see the doctor about this before on 20/07/2016. She was prescribed Laxido.

‘Laxido Paediatric Plain contains macrogol 3350 and the electrolytes sodium chloride, sodium hydrogen carbonate and potassium chloride.

Laxido Paediatric Plain is a laxative used for the treatment of chronic constipation in children aged 2 to 11 years. It is also used to treat a build up of hard faeces in the bowel in children aged 5 to 11 years, which may be a result of long-term constipation (this is known as faecal impaction). Macrogol 3350 makes your child’s faeces softer and easier to pass, giving them relief from constipation. The electrolytes help to maintain the body’s normal levels of sodium, potassium and water while your child is being treated for constipation.’

 The following side effects are most common: –

  •  abdominal pain
  • stomach rumbling
  •  diarrhoea
  • -vomiting
  • nausea
  • soreness of the anus (bottom)

https://www.medicines.org.uk/emc/PIL.30399.latest.pdf

My daughter experiences the abdominal pains and the stomach rumbling, but she is also at that time constipated – so I can’t say for sure that it is the medicine.

Last month I took my daughter to the doctor as she was experiencing constipation for 3 days. I told him that she does not always get constipated and that it only occurred maybe twice a month. The doctor examined her stomach and said that he could feel a blockage. He said that she may have a prolapsed bowel and for us to do more running. We have done more walking, but cannot do more running at the moment as we are both suffering the after pains of having a sprained ankle. The doctor prescribed another laxative but this time a syrup – Lactulose. When I went to pick it up, the chemist asked me ‘do you know how to properly use and administer the syrup?’… I didn’t. The doctor didn’t tell me. The chemist told me that my daughter was would take it daily, starting with a 5ml dosage then increased to 10ml and then 20ml. I was like ‘hang on, this is an ongoing treatment?’. He said it was. It was prescribed for chronic constipation. My daughter didn’t have chronic constipation, she had it maybe twice a month. I said that my daughter didn’t need that medicine and I would go back to the doctor for a review. I made a doctors appointment for my daughter after going to the chemist.

At the second doctors appointment, this time with a different doctor (we rarely see the same doctor) I explained to him why I had not taken the Lactulose for my daughter. The doctor asked about my daughter’s bowel movements. Her bowel movements had returned to normal, and had been normal since the day of the last appointment ( which was around 5 days). I told the doctor that I already had Laxido sachets for my daughters that she uses when she feels constipated, and that they help on the day – usually quite quickly. The doctor was fine with this. I asked how many sachets my daughter could take in one day. He advised 4, if needed. He advised me to change her diet to include brown rice, pasta and bread instead of white. More carrots, apples, pears, berries, raisins and popcorn. All of the things that the dentist had told me to avoid. I expressed this concern with the doctor. The doctor told me that dentists and doctors do clash a bit on that topic as berries and raisins etc are needed in a diet, but yes they do damage the teeth. The doctor said that these things are vital for fibre. I asked about bananas, he said that an apple had more fibre than a banana. He also said to give my daughter more water and for her to eat 4 satsumas a day.

I started to implement those changes to her diet. I have told my daughter’s father all of the above, but I don’t actually think that he is taking the diet change seriously.

My daughter does not have chronic constipation but she does have it now and then, flare ups maybe due to stress and anxieties that she has. ‘The goal of therapy for constipation is one bowel movement every two to three days without straining’  This is not an issue for her.

I am sure that if I were not so vigilant, my daughter would have taken much more medicine than needed. My father’s mother was always on at me to get her some antibiotics when she was a small child. Antibiotics for everything. She is unlearned, clearly. And that’s the thing, so many people are. And these very people are passing on their misinformation to others as if it were stead-fast advice. No advice is stead-fast. I research everything for myself before I come to my conclusions.

All of this is why it is important to do your own research in medications and what you are putting into your body. Just because a person works in an authority role such as a doctor or a teacher it does not mean that they always know what is best for your child. Use your head, trust your gut.

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