HEALTHNET

My friend said that a course of antibiotics should last at least 5 days. Is that so?

Antibiotics should only be used after a doctor's prescription and should not be used unnecessarily. An antibiotic would only help if the disease is caused by germs sensitive to it...

(Posted on 9 March 2006)

Q1. I had a cough and my doctor prescribed three days' antibiotics, saying that I have an infection in my chest. My friend said that a course of antibiotics should last at least 5 days. Is that so?

A1. Antibiotics should only be used after a doctor's prescription and should not be used unnecessarily. An antibiotic would only help if the disease is caused by germs sensitive to it. Your symptoms might all be gone when, say, half of the germs are killed. You need to continue taking the drug to ensure your body can get rid of the rest. Therefore the duration of antibiotic treatment (or the course) would depend on a number of factors.

Purpose of treatment
Prolonged courses are not necessary when antibiotics are used for prophylactic purpose. Examples are patients with certain heart diseases who need antibiotics before dental or surgical procedures to prevent infections of their heart valves.
The organism
Many antibiotics work only at critical stages of a bacterium's reproduction. Bacteria that grow slowly would therefore require longer courses of treatment, for example tuberculosis.
Nature of the infection
If the infected tissue have poor blood supply or are walled off by scarred tissue, longer courses would be necessary. Shorter treatments may be just as effective when infections are superficial. There are recommendations to treat uncomplicated bladder infections in women with a single dose of antibiotics.
Response to treatment
A patient whose response is just so-so would need longer treatment compared with the other who has responded rapidly, assuming that they have the same disease caused by the same bacteria.
The kind of drug and the dosage
Some new antibiotics stay in the body for a long time. The recommended duration of treatment is much shorter.

Contrary to what many people believe, the longer you take an antibiotic, the higher the chance of acquiring resistant bacteria.

Q2. My 5-year-old son complains of belly ache every morning. Can he be suffering from appendicitis?

A2. Acute appendicitis is one of the most common surgical emergencies. Most patients with acute appendicitis would be very ill if not operated on within 48 hours after the onset of abdominal pain. It is therefore highly unlikely that your son has acute appendicitis.

The appendix is a small pouch about the size of a small finger locating at the junction of the small and large bowels. Food particles can pass in and out of the pouch normally. When the pouch's opening is blocked, bacteria can get trapped in the appendix, and multiply rapidly. Shortly the pouch is distended with pus.

It is more unlikely that your son has chronic appendicitis. Cases of "chronic appendicitis" or "recurrent appendicitis" have been reported in the medical literature but are exceedingly rare. This follows an attack of acute appendicitis which has resolved spontaneously, only to reappear later with recurrent attacks of right sided abdominal pain.

Your son needs to be evaluated by a doctor before any treatment can be recommended. You need to seek medical advice as soon as possible if one or more of the following conditions are present:

Weight loss
Slow growth
Vomiting
Chronic diarrhea
Blood in stool
Unexplained fever

More than one third of children have recurrent abdominal pain that lasts for two weeks or longer. Many do not have an organic basis for the pain, although occasionally a cause such as chronic constipation, peptic ulcer, or urinary tract infection may be found.

Q3. I found a small worm in my 2-year-old girl's potty. What is it and what should I do?

A3. Roundworms and pinworms are the two most common types of intestinal parasites in Hong Kong. Adult roundworms measure about 10 to 30 cm long and pinworms 1 to 2 cm long. It is most likely that your girl is infested with pinworms.

Adult female pinworms crawl out to lay eggs on the skin around the anus. This can cause intense itchiness. It is the scratching that helps to disseminate the eggs to the others. After laying hundreds of thousands of eggs, the worm dies and that's how worms may be found in the child's potty or on the underwear.

Saving the worm for examination by the doctor is a good idea. Doctors may require all family members to receive treatment, so be prepared to bring other kids in the family along. Doctors may look for eggs of pinworm on a piece of clear cellophane tape put against the child's peri-anal skin.

Teach your children to wash hands carefully before eating or handling food, and after using the toilet. Wash beddings, underwear and pajamas frequently and keep fingernails trimmed. Tell your child not to scratch the bottom or bite the nails. The behavior could multiply the number of worms in the body by thousands. Pinworm eggs are very resistant in the environment and can be carried even on dusts. Some doctors may advise another course of treatment two or four weeks later to ensure eradication.

Source: Quality HealthCare