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MRSA in Infants (ER)

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Wednesday, February 11th, 2009 Emily Halevy | CWK Producer

“The younger we are, the less immunity we have. When we’re first born we have no immunity whatsoever to viruses, bacteria or any other organism.”

– Michael Ziegler, M.D., Children’s Healthcare of Atlanta

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“Okay Allison, it’s okay!” Dr. David Goo says to calm the crying child.

One-year-old Alison hurts and she has a high fever.

“She had a rising, or a boil, on her right buttock area,” explains Dr. Goo of Children’s Healthcare of Atlanta.  “And you could tell that it was hard, and warm, and red, and very, very painful. As well as, it had some pus inside of it.”

Six-week-old Riley has a similar boil just above her lip.

“I guess basically she had exposure to MRSA is that correct?” Michael Ziegler, M.D., also of Children’s Healthcare of Atlanta, asks the girl’s parents.  “And then started to develop these little pus lesions over her face and then got redness.  Has she had any fever at all?” “Nope,” her mother says.

Both girls are infected with M-R-S-A, methicillin resistant staph- a dangerous germ that is becoming more common.

But there is one factor that makes this bacteria even more dangerous for infants like Riley.  Their age.

“The younger we are, the less immunity we have,” explains Dr. Ziegler.  “When we’re first born we have no immunity whatsoever to viruses, bacteria or any other organism.”

That means it will be difficult for her small body to fight the infection and, in turn, it can quickly move into her blood stream.

“Once it gets into her blood stream it can also get into her central nervous system.  And each, each subsequent area of the body that it gets into is more and more serious,” Ziegler says.  “But the minute it goes from a simple superficial infection into the blood stream, especially in a baby, you’re talking about something that is potentially life-threatening.”

Riley is admitted to the hospital for several tests, including a spinal tap to be sure the infection hasn’t spread.  Then like Alison, doctors will drain the infection and give her antibiotics. 

The doctor says these germs are everywhere today and hard to avoid.  But for newborns, this advice: “Try to avoid the child having contact with too many people during at least the first month to two months of life.”

What We Need To Know

“One of the world’s most pressing public health problems” – that’s how the Centers for Disease Control and Prevention (CDC) classifies the growing resistance of bacteria to treatment by antibiotics. The CDC says “smart use” of antibiotics, rather than widespread overuse, is the key to controlling the spread of resistance. Antibiotics are used to treat bacterial infections responsible for many childhood illnesses. They were discovered in the 1940s, increasing dramatically our ability to fight diseases and infections. But according to Health Canada, inappropriate use of antibiotics in recent years has allowed many forms of bacteria to become resistant to these drugs. Germs are able to adapt and change according to their environment, so when antibiotics are taken inappropriately, the weaker germs are killed, while the stronger, more resistant ones survive and multiply, making it difficult for antibiotics to fight them the next time an infection occurs.

Consider the following statistics provided by the American Academy of Pediatrics (AAP) concerning the increase in antibiotic use:

  • According to a 1980 study from the Boston University School of Medicine, 4.2 million prescriptions were written for the oral antibiotic amoxicillin to treat ear infections. In just over 10 years, that number grew to more than 12.3 million prescriptions (an increase of 194 percent).
  • Prescriptions of another common oral antibiotic, cephalosporins, increased 687 percent during the same time.
  • It is estimated that 30 million prescriptions were written for ear infections alone in 1998.

Antibiotic resistance poses the risk of significant suffering and danger for children – and adults – who have common infections that were easily treatable with antibiotics at one time. Most children hate taking medicine. It tastes gross and smells funny. Many kids spit much of it out and do not receive the appropriate dosages. What parents may not realize is how dangerous this can be and how it contributes to the epidemic of drug and antibiotic resistance.

The U.S. Food and Drug Administration (USFDA) offers the following information regarding drug resistance:

  • Tuberculosis, malaria and childhood ear infections are a few of the diseases that have become resistant to antibiotics.
  • About 70 percent of bacteria that causes infections in hospitals are resistant to at least one of the drugs most commonly used to treat infections.
  • Some organisms are resistant to all approved antibiotics and must be treated with experimental and potentially toxic drugs.
  • Research has shown antibiotics are given to patients more often than guidelines set by federal and other healthcare organizations. Patients sometimes ask their doctors for antibiotics for a cold, cough or the flu, all of which are viral and do not respond to antibiotics. Also, patients who are prescribed antibiotics but do not take the full dosing regimen can contribute to resistance.

More than half of pediatricians surveyed said “parental pressure” contributed to oral antibiotics overuse. Dr. Richard Besser, medical director for the CDC’s National Campaign for Appropriate Antibiotic Use, says up to 40 percent of antibiotics prescribed in doctors’ offices are for viral infections, which are not treatable with antibiotics. How can parents help prevent antibiotic-resistant infections? According to Dr. Besser, …

  • Talk with your child’s pediatrician about antibiotic resistance. Ask whether or not an antibiotic is likely to be beneficial for the illness. Also, ask what else can be done to make your child feel better sooner.
  • Don’t give your child antibiotics for viral infections like the cold or flu.
  • Don’t save some of the antibiotic for use the next time your child gets sick.
  • Make sure your child takes the antibiotic exactly as prescribed.
  • Don’t give your child an antibiotic that is prescribed for someone else.

By not taking all of their medication, either because they spit it out or simply refuse to take it, children could jeopardize the future effect if the same antibiotic is prescribed again. Before convincing your child to take their medicine, it is important to understand exactly what the medicine is treating. The FDA suggests asking the following questions before leaving the doctor’s office:

  • What is the drug and what is it for?
  • Will this drug cause a problem with other drugs my child is taking?
  • How often does my child need to take this medicine?
  • How many days or weeks does my child need to take this medicine?
  • What if I miss giving my child a dose?
  • How soon will the drug start working?
  • What side effects does it have?
  • What should I do if my child gets any of these side effects?
  • Should I stop giving the medicine when my child gets better?

After you determine what the prescription is and how the medication should be administered, you then need to figure out how to get your child to take it. Experts from the Public Broadcasting Station’s Children’s Hospital recommend the following strategies:

  • Be sensitive, but be the boss – It is important to acknowledge your child’s feelings and let him/her know you know he/she does not feel well. But, at the same time, the treatment is non-negotiable.
  • Offer choices whenever you can – Allow your child to make some decisions, such as what he/she would like to drink with his/her medicine or when he/she would rather take his/her medicine (i.e., before or after school). By providing some choices, your child will feel like he/she has some control over the situation.
  • Make the medication taste better or easier to swallow – Keeping liquid medication cold may help it go down easier. Also, ask your pharmacist if you can add flavoring with juice or food. Honey may do the trick, but pediatricians advise against feeding honey to children under one.
  • Give medications at the same time and in the same place – It helps to create a designated spot in your house for giving medicine, preferably not your child’s room. This puts the treatment of the illness in perspective, so it doesn’t take over your house – and your child’s life.
  • Choose clear, age-appropriate words when you speak – Since many children interpret things literally, the specific words you use to describe your child’s treatment are very important. Some words may scare children and make them more resistant to treatment. Older children will want and need a full explanation to ensure their participation or to start treating themselves.
  • Praise the child for accepting the treatment rather than blaming him/her for the illness – Many children will feel responsible for getting sick or injured. It helps to remind them they did not cause this, and then praise them for following the treatment plan.
  • Explain how the medicine will help your child get well – Adults sometimes assume that a child knows what medicine and treatments can accomplish. But young children generally do not understand this connection. To excite a child about getting well, you might compare how he/she used to feel to how he/she feels now – and remind him/her of the activities he/she could not do yesterday that he/she can do today.
  • Listen to how a child feels and assess his/her illness accordingly – If a child says he/she is not feeling well, the first thing you should do is acknowledge it and take it seriously. Ask your child how he/she feels and how badly it hurts. This will allow you to determine the seriousness of the condition.
  • Avoid physical struggles to force a child to cooperate – While being firm, it is also essential you do not physically struggle with your child while trying to get him/her to take the pills.
  • Let another adult take over – For kids who are truly resistant, parents should divide up the responsibility of who gives the medicine or supervises the treatment. This gives one parent a necessary break, and helps the child realize that both parents are capable of handling this. For example, if one parent never does this, the child might think he/she does not know how to do it.

If just swallowing a pill is the problem, consider these tips provided by Fairview Health Information:

  • Put the pill in your child’s mouth and have him/her fill up his/her cheeks with water, swallowing as few times as possible. The pill should go right down.
  • Put the pill under your child’s tongue and have him/her drink water in gulps from a cup. The pill will often slip out and go down undetected.
  • A thicker liquid like milk may make pills easier to swallow, but ask your pharmacist first.

Resources

  • American Academy of Pediatrics
  • Centers for Disease Control
  • Children’s Healthcare of Atlanta
  • Children’s Healthcare of Atlanta Emergency Services
  • Children’s Hospital – PBS
  • Fairview Health Information
  • Health Canada
  • U.S. Food and Drug Administration

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