Every parent has been there. Your child starts to complain of a sore throat. You check their forehead — definitely warm. Oh no, not strep throat again. When you call the pediatrician’s office, the nurse practitioner tells you to bring them in for a strep test. But last year they had the same thing, you say, and they 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’s best to avoid giving your child an antibiotic unless they truly need it.
Many antibiotics are unnecessary
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. However, up to half of antibiotic prescriptions are unnecessary. Why does this occur, and why is it a problem?
Antibiotics help fight bacterial infections
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.
Most infections are viral
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.
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Problems with unnecessary use
You might be asking, “Hey, 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:
- When you take antibiotics, it also affects the bacteria that normally live in and on our bodies. A common side effect is diarrhea due to the antibiotics killing these good bacteria that live in our intestines and help digest food.
- When bacteria are exposed to antibiotics, some of them are not killed, because they are resistant to the effect of the medication. These resistant germs can spread, and when they cause infections they are harder to treat, requiring stronger and more expensive antibiotics. One such “superbug” that has become very common is called MRSA, which causes abscesses and other serious infections, and can be difficult to treat because of its resistance to commonly used antibiotics.
- Many viral infections can cause a rash. It can be impossible to tell if the rash is an allergy to the medication, or one that would have developed anyway because of the virus. We might suspect the child is allergic, meaning we may have to avoid that medication in the future. The next time the child truly needs an antibiotic, it may be harder to choose one that will work.
- There may be long-term effects. Recent studies have shown that antibiotic use in young children can increase the risk of asthma later in life, and other studies have linked early antibiotics to obesity.
Ask questions
What can you do to avoid unnecessary antibiotics for your child? Here are a few questions you can ask your health care provider if they prescribe an antibiotic for your child:
- What infection is the antibiotic for? How sure are you that it’s a bacterial infection?
- Is it okay to wait a few days to see if the antibiotic is necessary? (This is one of the recommendations from the American Academy of Pediatrics for ear infections, for example.)
- If an antibiotic is needed, is this the “narrowest spectrum” antibiotic we can use? Antibiotics typically kill a variety of different bacteria. Narrow-spectrum antibiotics kill only a few types, while broad-spectrum antibiotics kill many types. It is always best to pick the one that will kill the fewest types but still take care of the infection. Narrow-spectrum antibiotics tend to cause fewer side effects and are usually less expensive. For most children with bacterial respiratory and skin infections, narrow spectrum antibiotics are suitable.
Parents and health care providers always want what’s best for the child. But in some cases, it’s not so simple. As always, if you ever have any questions or concerns about your child’s health, reach out to their pediatrician.
