Question

In: Nursing

Dr. Wilbur, a physician in your practice group, has recently retired. You have inherited several of...

Dr. Wilbur, a physician in your practice group, has recently retired. You have inherited several of his patients. You are seeing one today: Aaron Phillips, age 6, who is accompanied by his mom, Sally. Aaron is suffering from an URT infection. From the signs and symptoms, as well as the negative results from a rapid strep test, you conclude that it is a viral infection. You suggest to Sally some decongestants and antihistamines that are appropriate for Aaron to take to offset his symptoms. Sally becomes confused and a little upset and asks for antibiotics because that is what Dr. Wilbur “always prescribes when Aaron gets sick.”

How would you respond to Sally’s request for antibiotics? Provide patient education on what to do for worsening symptoms.

Expert Solution

HOW TO RESPOND TO SALLY’S REQUEST FOR ANTIBIOTICS

Sally should be explained the following to make her understand about why antibiotics should not be given to treat viral infections and the harmful effects of antibiotics resistance.

Overuse and inappropriate prescribing of antibiotics worldwide is leading to the global healthcare issue of antibiotic resistance.

One cannot use an antibiotic for a viral infection because they are ineffective and may lead to “antibiotic resistance”.

Antibiotics cannot kill viruses because viruses have different structures and replicate in a different way than bacteria.

Antibiotics work by targeting the growth machinery in bacteria (not viruses) to kill or inhibit those particular bacteria.

Most viral illnesses do not need special medication and are “self-limiting”, meaning our own immune system will kick in and fight off the illness.

However, this can take time; a cough and cold can last from 7 to 10 days.

Viruses are structurally different from bacteria. Viruses live and replicate inside of a human cell, they cannot live outside of a human cell. Viruses insert their genetic material into a human cell’s DNA in order to reproduce.

Antibiotics cannot kill viruses because bacteria and viruses have different mechanisms and machinery to survive and replicate. The antibiotic has no “target” to attack in a virus. However, antiviral medications and vaccines are specific for viruses.

Antibiotic treatment of upper respiratory tract infection (URTI) does not alter the clinical outcome of the illness or prevent further complications. Antibiotics may also have side-effects - eg, diarrhoea, vomiting and rash.

Sometimes, in complicated or prolonged viral infections, bacteria may invade as well, and cause what is known as a “secondary bacterial infection”. In these cases, doctor may prescribe an antibiotic, to kill the specific invading bacteria, but the antibiotic is not being prescribed for the virus.

Using antibiotics for a virus:

Will not cure the infection
Won’t help you feel better
Will not prevent others from catching your virus

PATIENT EDUCATION ON MANAGEMENT OF WORSENING SYMPTOMS OF UPPER RESPIRATORY TRACT INFECTION

Explain that there are no drugs of proven benefit for the prophylaxis or treatment of the common cold, although many have been suggested. Medical management is centred around providing symptomatic relief.
Provide advice about the usual natural history of the illness and average total length of illness is 10 days.

Ensure adequate fluid intake.

Address any underlying concerns. Educate that colds are self-limiting and have no specific curative treatment may reduce anxiety and prevent unnecessary visits to the doctor in the future.
Advise adequate rest but that there is usually no need to take time off school and work.
Advise hygiene measures to reduce spread: frequent hand-washing, avoiding sharing towels and toys, etc.
Advise about self-care and over-the-counter measures which may help with symptoms

Steam inhalation - eg, by sitting in the bathroom while running a hot shower. Beware of the risk of scalding, particularly in young children.
Vapour rubs applied to the back or chest.
Gargling with salt water.
Sucking boiled sweets or sore-throat lozenges.
Nasal drops (sodium chloride 0.9%) for nasal congestion.
Decongestants and Antihistamines should be given as prescribed.
Educate to return to the hospital if the kids symptoms are worsening, or if they have not improved after two weeks. Early review should be made if they there are any symptoms of dehydration, if there is persistent fever or if there is difficulty breathing.

The kid should be also avoided close contact with others(eg, hugging, kissing) and avoid sharing towels and flannels. Discourage from sharing toys with other children.

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