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All Articles
Biting 101
Breastfeading: Mothers Mik
Child Support Services
Child’s Play
Cooking With Kids
F.Prac: Acne
F.Prac: Antibiotics
F.Prac: Breast Cancer Awareness
F.Prac: Flu Vaccine
F.Prac: Letter to the Expert
F.Prec: Asthma
Get Reading
Jet Lag
Kindergarten Entry
Making New Friends
Molluscum Contagiosum
Mother Knows Best: It’s My Baby
Music Therapy
Paperwork Procedures
Positive Guidance (part 3)
Positive Guidance (part 2)
Relo: Activities for teens
Relo: Did you know (p1)
Relo: Did you know (p1)
Relo: Ward Offices
Saving Breastfeeding
Sleep in Babies
Soothers (p1)
Soothers (p2)
Speech: Baby Signs
Speech: Bilingual Kids (p1)
Speech: Bilingual Kids (p2)
Speech: Creative Stupidity
Speech: Language Development
Speech: Speech & Language
Speech:...not "talking" yet?
Stanger Danger
Stress in children
Tooth Decay

Catherine Meunier is a family medicine physician and genetic counsellor who was trained in Montreal, Canada. Her areas of particular interest are pediatrics and women’s health. She is the mother of a 5 year old son and a 2 1/2 year old daughter and has been living in Tokyo for the last 9 months.

>>Thank you for an informative and colourful magazine. It is a great idea.

I just had one remark. You have a column called the family practitioner. This would be useful if the latest research based information was given. I am not a paediatrician, but The American Academy of Pediatrics new guidelines are not to give antibiotics systematically.

Catherine Meunier puts forward antibiotics as the most common form of treatment. I feel that the most common approach should not be put forward, but the best research based treatment. I believe this is important as antibiotics are drugs with possible side effects for the child and their use increases the number of resistant bacteria which poses a social threat. I join the new guidelines.

Thank you again for all your work. I look forward to reading Tokyo Families again.

Yours truly,

Henrietta Carbonel

Dear Mrs. Carbonel,

Thank you very much for your comments. For nearly two decades the optimal treatment of acute otitis media has been hotly debated. You are perfectly correct that inappropriate use of antibiotics is leading to bacterial resistance. Additionally, all medications can have adverse effects. However, if you carefully read the official AAP guidelines (as opposed to the Q&A to which you have referred) you will note that what I have written consistent with these recommendations. Only in select cases should a “watchful waiting” approach be used:

“This option should be limited to otherwise healthy children 6 months to 2 years of age with non-severe illness at presentation and an uncertain diagnosis and to children 2 years of age and older without severe symptoms at presentation or with an uncertain diagnosis. In these situations, observation provides an opportunity for the patient to improve without antibacterial treatment. The association of age younger than 2 years with increased risk of failure of watchful waiting and the concern for serious infection among children younger than 6 months influence the decision for immediate antibacterial therapy. Consequently, the panel recommends an age-stratified approach that incorporates these clinical considerations along with the certainty of diagnosis.”

Hence, the guidelines, as usual, support good clinical judgement. Unfortunately, in writing a very brief column such as the one in Tokyo Families, it is entirely out of scope to deal specifically with the exceptional or select cases.

Kind regards,

Catherine Meunier M.D., M.Sc., C.C.F.P.