Kids and antibiotics: Don’t overdo it

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.

Many antibiotic prescriptions 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. Yet 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 in children 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.

Problems with unnecessary antibiotic use

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:

• 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. I often treat children who have been started on an antibiotic and then develop 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 end up assuming the child is allergic, meaning we 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 these questions to your child’s doctor

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:

• What infection is the antibiotic for? How sure are you that it is a bacterial infection?
• Is it reasonable to wait a few days to see if the antibiotic is necessary? (This is one of the recommendations from the AAP 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.

Marc Gorelick, MD Former Executive Vice President and Chief Operating Officer Children’s Wisconsin

Children's Wisconsin is the region's only independent health care system dedicated solely to the health and well-being of children. In Milwaukee and throughout the state, we provide kids and their families a wide range of care and support — everything from routine care for ear aches or sore throats to life saving advances and treatment options.