Printer-Friendly Version

Forward to a Colleague

Permission for Use

Misuse of Antibiotics

Antibiotics Misuse Case 2

Mrs. Davis brought Stephen, her 2-year-old child, to our Friday evening pediatric walk-in clinic.  We had a fairly busy evening and had been hurrying to get everyone properly seen before the 8 pm closing time.  Mrs. Davis brought Stephen in because of fever and irritability.  I am the clinic's pediatrician for the evening and have not previously seen this patient or his mother.

The child has mild nasal discharge for two days and developed a fever of 100.6° F last evening.

The mother, an intelligent woman who is employed as a laboratory technician, says she had a bad night last night with the child awake and crying.  She held and walked him most of the night, but this helped only a little.

He has been refusing his usual solid foods, but took adequate amounts of milk and juices and continues to have wet diapers.  The child is sitting on her mother's lap, sucking vigorously on his pacifier and regards the examiner with a mixture of interest and suspicion.

In the course of the examination, he produces a moderate amount of yellow-green nasal discharge.  He has an occasional cough and cries when we examine him.  His examination is normal; there is no sign of dyspnea and the lungs are clear to auscultation.  The abdomen is normal.  There is no rash.  The child has a simple upper respiratory infection, assuredly viral in nature.  His illness does not meet well-established criteria for sinusitis or possible invasive bacterial disease.

Mrs. Davis appears tired and has dark circles under her eyes, not smiling during the entire visit.

With gentle warmth, I let her know, I am glad to tell you this seems to be nothing more than a "bad cold" (I say bad to match what I think is her perception of it).  Fortunately, there is no sign of ear infection, pneumonia, or other serious illness for her to worry about.  He can have acetaminophen (e.g. Tylenol) if he is fussy with his fever, but otherwise the fever is helping him fight this infection.  Saline nose drops or even a single drop of infant decongestant nose drops are good to clear his nose if he has trouble eating or breathing during the night, as long as you're careful not to use them more than once or twice.

"I have nose drops and tried Tylenol last night and it didn't touch him," she says with fatigue and a touch of anger.   She has never before worked with me and I find in her face no sign of trust or confidence in my judgment.  "Can't you give him an antibiotic?  I just can't have another night like last night!"

I think there is now a note of fear in her voice, as well.

Should I provide her with the antibiotic?  If I don't, will she go to another physician who will?  What would you do?