Blue Care Network Best Practices

Appropriate treatment for children with upper respiratory infection

Lansing Pediatrics treats cold symptoms, educates parents to minimize antibiotic use

Laurie Hult, M.D.

Trying to minimize the use of antibiotics has been one of the goals of the Healthcare Effectiveness Data and Information Set measures due to the emergence of antibiotic resistance as well as the costs associated with inappropriate antibiotic use. According to the Agency for Healthcare Research and Quality, studies have found that as many as 22 percent of office visits for upper respiratory infections, or the common cold, for children under 15 result in an antibiotic prescription. What's more, an estimated $227 million is spent each year on 7.4 million patients for the inappropriate treatment of URI.

"The biggest factor in reducing antibiotic use in children is to educate parents," says Laurie Hult, M.D. of Lansing Pediatrics. The office has eight doctors as well as nurse practitioners. On a typical winter day, the practice sees approximately 250 patients.

Dr. Hult examines Ava Shuart, 5.

When she sees patients with upper respiratory infections, Dr. Hult prefers treating cold symptoms to make children more comfortable. Treatment might include simple things like bulb suction and saline nose spray. "That provides the most relief and clears secretions and congestion," she said. She adds that sometimes middle ear fluid associated with a cold isn't going to clear up with an antibiotic.

In most cases, Dr. Hult says she follows her two-week rule before considering antibiotics. "My concern is when a cold lasts longer than two weeks and symptoms change. Then the child may have a secondary sinus infection," says Dr. Hult.

She educates parents by explaining that antibiotics are ineffective against viruses. In fact, she says, antibiotics can sometimes make things worse by causing diarrhea or thrush. Dr. Hult also provides handouts to parents and often highlights specific information for them.

Hult acknowledges that it can be more challenging to educate new parents who come in with a baby who has his or her first cold. For young children and babies, Dr. Hult tells parents to watch for new symptoms and an improvement or worsening of the child's symptoms. If a child doesn't get better, the office encourages parents to come back to the office for a recheck.

By the time children are in their teen years, they are more in tune with their bodies, says Dr. Hult. "I educate my teen patients on what symptoms to look for. With time you realize what a cold feels like and what a sinus infection feels like. For older children and teens, if their symptoms are getting worse and it's been more than two weeks, I will sometimes prescribe an antibiotic over the phone."

Taking the history during an exam or phone triage is important. "A cold sort of comes on," explains Dr. Hult. "With strep you can be fine one minute and not feeling well the next. If a child has fever and chills and a sudden onset, it's more likely to be a bacterial infection."

The office also has a phone triage line so parents can talk with nurses. Sometimes parents are not sure if their child just has a cold and they just want someone to check their lungs and ears, explains Dr. Hult. She also noted that the nurses provide a lot of education over the phone.

Dr. Hult says sometimes deciding when to use antibiotics is like solving a mystery. For example, what were the symptoms? She says, "Sometimes the child had a fever initially and it resolved itself. I'm more worried about a child with cold symptoms who developed a fever four or five days into it. That's not the normal progression for a cold, so it's important to know the chain of events," Dr. Hult says.

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