I recently read 2 medical articles regarding drugs and side effects; I have touched on that subject frequently. We are lucky in the modern world to have many treatments available to address all kinds of medical problems that our ancestors had to simply endure. However in reality each drug does have inherent risks; it’s imperative to use them in a cautious, thoughtful way. The 2 articles looked at 2 very commonly prescribed medications–antibiotics and steroids.
The 1st study found a significant correlation between antibiotic use with subsequent acute appendicitis. In 1.4 million children and 12,000 cases of appendicitis, the results were striking: a relative risk of 1.72–almost double — after one course of antibiotics. There were 3 other important findings: greater risk with “broad spectrum”(ie, more potent) antibiotics, a steadily increasing risk with each additional course of antibiotic treatment, as well as additional risk to children treated < 6 mo of age. The authors point out that this study only chronicles an “association”–they did not establish an exact “cause and effect” relationship, nor any specific mechanism to explain the association. But the data is clear, and troubling.
The second article looked at almost 2.5 million young, healthy adults receiving short courses of oral steroids and found a significant risk of GI bleeding, heart failure, and blood infections(sepsis) in those patients in the month after treatment compared to the 3 months prior. While not specifically looking at children, these young adults developed problems well known as risks of steroids, so “cause and effect” is well established here–what is new is the high risk of complications with even very short course of treatment.
Previously I’ve referenced articles noting the tendency of urgent care centers to overprescribe antibiotics. While that article did not mention steroids, my personal observation over the course of 35 years in practice is that unfortunate trend of too liberal prescribing holds for steroids as well. We should note that, with steroids, there are usually good, safer alternatives–including inhaled or topical forms, other safer non-steroidal drugs, and–not infrequently–no medicine at all.
In the world of covid, going to the ER or urgent care center must be measured carefully against the risk of exposure to serious infections there. My office now offers covid PCR testing (most insurance covers the cost) that has shown to be approximately 90% accurate. The turnover is usually +/-24 hours; those tests with faster turnover times tend to be less reliable. Usually, its safe to wait for regular office hours to assess your child’s condition and send the more accurate test from there. As we know, there is no specific treatment for covid anyway.
So give me a call if you are concerned about corona. We can address the issue together, decide if testing is appropriate, avoid unnecessary exposure (we usually do the testing right in the parking lot!), and, I am confident, avoid overprescribing for your child as well. Of course, in the event that the situation seems potentially more serious when we talk, I’ll help you there as well.
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