Antibiotics in children: when they’re necessary & when they do more harm than good

When your child is ill, we as parents want nothing more than to wave a magic wand and take away our child’s discomfort.

Unfortunately symptoms don’t go away easily and, in the normal course of an illness, the child will likely be in for a few days of misery.

I often see the look of dismay in parent’s eyes when I recommend symptomatic relief, using products that can be bought over the counter rather than prescribing an antibiotic.

Taking your child to a doctor is expensive and time consuming so walking out of the practice without treatment may feel like a waste of time.

In reality though, the doctor needs to discern whether or not an antibiotic is warranted. In the wrong setting, an antibiotic may do more harm than good. The converse is also true: there are very specific situations where antibiotics are absolutely necessary.

Why do some illnesses require antibiotic treatment and others not?

Both viruses and bacteria cause illness but their treatment is different because they themselves are different. A virus invades your living cells and can only multiply in that cell. It’s your own immune system that has to fight against the virus to stop it from invading more cells. An antibiotic would have absolutely no effect on a virus.

Bacteria on the other hand are living, one-celled organisms that reproduce on their own unless stopped. The job of an antibiotic is to stop the growth and reproduction of the bacterial cells.

How do I know if my child needs an antibiotic?

Most common childhood illnesses are viral and do not need antibiotics. A runny nose, cough and congestion related to the common cold are most likely due to a virus.

The same goes for many rashes. These symptoms make children miserable but an antibiotic will not improve these symptoms at all.

There are however, specific illnesses where your doctor would advise antibiotic treatment, including for urinary tract infections, strep throat, sinus infections, impetigo, certain skin infections and pneumonia, to mention a few.

Can I give my baby antibiotics?

Any baby that develops a fever in the first few weeks of life must be assessed urgently. Their immune systems are not fully developed and their health can deteriorate quickly.

While doctors are reluctant to give babies antibiotics, there are times when this would be essential.

In the case of a high fever, the doctor may opt to do blood tests first before prescribing antibiotics, but certainly a urinary tract infection or signs of pneumonia would need urgent treatment.

When it comes to ear infections, there are very specific guidelines from the American Society of Paediatrics as to when antibiotics are necessary. These include:

• A child who is younger than 6 months old.
• A child who is older than 6 months with severe symptoms.
• A child who is younger than 2 years old that has an infection in both ears.
• Children with conditions which make healing difficult like a cleft palate, an immune deficiency, cochlea implant or Down Syndrome.
• Or if it is difficult for a caregiver to watch the child closely over a three day period for signs that the ear infection is getting worse.

The decision as to whether your child needs an antibiotic or not will therefore depend on the findings of the doctor in consultation with you as a parent. If your child’s condition deteriorates after seeing the doctor it’s advisable to discuss the way forward with your practitioner.

Shouldn’t my child get an antibiotic for ‘just in case’?

The straightforward answer to this question is ‘NO’! As discussed, viruses won’t respond to an antibiotic and giving one, especially during the first two years of life, can be potentially harmful.

A lot of the potential risks of antibiotics are linked to disturbing the balance of good bacteria in the gut. This is often noticeable when a child develops vomiting and diarrhoea from an antibiotic.

We are learning more and more about the importance of gut integrity and health, such as supporting the immune system, protecting against infection, preventing certain autoimmune diseases and reducing inflammation in the body.

Added to this, frequent and unnecessary use of antibiotics can cause the bacteria to change and become resistant to the common antibiotics leading to the necessity for higher doses or broader spectrum antibiotics to treat these bacteria. Children may also be allergic to antibiotics and this may result in severe rashes and nausea.

How can I use antibiotics safely for my child?

• The number one rule is to use the antibiotic exactly as prescribed by your doctor. This means in the correct quantity, for the correct number of days. Cutting the treatment short may result in resistance.
• Don’t use an antibiotic that was prescribed for another child or sibling. Different infections require different treatments.
• Store the antibiotics out of your child’s reach. Any medicine can be harmful if taken in the wrong dose.
• Store the antibiotic correctly. Most antibiotics require refrigeration.
• Keep in mind that an antibiotic takes anything from 48 hours to 72 hours to work and the child will still have symptoms until the bacteria have been killed. You may be advised to give other medication such paracetamol over and above the antibiotic to control the symptoms.

Is there any way I can help prevent my child from needing antibiotics?

Once your child has a bacterial infection then antibiotics are necessary but there are some things that boost the immune system and help protect against bacterial infections. These include:

• Healthy diet: This is essential for good health. Adequate fruit and vegetables contain very important vitamins and minerals that boost the immune system. Added to this, a healthy diet also ensures good gut health, which enhances the overall wellbeing of a child.
• Vaccinations: Ensuring that your child’s vaccinations are up to date is another way of protecting against bacterial infections. As an example, before the introduction of the pneumococcal vaccine I used to prescribe antibiotics daily for babies with severe ear infections. As many as 2 to 4 children per week had to be referred to an ENT surgeon for grommets because of recurrent ear-infections. Since we started vaccinating against pneumococcus, the need to prescribe antibiotics for ear infections has dropped dramatically. The number of children getting pneumonia has also dramatically reduced with the introduction of the pneumococcal vaccine as this is a condition that is treated with antibiotics.

Antibiotics have saved millions of lives in the past and will continue to do so in the future if used correctly and responsibly. The World Health Organization, however, warns that antibiotic resistance poses one of the world’s greatest threats to health, making it one of the world’s most urgent health problems.

This is not something to be taken lightly. Insisting on telephonic scripts without your child being examined is one of the greatest issues when it comes to unnecessary or incorrect prescribing of antibiotics.

If at all possible, manage colds and flu using symptomatic relief only. This way, when your doctor does prescribe an antibiotic you will know that it is specific and necessary.

References:

https://www.cdc.gov/drugresistance/about.html#:~:text=Antibiotic%20resistance%20happens%20when%20germs,and%20sometimes%20impossible%2C%20to%20treat.
https://www.who.int/news-room/fact-sheets/detail/antibiotic-resistance
https://www.americannursetoday.com/pediatric-otitis-media-treat-not-treat-antibiotics
https://scholarworks.waldenu.edu/cgi/viewcontent.cgi?article=7070&context=dissertations
https://www.nationwidechildrens.org/family-resources-education/health-wellness-and-safety-resources/helping-hands/antibiotic-resistance
https://www.childrens.com/health-wellness/antibiotics-and-kids
https://pediatrics.aappublications.org/content/145/4/e20193138