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When Antibiotics Fail ? Speaker: Y. K. Amdekar
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a. It is important to decide which child needs an antibiotic. In general, antibiotic should not be used in absence of fever but at the same time mere presence of fever does not justify antibiotic.

b. Acute onset of fever may be taken as acute infection and one must differentiate between viral and bacterial infection. Detailed history including onset, response to paracetamol, behaviour during inter-febrile period, rhythm and progress by day 3-4 help in determining type of infection.

c. Antibiotic response is evident only after 2-3 days and if there is no response at the end of 4 days, one must evaluate again and not just change antibiotic irrationally.

d. Wrong diagnosis, improper choice of antibiotic, non-infective complications or immune-deficient host are reasons for failure of antibiotic and drug resistance should be the last probability only after other causes are ruled out.

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