Four Conditions That Do (or Don’t) Need Antibiotics

Like many living things, bacteria are prone to random mutations, including those that can render antibiotics ineffective against them. The more often a child takes an antibiotic, the greater the chance that a resistant strain will colonize in his system. Even if he doesn’t develop symptoms himself, he could easily transmit these harmful bacteria to others. A big part of the problem: Doctors are dispensing these drugs to infants and children far more frequently than they should. A University of Utah study concluded that about one-quarter of pediatric visits that led to antibiotics being prescribed were for respiratory conditions for which these meds were not clearly indicated. Often, pediatricians are simply appeasing parents, who don’t want to see their kid suffer and don’t realize that the medication has either no effect or a potentially harmful effect. Scientists believe the use of antibiotics in animal feed and the increasing use of antibacterial soaps and other products may also be contributing factors to antibiotic resistance.
There are other reasons to avoid excessive antibiotic use among kids. These drugs can have unpleasant and even deadly side effects, including diarrhea, thrush, and, in some cases, severe allergic reactions. And children who take broad-spectrum antibiotics (meaning those that target a wide variety of bacteria) four or more times before age 2 are 16 percent more likely to be obese by age 5, according to the online edition of JAMA Pediatrics. Researchers suspect that antibiotics may be killing off microbes that impact a child’s metabolism. We asked infectious-disease doctors to weigh in on whether kids really need these meds for eight common illnesses.
Common Cold
RX or Not? No
A cold is a viral illness that doesn’t respond to antibiotics. “If your sick child is getting better, even very slowly, he doesn’t need them,” points out Sandra Arnold, M.D., professor of pediatrics at the University of Tennessee Health Science Center, in Memphis.
Sinus Infection (Sinusitis)
RX or Not? Not unless symptoms are severe. In most cases sinusitis subsides without treatment, so your pediatrician might prefer to wait for seven to ten days, says Dr. Arnold. But if the symptoms (which include green discharge, nasal congestion, facial pain, and a sinus headache) are intense and include a fever, she may prescribe antibiotics.
Think before you pour: Antibiotics can cause tummy troubles and have been linked to obesity.
Ear Infection
RX or Not? Sometimes. Middle-ear infections in kids are often needlessly treated with antibiotics, since 80 percent resolve without them, says Dr. Wilde. The American Academy of Pediatrics recommends waiting two or three days and using a kids’ pain reliever for discomfort. However, children 6 to 24 months and older kids with severe symptoms can take oral antibiotics right away, while those with swimmer’s ear (an infection limited to the outer-ear canal) can be treated with antibiotic ear drops, which are less likely than oral antibiotics to lead to resistance.
Sore Throat
RX or Not? Only if it’s strep. The majority of sore throats are caused by viruses, with the notable exception of Group A Streptococcus, which can cause pneumonia, toxic shock, and sepsis. While most strep infections disappear on their own, doctors usually prescribe antibiotics to prevent the rare but serious complication of rheumatic fever, an inflammatory disease that can damage the heart. If your child has a sore throat, your pediatrician will likely perform a rapid test for strep (which won’t pick up every strain) and do a throat culture, which takes one or two days for results. “It’s generally worth holding off on antibiotics until there is a positive result,” says Iona Munjal, M.D., director of the Pediatric Antimicrobial Stewardship Program at the Children’s Hospital at Montefiore, in New York City.
Look for the remaining four conditions in the December issue of The Magazine of Santa Clarita.