Clinical Reference Systems: Pediatric Advisor 10.0
Antibiotics: Preventing Unnecessary Use
Antibiotics are strong medicines that can kill bacteria.
Antibiotics have saved many lives and prevented many serious
complications. However, antibiotics have no impact on viral
infections. One of the more important decisions made daily
by every physician is whether a child's infection is viral
or bacterial. Parents can learn to make some of these
Viruses cause most infections in children including:
- All colds
- All croup
- 99% of coughs
- 95% of fevers
- 90% of sore throats
- 99% of diarrhea and vomiting.
Bacterial infections are much less common than viral
infections. Bacteria cause:
- Most ear infections
- Most sinus infections
- 10% of sore throats (Strep throat)
- Whooping cough (pertussis)
- Some pneumonia (lung infection).
Common Myths about Symptoms
These symptoms are sometimes misused as signs of a bacterial
- Yellow nasal discharge. Yellow discharge is more likely
to be a normal part of the recovery from a cold than a
clue to a sinus infection.
- Yellow phlegm (sputum). This is a normal part of a viral
tracheitis or bronchitis, not necessarily a sign of
- High fevers. A fever can be caused by a virus or
Reasons Not to Overuse Antibiotics
Some people think that children with colds need antibiotics
to prevent ear or sinus infections. Following a cold, about
10% of children will develop an ear infection and 1% will
develop a sinus infection. Giving antibiotics to the other
89% who don't need them can cause the bacteria to become
more resistant and your child to have unnecessary side
effects. It is better to wait and give antibiotics to
children who really have a bacterial infection.
When bacteria become resistant to an antibiotic, that
medicine can no longer kill that type of bacteria. The more
antibiotics that are used, the more bacteria become more
resistant to the medicine. Research shows that half of the
prescriptions for antibiotics are not necessary. This makes
future treatment of bacterial infections more difficult.
Many bacteria are now resistant to antibiotics that used to
control them. When we turn to newer and more expensive
antibiotics, bacteria develop resistance to them as well. In
the battle between antibiotics and bacteria, the bacteria
seem to be winning.
All antibiotics have side effects. Unless your child really
needs an antibiotic, there is no reason to risk the side
effects of the medicine. Some children taking antibiotics
develop diarrhea, nausea, vomiting, or a rash. If your child
gets a rash, your doctor must decide if the rash is an
allergic reaction to the drug or if it is an unrelated viral
rash (such as roseola). Because it's difficult to be sure,
your child may be considered allergic to a family of
antibiotics when he really isn't. Then your child can't
take that type of antibiotics again.
If your child has a viral illness, an antibiotic will not
shorten the course of the fever or help the other symptoms.
Antibiotics will not get your child back to school or you
back to work sooner. If your child develops side effects
from the antibiotic, he will feel worse instead of better.
Antibiotics should be used for ear infections, sinus
infections, Strep throat and other bacterial infections.
When your child has yellow nasal discharge, yellow phlegm,
high fevers and other normal symptoms associated with coughs
and colds, treat your child with over-the-counter medicines
or home remedies. Many just need extra TLC (tender loving
care) until they feel better. Call the doctor if your child
develops any new signs that suggest a bacterial illness.