Doc's please - antibiotics question
Discussion
My 9 month old has a rather serious ear infection, has done for a good 3 weeks now. Last week the doc prescribed him a 5 day course of amoxycilin (sp?).
He still seemed to be in pain this morning so the wife popped him back down there, the doctor confirmed that one ear is still swollen and bright red, the other just "inflamed pink" (or in other words, exactly the same as before the antibiotics)
Doc then said that she didn't really want to prescribe more antibiotics as it could be viral and just disappear on it's own, she also noted a swelling in his face and suggested it could be blocked glands. Parting decision was "I'll give you another prescription for antibiotics, just in case you feel he needs them".
WTF? SHE's the medical professional, how are we supposed to decided if he needs them or not?!
Pharmacist has said that a second course of antibiotics that close to the first (and of the same type, strength etc) is utterly pointless.
So WTF do we do? (other than find a new docs to register at...) Is it bad practice to give a second dose without clue if it's going to help or not, is there any point in giving a second dose so soon after a first course has given no visible gain?
He still seemed to be in pain this morning so the wife popped him back down there, the doctor confirmed that one ear is still swollen and bright red, the other just "inflamed pink" (or in other words, exactly the same as before the antibiotics)
Doc then said that she didn't really want to prescribe more antibiotics as it could be viral and just disappear on it's own, she also noted a swelling in his face and suggested it could be blocked glands. Parting decision was "I'll give you another prescription for antibiotics, just in case you feel he needs them".
WTF? SHE's the medical professional, how are we supposed to decided if he needs them or not?!
Pharmacist has said that a second course of antibiotics that close to the first (and of the same type, strength etc) is utterly pointless.
So WTF do we do? (other than find a new docs to register at...) Is it bad practice to give a second dose without clue if it's going to help or not, is there any point in giving a second dose so soon after a first course has given no visible gain?
Davi said:
WTF? SHE's the medical professional, how are we supposed to decided if he needs them or not?!
By asking the interweb?Oh
Seems a bit odd to me, perhaps she gave you another prescription because she thought that's what you wanted. As far as giving them to miniDavi, I wouldn't. If the first lot didn't work then the second are unlikely to and it'll just result in diarrhea. Second opinion?
If both ears are affected, then the likelihood is that he has a viral infection. Very uncommon for both ears to get a bacterial infection (otitis media) at the same time. Its a nightmare for them, but Calpol and Ibuprofen, together with plenty of fluids, is about all you can do. It will run its course.
And, with the greatest respect to the poster above, A+E is most definitely NOT the answer. You will not get stronger antibiotics, nor will you get stronger analgesia.
An A+E doc is no more likely to do anything more than a GP will. They don't just give IV antibiotics because they can....
Edited to add that the Ibuprofen strength should be 100mg in 5ml suspension as he is only 9 month old.
And, with the greatest respect to the poster above, A+E is most definitely NOT the answer. You will not get stronger antibiotics, nor will you get stronger analgesia.
An A+E doc is no more likely to do anything more than a GP will. They don't just give IV antibiotics because they can....
Edited to add that the Ibuprofen strength should be 100mg in 5ml suspension as he is only 9 month old.
Edited by LMC on Tuesday 6th January 17:18
Davi said:
Parting decision was "I'll give you another prescription for antibiotics, just in case you feel he needs them".
WTF? SHE's the medical professional, how are we supposed to decided if he needs them or not?!
Pharmacist has said that a second course of antibiotics that close to the first (and of the same type, strength etc) is utterly pointless.
So WTF do we do? (other than find a new docs to register at...) Is it bad practice to give a second dose without clue if it's going to help or not, is there any point in giving a second dose so soon after a first course has given no visible gain?
My first move would be to ask the doctor what the hell she is playing at, not the interweb.WTF? SHE's the medical professional, how are we supposed to decided if he needs them or not?!
Pharmacist has said that a second course of antibiotics that close to the first (and of the same type, strength etc) is utterly pointless.
So WTF do we do? (other than find a new docs to register at...) Is it bad practice to give a second dose without clue if it's going to help or not, is there any point in giving a second dose so soon after a first course has given no visible gain?
A, A second dose of the same thing will do nothing.
B, As you say, SHE is the expert, not you, so why does she leave it up to you to decide whether to administer the useless drugs??
C, Ask that doctor herself if you can see another doctor who is prepared to make a decision on what is happening, rather than fob you off.
There, that is my professional opinion as a mechanic.
My 11 month old daughter has been in a very similar situation. Tried a course of amoxycillin which didn't work, then a longer course of lower strength antibiotics (pyre......... something or other!) in a bid to get rid of the infection over a longer period of time as it was doing the rounds between ear and nose. That seemed to be working, until NYE when her ear 'popped' again and some more yucky stuff came out. Just seen the docs again today and he's said no more anitbiotics, and is instead referring us to the ENT unit at the hospital so they can do further checks/observation.
Unfortunately I wasn't at the consultation this time, just the wife - otherwise I'd have been having words with the Doc rather than asking here. Wife would normally have been a little more 'aggressive' with her questioning but the 3 weeks of zero sleep have left us both a bit apathetic
Apparently Doc also reckons that his face is slightly swollen on one side so it could be a salivary gland or the mumps?! Nothing like some vague answers with no definitive course of action suggested...
Wife has just been to the pharmacist, who suggested that the first course was unusually short so it wouldn't hurt to continue with a second up to the more "normal" course length, but agreed it did seem unlikely if the first lot hadn't worked the second lot would have any affect.
Apparently Doc also reckons that his face is slightly swollen on one side so it could be a salivary gland or the mumps?! Nothing like some vague answers with no definitive course of action suggested...
Wife has just been to the pharmacist, who suggested that the first course was unusually short so it wouldn't hurt to continue with a second up to the more "normal" course length, but agreed it did seem unlikely if the first lot hadn't worked the second lot would have any affect.
Pharmacists frequently give advice on areas of medicine they have little or no knowledge of, I would recommend discussing things with your doctor rather than listening to them.
Edit to add - LMC is spot on about A&E but the ibuprofen comment is a little misleading, 100mg is not the dose to give a 9 month old. LMC is just referring to the concentration, not the dose, read the label carefully!
Edit to add - LMC is spot on about A&E but the ibuprofen comment is a little misleading, 100mg is not the dose to give a 9 month old. LMC is just referring to the concentration, not the dose, read the label carefully!
Edited by Sevo on Tuesday 6th January 18:05
If both eardrums are red and inflamed it's likely to be a viral infection and will settle of its own accord. If this is the case then repeated courses of antibiotics won't help and could cause more harm than good (as the normal gut bacteria are killed off and Davi Jr gets diarrhoea making him feel even worse!).
The question is where do you go from here....
What you could do is go to A+E and explain what has been happening and tell the A+E doc that the swelling is a new phenomenon that wasn't there when the GP saw him. A+E docs like to see new signs and symptoms (not those that have already been seen by a GP and treatment initiated) so it's worth presenting this swelling as a new sign. You could also report that Jr's now feeling somewhat under the weather and isn't eating, but more importantly drinking as much as he was. (The most important thing with kids is that they drink adequately and that their nappies are as wet as they used to be and their urine isn't too concentrated. As long as they're drinking then they can get over most bugs on their own.)
Your access to ENT will probably be easier via the A+E route than via your GP. If ENT is on-site then they may come down and see Jr, alternatively you may get an emergency clinic appointment (usually to be seen within 48 hours), or alternatively you may see a switched on A+E doc who is happy to deal with the problem to your satisfaction, and generally that means explaining what the problem actually is and what is likely to happen over the next day or so.
You mustn't feel fobbed off by the doctor that you see, ultimately it's the squeaky wheel that gets the oil and if you have genuine concerns about Jr then go and seek help. Children get priority in A+E and some have a dedicated A+E for children so you shouldn't (touch wood) have to wait too long if you decide to go down this route.
Ultimately, if you have concerns, seek assistance. Even reassurance is worth its weight in gold.
The question is where do you go from here....
What you could do is go to A+E and explain what has been happening and tell the A+E doc that the swelling is a new phenomenon that wasn't there when the GP saw him. A+E docs like to see new signs and symptoms (not those that have already been seen by a GP and treatment initiated) so it's worth presenting this swelling as a new sign. You could also report that Jr's now feeling somewhat under the weather and isn't eating, but more importantly drinking as much as he was. (The most important thing with kids is that they drink adequately and that their nappies are as wet as they used to be and their urine isn't too concentrated. As long as they're drinking then they can get over most bugs on their own.)
Your access to ENT will probably be easier via the A+E route than via your GP. If ENT is on-site then they may come down and see Jr, alternatively you may get an emergency clinic appointment (usually to be seen within 48 hours), or alternatively you may see a switched on A+E doc who is happy to deal with the problem to your satisfaction, and generally that means explaining what the problem actually is and what is likely to happen over the next day or so.
You mustn't feel fobbed off by the doctor that you see, ultimately it's the squeaky wheel that gets the oil and if you have genuine concerns about Jr then go and seek help. Children get priority in A+E and some have a dedicated A+E for children so you shouldn't (touch wood) have to wait too long if you decide to go down this route.
Ultimately, if you have concerns, seek assistance. Even reassurance is worth its weight in gold.
The doc probably thought it was under the threshold for more antibiotics, but being so young, children go downhill so quickly that another prescription has been issued to provide cover (stop bacterial infection taking hold even where a virus is responsible for the problem) should she get worse.
My Dr often provides a delayed prescription or provides a prescription and leaves it up to me to decide if I really need to take it. Often knowing you have a prescription should things get worse allows the anxious patient to get better naturally without the need to use the antibiotics.
My Dr often provides a delayed prescription or provides a prescription and leaves it up to me to decide if I really need to take it. Often knowing you have a prescription should things get worse allows the anxious patient to get better naturally without the need to use the antibiotics.
A&E=Accident and Emergency, it is, as the name suggests, there for accidents and emergencies not for earache. GP's can access ENT casualty clinics as easily as A&E can. Abuse of the A&E service helps no-one.
It is likely that the GP is more senior than the person you see in A&E and almost certain that they have seen more earaches, if you are not happy with the service from your GP make an appointment with someone else in the practice and explain your concerns.
It is likely that the GP is more senior than the person you see in A&E and almost certain that they have seen more earaches, if you are not happy with the service from your GP make an appointment with someone else in the practice and explain your concerns.
Sevo said:
A&E=Accident and Emergency, it is, as the name suggests, there for accidents and emergencies not for earache. GP's can access ENT casualty clinics as easily as A&E can. Abuse of the A&E service helps no-one.
It is likely that the GP is more senior than the person you see in A&E and almost certain that they have seen more earaches, if you are not happy with the service from your GP make an appointment with someone else in the practice and explain your concerns.
Yeah, nice on Sevo, good advice It is likely that the GP is more senior than the person you see in A&E and almost certain that they have seen more earaches, if you are not happy with the service from your GP make an appointment with someone else in the practice and explain your concerns.
While GPs may be able to access ENT emergency clinics many aren't actually aware of the process of how it's done. In the meantime, while appointments are being made with other GPs in the practice there's still a 9 month old kid (and his parents) who need sorting out. If parents are concerned about their children then in my opinion it's perfectly reasonable for them to seek medical help in any way, shape, or form (including the A+E department). I don't want to get into a dick-swinging competition but the majority of gasmen haven't served their time in A+E, they were too busy sux racing, moaning about their on-call room or trying to unravel the mysteries of the Sun crossword! Would you seriously think that the parents of a 9 month old child were wasting your time if they came to see you (if you can imagine the horrors of leaving the anaesthetic ivory towers and putting yourself in the shoes of a Cas Officer) because they wanted reassurance?
SiH said:
Your access to ENT will probably be easier via the A+E route than via your GP. If ENT is on-site then they may come down and see Jr, alternatively you may get an emergency clinic appointment (usually to be seen within 48 hours), or alternatively you may see a switched on A+E doc who is happy to deal with the problem to your satisfaction, and generally that means explaining what the problem actually is and what is likely to happen over the next day or so.
You mustn't feel fobbed off by the doctor that you see, ultimately it's the squeaky wheel that gets the oil and if you have genuine concerns about Jr then go and seek help. Children get priority in A+E and some have a dedicated A+E for children so you shouldn't (touch wood) have to wait too long if you decide to go down this route.
Ultimately, if you have concerns, seek assistance. Even reassurance is worth its weight in gold.
NHS direct or out-of-hours GP service first, then if no joy a trip to A&E, early hours of the morning is usually quiet. Our out-of-hours service is excellent - consists of phoning them up, they then get a nurse to phone you back and question you and they are very very good, and won't hesitate to deal if new symptoms have emerged.
SiH said:
Yeah, nice on Sevo, good advice
While GPs may be able to access ENT emergency clinics many aren't actually aware of the process of how it's done. In the meantime, while appointments are being made with other GPs in the practice there's still a 9 month old kid (and his parents) who need sorting out. If parents are concerned about their children then in my opinion it's perfectly reasonable for them to seek medical help in any way, shape, or form (including the A+E department). I don't want to get into a dick-swinging competition but the majority of gasmen haven't served their time in A+E, they were too busy sux racing, moaning about their on-call room or trying to unravel the mysteries of the Sun crossword! Would you seriously think that the parents of a 9 month old child were wasting your time if they came to see you (if you can imagine the horrors of leaving the anaesthetic ivory towers and putting yourself in the shoes of a Cas Officer) because they wanted reassurance?
I'm working in A&E at the moment actually (for my dual certification training). I have no problem with kids attending A&E with anything, merely trying to point out that A&E is not the best place. And as for GP's not knowing about ENT cas...I've never met any doctor above house officer grade that isnt aware of the ENT cas clinic service.While GPs may be able to access ENT emergency clinics many aren't actually aware of the process of how it's done. In the meantime, while appointments are being made with other GPs in the practice there's still a 9 month old kid (and his parents) who need sorting out. If parents are concerned about their children then in my opinion it's perfectly reasonable for them to seek medical help in any way, shape, or form (including the A+E department). I don't want to get into a dick-swinging competition but the majority of gasmen haven't served their time in A+E, they were too busy sux racing, moaning about their on-call room or trying to unravel the mysteries of the Sun crossword! Would you seriously think that the parents of a 9 month old child were wasting your time if they came to see you (if you can imagine the horrors of leaving the anaesthetic ivory towers and putting yourself in the shoes of a Cas Officer) because they wanted reassurance?
Cheers for all the thoughts and advice, we went for further consultation and are going with the antibiotics - it was confirmed the original course may have not been of sufficient length to shift the problem if it is bacterial. If it's not sorted / diminished after a further 5 days it's time for a rethink.
staceyb said:
A&E, they will be able to give you stronger antibiotics and possibly some painkillers for the little un. Never mess about with eyes or ears. My hearing was permanently damaged by an ear infection when I was about the same age.
Spot on, my hearing was damaged at a much later age due to an invection. Ruined my DJ career!!
d for Adults, so for one so young must be a total bYep, go to Accident & Emergency (no Idea why they call it that) and see a real Dr (although they are likely to have only just qualified and your GP will have far more experience) and get some of the special, strong antibiotics (although they are probably unnecessary).
No seriously, go back and see your GP, or another GP. The mainstay of treatment is analgesia and antibiotics are rarely needed (although often given). The fact they did not help may indicate it is viral but it sounds like your GP gave you a delayed script, usual advice is give it 24hrs then if no better make up script at pharmacy.
Hope your child gets better.
Kam
By the way, we keep all the really strong antibiotics for ourselves.
No seriously, go back and see your GP, or another GP. The mainstay of treatment is analgesia and antibiotics are rarely needed (although often given). The fact they did not help may indicate it is viral but it sounds like your GP gave you a delayed script, usual advice is give it 24hrs then if no better make up script at pharmacy.
Hope your child gets better.
Kam
By the way, we keep all the really strong antibiotics for ourselves.
Anyone who goes to the A&E in this situation does not deserve an NHS to be free at the point of contact.
Anyone who says get an ENT opinion, also shouldn't have a free NHS.
They are both total abuses of the system.
Your doctor is not a bumbling moron, she knows a good deal about the rights and wrongs of giving antibiotics for ear infections.
If she hasn't made that clear to you go back and ask the relevant questions of her till you get the answers that satisfy you.
Not all mums that go in and see a doctor about an ear infection want a half hour discussion of the rights/wrongs and research on the subject, but some do. If you are a 'do', say so, and the doctor will only be too pleased to tell you why she seemed to be leaving the decision to you after the first lot of Abs.
Not everything that appears stupid is.
And bloody hell, every GP, has at some time been that seemingly 'switched on' casualty doctor in their training you doofus.
Anyone who says get an ENT opinion, also shouldn't have a free NHS.
They are both total abuses of the system.
Your doctor is not a bumbling moron, she knows a good deal about the rights and wrongs of giving antibiotics for ear infections.
If she hasn't made that clear to you go back and ask the relevant questions of her till you get the answers that satisfy you.
Not all mums that go in and see a doctor about an ear infection want a half hour discussion of the rights/wrongs and research on the subject, but some do. If you are a 'do', say so, and the doctor will only be too pleased to tell you why she seemed to be leaving the decision to you after the first lot of Abs.
Not everything that appears stupid is.
And bloody hell, every GP, has at some time been that seemingly 'switched on' casualty doctor in their training you doofus.
Edited by julian64 on Wednesday 7th January 10:24
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