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When Does A Child Need Antibiotics?

Posted by Lisa LaGrou December 5, 2012 Family Health

altOne of the more common questions parents ask their pediatrician is whether an antibiotic is needed for a child’s infection. The answer to the question is a complex one. First, one must understand what an antibiotic can and cannot do, and the discussion has to start with the differences between viruses and bacteria.

Viruses are small organisms which infect other organisms (humans for the sake of this article) and reproduce in the body. They are the most common infecting organisms of humans, responsible for upper respiratory infections (i.e., “colds”), the majority of all bronchitis, many ear infections, most sore throats, pneumonias, meningitis, cold sores, etc.  Viruses can rapidly spread from one person to another. There are very few medicines which can stop the growth of viruses. Antibiotics have no effect on viruses.

The majority of infections that pediatricians see in the office consist of respiratory infections. The respiratory tract consists of the nose, sinuses, ears, throat (the upper tract), and lungs (the lower tract).  Most upper respiratory infections (URIs) are caused by viruses and antibiotics will not be helpful. There are some exceptions, of course, and your doctor can tell you when an antibiotic is indicated. Symptoms of URIs can include fever, runny nose, congestion, cough, and sore throat. Many lower respiratory infections are caused by viruses as well, such as bronchiolitis (RSV) or croup; however, many lower tract infections are bacterial and will be treated with an antibiotic.

Bacteria are larger organisms than viruses which do not need a human to survive and reproduce. Our bodies and our world are full of bacteria, most of them helpful, although some of them can cause significant disease. The “good” bacteria are on our skin, in our mouths, in our intestines, and in some of our food, such as yogurt. Our own bacteria can cause disease if they are found in the wrong place such as when our skin bacteria invade a wound or if bacteria from the stool get into the bladder and cause a urinary tract infection. Other bacteria do not live in or on our bodies but spread from person to person to cause illnesses. Strep is a good example of this. Antibiotics are helpful in ridding the body of bacteria, both good and bad.

Ear infections represent one of the most common reasons for which antibiotics are prescribed in children and they present yet another dilemma.  The ears communicate with the back of the nose and throat so they are susceptible to becoming infected when the nose is involved. Fluid can get in the middle ear space (behind the eardrum) and can stay there without infection simply as fluid, or it can get infected and lead to significant symptoms. The diagnosis of an ear infection is based solely on a physical exam. Most ear infections are caused by bacteria, but the thinking is changing about what to do with them. In years past in the United States, all ear infections would be treated with antibiotics; in other countries, antibiotics are rarely used and there is no significant increase in complications. Based on recent data, approximately 80% of ear infections in children over 2 years old will get better without antibiotics so there has been a push to prescribe fewer antibiotics.

You may be asking yourself, why are we so worried about using antibiotics?  What harm can they do? From your child’s standpoint, any medicine can have potential side effects, such as allergic reactions, vomiting, thrush and/or diarrhea. These last two occur when the antibiotic gets rid of the good bacteria in the body. Also, overuse of antibiotics can mean a diminished effectiveness of the medicine for your child. From a public health perspective, overuse of antibiotics has been shown to facilitate bacterial resistances to antibiotics. This means that bacteria which were once killed easily by nearly any antibiotic now require stronger antibiotics. The fear is that there will come a time that those bacteria will continue to become resistant to all of the antibiotics that we have, potentially causing an epidemic. Scientists are working hard to discover a safe and effective new antibiotic, but the process is difficult and time-consuming

Many people believe that the degree of fever a child has or the color of the mucus is an indicator of a bacterial infection. A green runny nose is a symptom of an infection, but does not differentiate between a viral or bacterial cause. Unfortunately, there is no sure-fire way to predict a bacterial infection based on symptoms alone. Symptoms coupled with a physical exam are still the only way to determine which infection would be helped by an antibiotic.

For those viral infections where antibiotics are not indicated, there are still treatments that will ease your child’s symptoms. Depending on your child’s age, your doctor may recommend some over the counter antihistamines or cold remedies. Acetaminophen (the active ingredient in Tylenol) and ibuprofen (the active ingredient in Motrin or Advil) can lower fever and soothe muscle aches. Drinking plenty of fluids will prevent dehydration and aid the immune system. Humidifying the air can alleviate congestion.  Sleeping upright can help the complications of mucus drainage. Lozenges can ease a sore throat. Chicken soup can be very comforting and has healing properties for reasons that are not fully understood.

So when your child is sick, treat the symptoms and. Seek medical attention for any of the following: high fever or any fever lasting more than three days, persistent vomiting or concerns of dehydration, persistent cough or a cough that interferes with sleep or school, stiff neck, ear pain, or a rash. Remember that most respiratory infections are viral and antibiotics are only helpful when a bacterial infection is properly diagnosed.

This article was submitted to Oakland County Moms by Dr. Steven Antone on behalf of Northeast Pediatrics 248-652-3300.

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