Your child has a fever and sore throat. Oh no, not strep throat again! When you call the pediatrician’s office, the nurse practitioner tells you to bring her in for a strep test. But last year she had the same thing, you say, and she took antibiotics and got better. Couldn’t they just call in a prescription over the phone?
Yes, that would certainly be easier. But it wouldn’t be better. In this case, without doing a strep test, there is no way to know if that sore throat needs antibiotics, and it is good to avoid giving your child an antibiotic unless she truly needs it.
Antibiotics remain one of the most commonly prescribed medications for children in the United States. Roughly 1 in 30 children has had an antibiotic in the past month, and that rate is higher for the youngest kids. Yet up to half of antibiotic prescriptions are unnecessary! Why does this occur, and why is it a problem?
Fever usually indicates an infection, which can be caused by two main types of microbes (“germs”): viruses and bacteria. Antibiotics do not kill viruses, as the body fights these off on its own. However, antibiotics can help the body fight off bacterial infections, so it is appropriate to take them in those cases.
The fact is that the large majority of infections in children are viral, which means that most do not need an antibiotic. Unfortunately, it can be hard to tell which germ is responsible. Some kinds of infections, such as colds (also called “upper respiratory infections”) are almost always caused by a virus. Others, like urinary infections, are almost always bacterial. But many common ones, like sore throats, ear infections, and pneumonia, can be caused by either. Sometimes a test can be done, such as strep test for sore throat. (Strep is a bacteria, so it is treated with antibiotics.) In other cases, there are clues from the history and physical exam that can help determine which it is. And sometimes, quite frankly, it’s a bit of a guess.
You might be asking, Hey, Dr. Gorelick, if you can’t be sure, why not just be on the safe side and take an antibiotic? Well, aside from being a waste of money, there are definite problems with unnecessary antibiotic use. Here are a few:
What can you do to avoid unnecessary antibiotics for your child? A number of health professional organizations, including the American Academy of Pediatrics (AAP), have started the Choosing Wisely campaign as way to help doctors and patients and families avoid medical treatment that is not beneficial. Antibiotic overuse is one of the targets. Here are a few questions you can ask your health care provider if she prescribes an antibiotic for your child: