小朋友久咳多痰，應該服用抗生素嗎？(Scroll down for English version)

三天前蕃薯媽媽想起原來大蕃薯已連續傷風咳不停嗽差不多近一個月，連小兒傷風咳藥都已食左好多樽。蕃薯媽媽也覺得是時候要出動絕招了。 蕃薯爸爸不敢怠慢，立刻帶大蕃薯去海怡東商場睇余衛祖醫生。

本來余醫生診證後只肯開普通的傷風感冒藥，但這些普通藥我們自行都能到藥房配到呀！ 蕃薯爸爸暗示給醫生聽普通藥已食過好多但又無效後醫生又反問我要開抗生素嗎？蕃薯爸爸只能一直滴著冷汗回答道：我過來看你的目的就是想聽你的判斷，我不能代你處方藥物呀！還好從我們對話中他發覺兩隻小蕃薯幾乎都不看醫生， 他問我們是否醫護人員。我本來都不是太想隨便吹噓，但醫生問到我便照直答話媽媽係公共衛生專科醫生， 余醫生見我們有專業資格，吾似係會濫用先至肯處方抗生素比大蕃薯導致抗生素抗藥性。

後來我們拿到抗生素回家後先發覺那樽藥本身又衍生另一問題。 首先藥物是印度生產， 模式古老，藥盒指示模糊，連護士都不清楚該如何使用。 蕃薯爸爸到現在都搞不清楚到底是每次倒5ml的藥粉出來然後再開水呢？還是加水混合藥粉到瓶身的一半然後每次餵5ml呢？藥瓶設計又差，不斷滲漏，劑量指示又不清晰，到底“一格”的意思是2.5ml 還是5ml呢？蕃薯爸爸隔天才發現原來連診所的姑娘也搞錯了。 然後最糟就是我們發現原來藥量只夠三天！蕃薯媽媽當然大為緊張因為這個藥量只有平常標準的一半左右，果然大蕃薯食完一瓶後病徵只是好了一半，如果那時停藥的話便會導致身體及病毒都變抗藥性。 下次再病就麻煩了。蕃薯爸爸半來答應了大蕃薯的學校會當講故事義工，但都管不到了，立刻一早衝到醫生處再買一瓶又衝到學校立即餵一劑。食了六天抗生素及重量傷風感冒藥後到最近兩天才開始康復。

這次經驗讓蕃薯媽媽懷疑余醫生的診斷及處方是否正確， 她做了一些研究， 結果如下：

"抗生素可有效治療患有慢性（超過四周）濕咳的兒童，就診時可考慮使用抗生素"

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6513288/

Cochrane 系統性回顧（Cochrane 評估是國際公認的實證醫療保健的最高標準）

Q&A 一位媽媽的問題 :

1-為什麼要質疑 大蕃薯 是否需要抗生素？

正常的感冒通常是由病毒引起的。由於長時間咳嗽+流鼻涕，懷疑細菌感染（所以需要抗生素？）。注意，乾咳（無痰）與濕咳不同。 （家長分享見下一個問題）

2-咳嗽有痰 vs 咳嗽無痰?

H已經咳嗽好幾個月了。上週，他做了鼻腔和咽喉拭子測試，但沒有發現任何結果，因此醫生說不需要使用抗生素。他像過去一樣給予了順爾寧（Singulair）和氟昔肽（Flixotide）

“乾咳還是濕咳？”

"乾咳"

「感染病毒後長時間乾咳或與氣喘相關的症狀很常見

My kid has been coughing for ages...

To give or not to give antibiotics?

Three days ago, Mum suddenly realised that R had been coughing for nearly a month with a runny nose and she decided that it was time he needed antibiotics.

Without further ado, Dad took R to see Dr Yu Wai Cho in South Horizons, here is our experience: Dr Yu refused to prescribe R antibiotics initially, saying he could not see any green runny nose and did not want to contribute to antibiotic resistance. In fact, he did not look up R's nose, so we are not sure how he would have been able to see it. If he had refused antibiotics, we would have been very unahppy, as we can get usual cough and runny nose medicine from the pharmacist, but not antibiotics.

Then one issue led to another; the antibiotics medicine itself posed another problem for us. The clinic's assistant wrote "1 interval" on the dosing, but what is 1 interval? Since the first interval on the dosing cup was 2.5ml, we agreed it must mean 2.5ml. Dad however, suspected that we get it wrong. After repeatedly asking 2.5 or 5ml, we rechecked the bottle the following evening. Did the nurse possibly write "5ml"? but it was unclear as it was written over other words. Dad called the nurse and asked again (she had not appropriately explained before either). She stated it was 5ml and had not realised the cup had changed to 2.5ml intervals!

We then had more havoc in the dosage. By calculation, the bottle was 60ml; he needed 15ml/day, so in fact, the antibiotics were for four days. Did the doctor intend Rory to take antibiotics for four days only? He never explained. Usually, antibiotics are given for 7-10 days (see article below). If antibiotic resistance develops, the antibiotics may not work next time. When the first bottle was finished, R still showed minor symptoms of infection. Dad originally planned to do volunteer work at school the following day but had to give it up and rushed to Dr Yu's clinic to buy another bottle of antibiotics, spending an extra $100! The symptoms only started to show improvement after taking six days, two bottles of antibiotics and a heavy dosage of regular medicines.

Our experience with Dr Yu led Mum to question whether he was right and do some research. Here is the research result:

"Antibiotics are effective in treating children with chronic (greater than four weeks) wet cough and could be considered when they present to doctors."

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6513288/

Cochrane systematic review (Cochrane Reviews are internationally recognized as the highest standard in evidence-based health care)

Q&A section

1. Why question whether R needs antibiotics?

The normal cold is usually caused by a virus. Due to long the cough + runny nose , suspect bacterial (therefore need antibiotics?). Note, dry cough (no sputum) is different from wet cough. (see next question for parent sharing)

2. Cough with sputum vs cough without sputum:

“H’s been coughing for months. Last week he took a nasal and throat swab test and nothing was found so the doctor said antibiotics aren’t required. And he gave Singulair and Flixotide as in the past.”

“Dry or wet cough?”

“Dry”

“Quite common to have dry post-viral cough for long time or asthma-related”