Posts Tagged ‘environmental health’
physical examination photo copyright istockphoto
Ear infections (otitis media) are serious business, whether you’re a parent or practitioner. Approximately 75% percent of children have one by the age of three and almost half of them have 3 or more ear infections by that age. By the age of 7, 93% of children have experienced an ear infection. This led to a total of 8.8 million ear infections in children during the year 2006, and most of those were in children 7 and under. These infections cost those of us in the US approx $5 billion dollars annually to address, and are the primary cause for childhood antibiotic prescription.
In fact, the typical situation involves an upper respiratory infection, which leads to a visit to the primary care provider. This in turn results in a peek into the ears and, quite often, a diagnosis of an ear infection as well. In some cases, the ear infection causes pain, and the child’s complaints spur the visit to the care provider. Regardless, this diagnosis usually results in a prescription for an antibiotic, and in many cases, the antibiotic of choice is stronger than the drug used to treat the previous infection. The prescription begins and within a few days, the symptoms subside and parents once again are increasingly grateful for the benefits of modern medicine.
While this scene plays out all across our country, many parents don’t realize that this standard practice is in direct conflict with evidence-based medicine, AAP guidelines, and the standard of care for ear infections across the world. Even fewer parents realize that this standard practice may be causing our children more harm than benefit.
Here’s the catch. Actually, there are a couple:
1. Ear infections are not always correctly diagnosed. According to the AAP, “The diagnosis of AOM, particularly in infants and young children, is often made with a degree of uncertainty.” (AOM = acute otitis media) Each year, thousands of prescriptions for antibiotics are written for conditions that never were ear infections.
2. Studies show that antibiotics don’t have a benefit in most ear infections. The vast majority of ear infections resolve on their own without antibiotic treatment. This takes a couple of days in many cases, and can coincide with antibiotic treatments, leading many parents to believe the antibiotic is actually curing the infection, furthering the belief that they won’t go away on their own.
3. Because antibiotics are overused in ear infections, we’re now having to use stronger drugs than we could have used in previous generations. This means more side effects and more resistance. According to the AAP, “Greater resistance among many of the pathogens that cause AOM has fueled an increase in the use of broader-spectrum and generally more expensive antibacterial agents.” For more info about the very real risks of antibiotic overuse, see here.
4. Antibiotics don’t relieve pain or distress. They will not make our little ones feel better sooner. Pain relief treatments are responsible for that. Reducing the inflammation and the accumulation of fluid will make our little ones feel better; an antibiotic does neither of those things. However, a study published in Pediatrics in 2003 does show that an herbal ear oil treatment can help to relieve the inflammation, reduce pain, and reduce the duration of the illness, faring much better than the antibiotic test group.
5. The AAP has clearly recommended since 2004 that practitioners use the “wait and see” approach for most children. Given that 61% of children naturally have decreased symptoms within 24 hours, with or without antibiotics, and that 75% of children have a decrease in symptoms within 7 days, the official recommendation is that antibiotic use be delayed for the first 48-72 hours in most children. This will dramatically reduce the use of needless antibiotics, reserving them for the small percentage of children that would receive the most benefit. Additionally, studies show that immediate antibiotic treatment does little to reduce the duration of the infection and does nothing to reduce pain or distress in the child.
So here’s the crux of the problem – why does this matter? So what if antibiotics don’t work on most ear infections and we’re using stronger antibiotics than ever before? Parents need to feel like they’re doing something and this gives the parent comfort. And after all, some ear infections do need antibiotics.
The problem is – antibiotics have risks. In fact, the risks of antibiotic treatment, according to several studies, outweighs the potential benefit. According to the studies, initiating antibiotic use at the first visit may reduce the symptoms by 1 day in between 5% and 14% of children. However, it will cause adverse effects in 5% – 10% of children, it can cause infrequent but serious side effects, and it increases the risks of antibiotic resistance. These side effects are numerous and can lead to chronic health concerns. When it takes between 7 and 20 prescriptions for 1 child to benefit, and each of those prescriptions have clear risks, the overall situation just isn’t worth it. That, coupled with the success of wait and see approaches in European countries, played a role in prompting the AAP to make those recommendations years ago.
So the keys for ear infection management include: prevention (breastfeeding!), obtaining an accurate diagnosis or having clear conversations about the degree of certainty with a diagnosis, focusing treatment measures on comfort and the natural options that have clear records of success (many natural options do not have clear records of success and some are risky), and keeping an eye on the infection for the first few days to seek advanced help if indicated. Not only does this benefit our own children, it helps to reduce the overall antibiotic load, reducing our community risks of antibiotic resistance.
Sources:
NIH Pub. No. 97-4216 July 2002
Gates GA. Cost-effectiveness considerations in otitis media treatment. Otolaryngol Head Neck Sur. April 1996. 114 (4): 525-530
Soni, A. Ear Infections (Otitis Media) in Children (0-17): Use and Expenditures, 2006. Statistical Brief #228. December 2008. Agency for Healthcare Research and Quality, Rockville, MD
Rosenfeld RM, Vertrees JE, Carr J, et al. Clinical efficacy of antimicrobial drugs for acute otitis media: metaanalysis of 5400 children from thirty-three randomized trials. J Pediatr.1994;124 :355– 367
Del Mar C, Glasziou P, Hayem M. Are antibiotics indicated as initial treatment for children with acute otitis media? A meta-analysis. BMJ.1997;314 :1526– 1529
Glasziou PP, Del Mar CB, Hayem M, Sanders SL. Antibiotics for acute otitis media in children. Cochrane Database Syst Rev.2000;4 :CD000219
Rosenfeld RM, Kay D. Natural history of untreated otitis media. In: Rosenfeld RM, Bluestone CD, eds. Evidence-Based Otitis Media. 2nd ed. Hamilton, ON, Canada: BC Decker Inc; 2003:180–198
Subcommittee on Management of Acute Otitis Media Diagnosis and Management of Acute Otitis Media Pediatrics Vol. 113 No. 5 May 1, 2004; 1451 -1465
How it all began…
To understand the issue of microbial resistance, it is best to understand this history of antibiotics and their use. So, like anything I write, we’ll start at the beginning… In 1928, a Scottish biologist by the name of Alexander Fleming (pictured above) was conducting research in a laboratory. Having accidentally contaminated one of his bacterial cultures with a fungus, he returned to work one day to find that the fungus had destroyed all of the bacteria surrounding it in the culture. “That’s funny,” he remarked, not realizing that this funny incident would soon become legendary. Alexander Fleming had discovered the source of the first modern antibiotic, penicillin. In 1929, his work was published in medical journals and the course of medicine would be changed dramatically. Over the next two decades, researchers refined his discovery, working with the chain of fungus to isolate the active principles and make it suitable for human use. By the mid 1940s, antibiotics were ready to be used in modern medicine, sparking a revolution in medicine as it was known at the time.
Suddenly, diphtheria, typhoid, pneumonia, meningitis and other horrific diseases were curable. No longer did parents have to dread the word diphtheria from their physicians – this new miracle drug could cure it. It could cure everything! When the public discovered the drug, they rushed to purchase it, and manufacturers made sure that it was readily available. It was included in cough drops, lotions, cough remedies – over the counter medicines for just about any ailment… no prescription needed!
Alexander Fleming had a problem with this. He advised that the drug should be only made available through iv administration so that it could be regulated in a hospital. If it was made available to the public, he warned, bacterial resistance would emerge. While scoffers abounded, the first documented antibiotic resistant bacterial infection occurred only a year later. Within a decade, 59% of bacterial strains isolated from sick patients were resistant to penicillin – over half!
Not to worry though! The war on infection was now won. New antibiotics began to pour out from researchers and manufacturers. With every resistant strain was a new, stronger and more harsh antibiotic. The days of dangerous life threatening infections were something of the past. Physicians began using this new tool for everything that came along – bacterial infections, viral infections, fevers, colds, anything… just in case.
So, you may wonder… where exactly is the problem? How is this a bad thing? It’s not… it’s a great advancement of modern medicine. However, it’s an advancement we may lose very soon, if things don’t change dramatically.
As Fleming warned, resistance can occur with bacteria – quickly. Bacteria have the ability to swap genes with other bacteria and they can mutate to form resistance to attackers in their environment. What this means is that when antibiotics are used widely, bacteria will learn how to thrive in spite of it – it adapts to its environment so that it is not wiped out. This can take place in a matter of minutes, but it takes researchers decades to release new antibiotics. We take far longer to come up with new ammo than it takes bacteria to come up with new resistance abilities. When this happens, if we don’t create new antibiotics that keep up with the resistance, bacterial infections cannot be cured. Global health professionals are telling us that if things don’t change, we will be thrown back to a pre-antibiotic era of medicine, where we don’t have the ability to cure bacterial infections and lives that could have easily been saved will be lost.
Consider these facts:
- For decades, an incurable bacterial infection was unheard of… it didn’t exist. Now, 19,000 individuals die annually in the United States due to antibiotic resistant infections. (25,000 in the EU)
- In the 1990s, 20 pharmaceutical companies were researching new antibiotics. Currently, there are two.
- The World Health Organization has declared that the single greatest threat to worldwide health today is antibiotic resistance … not AIDS, not famine, not malaria… antibiotic resistance.
- New stains of resistant bacteria are being discovered frequently – many worse than the previous discovery.
- Antibiotic resistant strains can be acquired from the community, not just the hospital, which means they are spreading throughout society becoming more and more prominent.
- Roughly 440,000 new cases of drug resistant tuberculosis arise annually worldwide … resulting in approximately 150,000 deaths.
- Without reliable antibiotics, routine procedures such as surgery, chemotherapy, organ transplants and similar procedures would become dangerous and risky – if possible at all.
- Almost half (49%) of our beef in the US contains drug resistant bacteria. Our poultry also contains a significant amount of antibiotic resistant bacteria.
The problem is not isolated to any specific country; it is an issue the entire world shares and the entire world will lose the benefits of antibiotics if action is not taken. The World Health Organization assures us, “No action today = no cure tomorrow.” In this series, I’m going to cover how exactly this happens, what is causing it, how it affects each of us, what we can do about it, and what happens on a large scale when we each take action. The good news is that we do have time to act… antibiotics can be saved. But now is the time to do so… not after we’ve lost the benefit of one of the greatest advancements in modern medicine.
Antibiotic resistance is a hot topic right now. We’re finding that new superbugs exist – more dangerous than the last. And we’re finding that resistant bacteria is everywhere – including our food supply! This issue isn’t a new one… far from it. We’ve been warned for years that this is a big concern – Alexander Fleming even predicted it decades ago! We teach about responsible antibiotic use and prevention of resistance in our courses – and have since the formation of the school in 2007.
So, I’m prepping a series about resistance. Just the facts… how this happens, why it’s a concern and what we can do to protect our children and their children from entering a pre-antibiotic era soon. We also have some fabulous guest posts from Elizabeth Battle, a Clinical Master Herbalist student with Vintage Remedies on some antibiotic herbs that make great options. Interested? Stay tuned… and if you have specific questions, I’m still tweaking the posts and would love to fit those answers in for you. Just leave your thoughts or questions in the comments below.
With the launch of our big new project a mere 2 days away, we’re working overtime here at the Vintage Remedies office. There are so many important details about the new program that we don’t want you to miss. So, even though we can’t tell you what it is just yet, we can give you some pointers of things not to miss when it comes out. (And you might just call these subtle hints about the awesomeness of the new launch!!)
1. Giving Back. We’ve always dreamed of having a one-to-one aspect to Vintage Remedies, but haven’t had just the right project to make that work. Now we do and we’re so excited about this feature of the new launch. So, when we make our big announcement Tuesday, don’t miss the “Giving Back” tab on the right!
2. Connections. This new launch will have its own facebook fan page, twitter page and newsletter – completely separate from the regular Vintage Remedies pages. On these new pages, we’ll post even MORE practical tips for natural living. Don’t forget to sign up, like us and follow us! (And here’s a hint – you’ll earn more entries in our giveaways when you do!)
3. Benefits. This new launch is extremely versatile! It benefits the workplace, medical professionals, families, childbirth professionals and so many more people! (Confused yet? It’ll all make sense Tuesday…) So, if you’re a medical, childbirth or wellness professional, an employer, a mom or a part of a family (that’s everyone!) be sure to click on the “Benefits” tab to see how this new launch will best benefit you and your unique needs!
4. Completely Unique. Sometimes we take a concept that’s already being done and do it better. We did that with our Herbalist courses, and are proud to offer the best available! But sometimes, we get a little creative and come up with a completely new idea that’s never been done before. Like Vintage Remedies for Girls, Guys and Kids. We love both types of projects, but this one is completely unlike anything else. Make sure you read through the description to fully explore all of the great features and components of the new launch. Trust us – having worked on each individual aspect of the project, we know there are features galore!
5. Exclusivity. We’re thrilled about this new launch and expect it to be a HUGE hit. To share our excitement, the first 25 to participate will benefit from some special savings. Unlike our previous releases where the pre-release phase was determined by a specific date, this one is restricted to the first 25, so you don’t want to delay. Plus, there are big benefits to being the first in your area… you’ll see why on Tuesday!
Excited yet? We are! We’ll be posting more giveaways soon. The next three will have a combined retail value of OVER $500! Definitely stay posted, enter the giveaways and join us Tuesday for the big announcement. We know you’ll love it as much as we do. See you then!
As promised, today’s giveaway is the week’s biggest and best. Are you ready? We’ll be giving away a $100 gift certificate that can be used towards the School of Natural Health! We have never before done anything like this and are excited about offering this one-time opportunity for the winner.
Here are the specifics: The winner will receive a $100 gift certificate towards any Vintage Remedies School of Natural Health program. Current students can use it to upgrade to another program, or for various continuing education units that we offer from time to time. For enrollments or upgrades, it will apply towards both the installment plan or the pay in full options for both the brand new Virtual Vintage Remedies and the Traditional Textbook options. (With the installment option, it will be spread evenly across the payments.) It IS transferable – so friends can enter for you to increase your chances of winning! Certificate will be awarded Saturday, June 26th and will expire on Thursday, September 30, 2010.
To enter, leave a comment below. Want multiple entries? Here’s how: You (and your friends) can get a second, third or even fourth entry by sharing the giveaway with your / their friends. Let them know on twitter, facebook and / or your blog how much you LOVE Vintage Remedies and link to the Vintage Remedies site and / or the giveaway here on my blog. (Or – you can tag @VintageRemedies on your facebook post!) Post another comment for each of the places you shared the giveaway and you’ll get additional entries. (hint: you can save time by using the “share” and “retweet” buttons below!)
(Today’s giveaway will end at midnight CDT today – June 25, 2010. A winner will be drawn from the entries and announced tomorrow morning when the next giveaway is posted.)
UPDATE: This drawing is now closed. The winner, chosen by random.org, is comment #5: Leah Hitson! Congrats! Thanks to everyone that participated! We had a blast!
