The advances that have been made in medicine over the past few decades have been mammoth. One area that has "exploded" has been in the development of antibiotics that are used to fight infections. There are so many new antibiotics available, that it is a formidable task to keep them straight in one's mind...let alone be able to just pronounce them.
With each new antibiotic comes a whole new set of side-effects. These include stomach upset, diarrhea, cross-reactions with other medications and cost. In pediatrics, one of the biggest obstacles is taste. It amazes me that in 1997, some of the newer antibiotics are the most awful tasting things known to man.
The Smiths (not their real name) are a family that I have known since their four year old son Stuart, was born. We have developed a very close relationship over the years, and they are a "typical" American family, complete with a dog named Max.
I saw Stuart one day for a bout of strep throat. He was quite ill with a temperature of 103 degrees and a fiery red throat. Since he had just gotten over an ear infection, and his strep test was now positive, I told mom that I wanted to put Stuart on a new antibiotic. It was to be taken twice a day, and was a chewable tablet. This pleased mom even though I warned her that it could cause loose stools if given on an empty stomach. "No problem", she said with confidence.
I was surprised when I saw Stuart's name on the schedule just three days later. He still had a fever, and now he had another ear infection...in spite of the new antibiotic. I was a bit perplexed that it had failed as it was touted as being an excellent new drug. With my confidence in this new antibiotic shaken, I said that I had no choice but to change the antibiotic.
During our visit, mom told me that their house was up for grabs these past few days. Not only was Stuart sicker, dad was calling the vet that morning to see if he could see Max. It seems as if Max had terrible diarrhea and had lost an inordinate amount of weight. The vet was probably going to have to hospitalize Max to run some tests.
As we talked, Stuart seemed a bit uneasy when we discussed Max's sudden demise. Stuart became fidgety and squirmed in his seat. He interrupted us no less than three times saying he wanted to go home. Mom attributed this behavior to his not feeling well. I wrote her a new prescription and told her I wanted to see Stuart in two days to check on his progress. As they left, I sensed that something wasn't quite right, but I just couldn't put my finger on it.
I received a frantic call from mom later that day. Before she filled the new prescription, she tried the original antibiotic one more time. It seemed she intuitively sensed a ruse. She said that she gave Stuart his medication as she had always done. She put it on his Sesame Street table with a cup of juice and a snack to wash it down. When she called him to take his medicine, he came in the room with Max right behind. Although he was four pounds lighter, Max excitedly sat next to Stuart with his tail wagging so hard that it made a thumping sound as it hit the floor. Mom gave Stuart his pill, watched him put it in his mouth, and said "Good boy", as she left the room. But she watched him closely from the kitchen.
Feeling that the coast was clear, Stuart took the pill from his mouth, made Max sit, and flipped it in the air. Max snatched it right out of mid-flight. The case was solved.
I praised mom for her brilliant epidemiological work. Max did not have a rare canine disease and the Smiths were spared a hefty veterinarian bill. Stuart would get over his ear infection and strep throat. And once again, my confidence was restored in the new antibiotic.