Having kids has shown me how much of medicine is about incentive alignment, rather than doing no harm. Every time one of my kids gets an ear infection, pinkeye, or a sore throat, my daycare requires a doctor’s note and antibiotics to be given before they are allowed back in daycare. The urgent care doctors always prescribe antibiotics, even though the most likely cause is viral and most bacterial infections resolve within 3-5 days with or without antibiotics. I had one case where the strep test was negative, and the doctor still prescribed antibiotics because it could be a false negative. And my kids are allowed back in daycare after 0-24 hours depending on the diagnosis, even though the medicine takes 3-5 days to work.
I was shocked to go through this the first time, after reading so much about the over-prescription of antibiotics. But doctors would rather write a prescription than explain the evidence to stressed parents and daycare providers. And daycares all copy each others’ policies, because nobody wants to admit that kids are just contagious snot-monsters and medicine can’t really help.
It’s pure theatre, at the expense of kids’ health (antibiotics do a number on the digestive system) and leads to antibiotic-resistant strains. But at least nobody ever had to stop and have a difficult conversation.
That's crazy. I have small kids and the doctors never give antibiotics. They just say it's something viral and to give Tylenol / Ibuprofen to treat discomfort. The daycare doesn't have any rule like that either they just check for fevers and they have to stay out until no fever for 24 hours. When one was really sick with croup they gave him some steroids but that's it. We have even switched doctors 3x and always been the case.
Yeah, my kids have had what feels like every illness under the sun, and I can count on one hand (maybe one finger?) the number of times we’ve been given antibiotics. They’re in public school, which may have something to do with it, but the rule has always been 24 hours sans fever with no antipyretics and you’re good to return. Sorry to hear that the parent poster has encountered such bizarre rules, that’s pretty lame.
Wow, I’m shocked (and heartened) to hear that your experience has been so different. Maybe it’s just the area I’m in or my healthcare provider. I always expect to be told “it’s a common cold, get the kid some rest and leave urgent care to the real illnesses” but I’ve literally never had that happen.
Definitely varies by country. In Czechia, they give antibiotics only after three days of fever or symptoms that strongly hint at bacterial infection. And they usually do at least a CRP test, often a cultivation.
The daycare rules here vary place by place, though. Some of them just check for fever, some don't like running noses.
I am on the west coast in the US, and my kids’ pediatric group almost never gives antibiotics. They typically tell me over the phone not to bother coming unless it has been a very high fever or multiple days of worsening symptoms.
Only antibiotics we have had were after they looked in ear and said the redness and pus indicated bacterial as well as the color and consistency of conjunctivitis discharge.
And around here, daycares do not require any doctors’ note. They just tell you not to bring your kid in if they have fever or vomiting or diarrhea within the last 24 hours.
I go to Palo Alto Medical Foundation in the Bay Area, literally down the street from Stanford. If there were any region I would expect to follow evidence-based practices I would expect it to be them.
There is damn good reason for that. Wife is a doctor, although not a pediatrician. There are some long term stats that if kid receives antibiotics before age of 1, the risk of getting diabetes later in life jumps by at least 30%.
We have tons of doctors as friends, most work in biggest hospital in Switzerland (HUG in Geneve), and all with small kids adhere to this and try to steer away from atbs as much as possible. Its not some quack unproven theory.
Thats just 1 specific situation, you can deduct that atbs do quite a mess in those little bodies and it doesnt stop with age of 1.
If you meant even adult people dont get atbs automatically, thats also is great approach especially longterm. Most infections dont need them, they do more harm than good in the body. But uneducated folks that suffer seek literally anything that can help them, some basic medical facts be damned, so doctors sometimes give up and give atbs to obnoxious patients. Then there are of course those bacterial infections where they help, but they are rather small % and usually not the most severe ones.
Meanwhile here in Vietnam (and I guess for most of the developing world) I can walk into a pharmacy and ask for any medication they have available, including antibiotics, and they'll hand it over, no prescription needed.
I've heard this is slowly changing in the big cities but I'm not holding my breath.
From a friend who was involved in health care analytics decades ago, they'd frequently find that specific norms of healthcare practice depended highly on senior medical personal (e.g., a head physician within a department), and that you'd find major differences in standards both at different-but-comparable groups and at the same group following a major personnel change (retirement, moving elsewhere).
Another friend doing roving-doctor work at a number of smaller clinics and facilities described wildly different standards amongst physicians specifically regarding antibiotic prescriptions (my friend resisted prescribing them without specific indication, other doctors offered them as a default).
As with many other aspects of the world, what we observe directly is very much through a drinking straw (if you can find one of those any more): it's a very narrow view. This doesn't mean your experience is invalid or even infrequent. It does mean that it's likely not especially generalisable.
That said, what seems to change overall behaviours most is standards and norms being applied through policy, whether institutional (think Kaiser in California) or at the governmental level (government-offered services, etc.). Thought comes to mind that much of the US is now experiencing the negative aspects of that last, as with many tools, it can cut both ways.
Must be specific your region. Not my experience around Atlanta.
Around here common illness kids can come back after 24 hours of symptom free (daycares dont ask how they became symptom free). Super contagious like pinkeye requires doctors note that it's not pink eye, or put on a treatment plan.
> bacterial infections resolve within 3-5 days with or without antibiotics.
Citation needed
I do worry about overuse of antibiotics but I know a lot of times it just doesn't "go away without", or the viral infection ends up evolving to a bacterial one
Though what the doctors should do is give the prescription but say just to take it if the situation doesn't improve. This way you save a return to the doctor if it doesn't get better.
I don’t have any citation, but if you google bacterial ear infection or strep throat you’ll see that it’s true. And my pediatrician agrees with me, even if the urgent care docs don’t mention it.
Yes, but even your link says that complications are uncommon. I’m not advocating waiting until you’re on death’s door, but isolating and waiting 2-3 days to see if you’re getting better is fine.
> The urgent care doctors always prescribe antibiotics, even though the most likely cause is viral
This is irresponsible, tackling AMR is a WHO priority and local guidance (e.g. NICE, I don't know about the states - is it ICER? the CDC?) should reflect this and steer away from "just in case" antibiotic prescriptions.
I was shocked to go through this the first time, after reading so much about the over-prescription of antibiotics. But doctors would rather write a prescription than explain the evidence to stressed parents and daycare providers. And daycares all copy each others’ policies, because nobody wants to admit that kids are just contagious snot-monsters and medicine can’t really help.
It’s pure theatre, at the expense of kids’ health (antibiotics do a number on the digestive system) and leads to antibiotic-resistant strains. But at least nobody ever had to stop and have a difficult conversation.