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RESISTING ANTIBIOTICS



When Professor Alexander Fleming noted the powerful effect of penicillium notatum mold on a lab dish of staphylococcus bacteria back in 1928, a new era in medical treatment was born. Infected wounds and previously life-threatening or debilitating illnesses, including many childhood diseases, soon became treatable—and survivable—as scientists developed a range of powerful antibiotic drugs. For those of us raising families now, the magnitude of this advance is difficult to imagine or overstate. Yet less than a century later, these medical gains are under threat.

The reason? Antibiotic resistance.

Antibiotic resistance refers to the ability of disease-causing bacteria to combat and survive exposure to our life-giving antibiotic drugs. There may be several reasons why this resistance has developed, and these will be explored in more depth in a future post. Parents and other caregivers, however, should understand that major factors in the development of antibiotic-resistance organisms are generally considered to be 1) overuse and incorrect use of antibiotics—that is, taking antibiotics when the illness does not call for it (in the case of viral infections, for instance, which are not affected by antibiotics) and 2) incorrect use of correctly prescribed antibiotics (for example, not finishing the course or not sticking to scheduled times for taking the medicine).

When disease-causing bacteria develop resistance to several antibiotic drugs, we refer to them as “superbugs.” Some strains of bacteria that cause serious illnesses such as tuberculosis have become superbugs, requiring newer and more powerful antibiotics to stop them. The difficulty is that scientists have been unable to develop new traditional antibiotic drugs as quickly as resistance is developing. The presence of superbugs means that we may soon find ourselves in an era that very much resembles the pre-antibiotic age, when many lives were lost because wounds and bacterial illnesses could not be treated effectively. This is already the situation with certain superbugs such as MRSA (methicillin resistant Staphylococcus aureus), which media reports often refer to as the “flesh-eating” bacteria.

Here in Kenya—where most anyone can walk into a pharmacy, order any antibiotics desired and take them without receiving any advice or supervision from a doctor to ensure their correct use—resistance is a growing problem. It is vitally important that we understand the threat that individual actions of this nature, multiplied many times all over the country, pose to the health of everyone here. The subject of antibiotics use is multifaceted, and we’ll be covering it in a series of posts inspired by parents’ response to our recent article on scarlet fever. To safeguard the effectiveness of antibiotics for situations when they are vitally needed, we really should be thinking in terms of using these powerful drugs less often. This article from an American pediatrician, Dr. Wendy Sue Swanson, explains why.

Still not convinced?

Here, Dr. Swanson explains exactly when antibiotics do (and don’t) help.

THE SCOOP ON SCARLET FEVER

Not even a century ago, a scarlet fever outbreak was news that frightened parents. Normally, a sore throat is something children shake off in a few days or a week. In the case of scarlet fever, which is caused by the streptococcus A bacteria, the illness can cause such complications as ear infections, sinusitis, skin infections, throat abscesses, pneumonia, kidney disease and arthritis if the bacteria spreads. In rare cases, scarlet fever progresses to rheumatic fever, an inflammatory condition that may affect major organs including the brain and heart.

Fever and a sore throat, often very painful and bright red, usually are the first symptoms in a child with scarlet fever. Your child may experience other flu-like symptoms (nausea, vomiting, headache and more general aches and pains). Scarlet fever, however, has two distinguishing symptoms that make it stand out from other childhood diseases.

The first is a red, flat rash that appears a few days after the first symptoms and eventually becomes a rash of small bumps that give the skin the texture of sandpaper. On darker skin, the rash may not appear red, but the rough texture is an indicator of strep. The rash may spread over most of the body.

Scarlet fever also causes changes to the tongue. It’s often very swollen, red and covered in a whitish film and may have a bumpy appearance like a strawberry.

Other reddish discolorations of the skin may occur. When the infection clears, the affected skin of your child’s toes, fingertips and groin area may peel for as long as several weeks.

Children with scarlet fever may be quite uncomfortable for some days. Because the throat and tonsils may be very red and swollen, swallowing can be painful and difficult. Some families find that cold drinks or even ice cream can numb the pain and make swallowing easier. As with other illnesses, fever and achiness may be treated with paracetamol.

Fortunately, scarlet fever is easily cured with antibiotics, but testing and diagnosing the strep infection is key. This is done quickly via a simple throat swab and culture to identify the streptococcus A bacteria. Antibiotic treatment is required in the case of a positive strep culture. Children usually are prescribed a 10-day course of treatment in syrup form. Antibiotics will help to alleviate uncomfortable symptoms and also reduce spread of the illness to others. Because of resistance problems, you should never attempt to treat your child with antibiotics without visiting and obtaining a prescription from your pediatrician.

Strep germs spread easily via droplets (from sneezing and coughing), sharing of glasses, plates and implements, or occasionally from contact with someone else’s streptococcal skin infection (impetigo). A simple way to stop the spread of scarlet fever is to insist that schoolmates, friends and family members use individual dining implements, baths, towels, clothes and bedding. Washing hands thoroughly with soap, particularly when there is an outbreak, is also important to prevent others getting sick.

UNDERSTANDING VACCINES: HPV (GARDASIL, CERVARIX)

As parents, we face a number of unfamiliar vaccine options. Because we didn’t grow up with some of the newer vaccines or learn about them in school, they are not always well understood. And, since some of these vaccines often are not part of national immunization schedules, a lot of parents wonder how necessary they are or if the extra expense is cost effective.

Over the next weeks and months, we’ll be posting about some of these newer immunizations. We’ll start today by sharing some basic information about the HPV (human papillomavirus) vaccine. The HPV vaccine was first licensed for use in 2006 and has been available in private clinics in Kenya for several years. You may have heard that the government recently launched a countrywide drive to vaccinate all Kenyan schoolgirls of a certain age against HPV.

HPV is an extremely common sexually transmitted virus—the world’s most common sexually transmitted infection (STI), in fact. Most of the time HPV causes little trouble, which is why you might not know much about it. Some strains of the virus, however, are responsible for the majority of cases of cervical cancer—that is, cancer of the neck of the womb. Of all cancers, cervical cancer is the second most common cancer in Kenya and the type that kills the most women here. Worldwide, the number of deaths attributable to this disease is more than 275,000 annually, and East Africa has the highest incidence of invasive cervical cancer in the world.

The cost of the HPV vaccine is certainly far lower than either the cost of treating precancers and cervical cancer in its curable stage, which depends upon early detection via PAP smears, or the losses to families and the economy when women succumb to the disease at a more advanced stage. It’s worth remembering, also, that HPV contributes to infertility, since a woman who survives aggressive cervical cancer may be unable to bear children due to treatment. In the brief time since it became available, the HPV vaccine has been responsible for some very impressive health outcomes.

Most of the vaccinations administered to babies and children protect them against diseases that could appear at any time during childhood and strike younger children particularly hard. It’s somewhat unusual for a vaccine to protect against a disease that may not affect a child for many years to come. Yet, that is the case with the HPV vaccine, which is recommended for both girls and boys from the age of nine. This is because the vaccine provides the strongest immunity when all three doses are administered well before a young person becomes exposed to the live virus through sexual activity. By vaccinating your child early, you ensure that she or he is as fully protected as possible well before sexual debut, no matter when that happens to occur.

Parents of boys may be confused about vaccinating against HPV when it is said to be the cause of a cancer that only women get. Simply put, unvaccinated boys grow into unvaccinated men who will one day contribute to spread of the virus. In addition, certain strains of HPV cause genital warts as well as some cancers (penile, anal, mouth and throat) that do affect males. These cancers, although statistically much rarer than cervical cancer, are still worth guarding against.

We hope we’ve raised your interest in protecting your children, especially daughters, with the HPV vaccination series. We’re pretty sure we’ve also managed to raise a few more questions in your mind. For this reason, we’ve prepared a fact sheet about HPV immunization. The fact sheet will shortly be posted on our Facebook page and will be come a permanent part of our website.

If you have additional questions, or to schedule an appointment to immunize your child, please speak with the clinic nurse on 254 722 519 863 or 254 733 668 517. You may also email reception@muthaigapediatrics.co.ke