The Use of Antibiotics
What are antibiotics?
Antibiotics are powerful and important medications used to treat bacterial illnesses. When used properly they can save lives, but used improperly, they may actually harm your child. There are two main types of germs that cause most infections- bacteria and viruses. Bacteria have a cell wall that protects the germ while viruses do not have a cell wall. Because antibiotics work by destroying the cell wall, they are only useful against bacterial germs that have such a cell wall. On a daily basis, as health care providers, we make the decision whether or not a child has a bacterial or viral illness. As parents, it is important for you to understand how the distinction between bacterial and viral infections so that you may better understand our rationale for treatment.
Viruses actually cause the majority of childhood illnesses including:
- ear infections - 75% are estimated to be caused from a virus.
- pink eye - 80% are viral
- coughs - 99% are viral
- sore throats - 90% are viral
- fevers - 95% are viral
- diarrhea and vomiting - 99% are viral
- Also all cases of common colds, croup, bronchiolitis and influenza (flu) are viral.
Antibiotics cannot cure viral infections. Your child usually recovers from these common viral infections when the illness has run its course, usually 3-5 days. Coughs can linger 7-14 days. Supportive care at home is usually all that is needed to make your child comfortable while he or she fights the virus.
My child has yellow and green nasal discharge or mucus, doesn’t that mean the infection is bacterial?
The course of a regular virus can cause many changes in the color of nasal secretions and mucus. The color may be clear, progress to yellow, and then green within the course of a cold. The change in color is caused from the body’s immune system sending white blood cells to the site to help fight the virus. These cells contain a greenish-colored enzyme and will often turn the nasal discharge and mucus the same color. Therefore, color of discharge or mucus does not mean a bacterial infection. Similarly, high fever (104 or 105) is very common with viruses and does not necessarily indicate that an illness is caused by bacteria either.
Won’t antibiotics help prevent my child from getting a more serious illness?
Occasionally children with a viral illness will go on to develop a secondary bacterial infection. This does not mean that viruses magically morph into bacteria. Rather, viruses occasionally cause damage to the mucus lining of the ear, nose, throat, and lungs allowing bacteria that normally reside there to penetrate and cause a bacterial infection. However, after a cold only 10% of children will develop a bacterial ear infection and 1% will develop a sinus infection.
What is antibiotic resistance?
Since bacteria are living organisms, they are constantly changing in an ongoing effort to resist the drugs that kill them. When adults and children use antibiotics incorrectly, bacteria change so that the antibiotic can no longer kill that type of bacteria. This makes the future treatment of bacterial infections more difficult. Some new strains of bacteria have become resistant to antibiotics. Each time we take antibiotics, the sensitive bacteria are killed, but resistant bacteria may be left to grow and multiply. These resistant bacteria can also be spread to others in the family and community.
Are there any other downfalls to using antibiotics?
Many parents think that antibiotics will be a quick fix for an infection or illness. However, antibiotics can have unpleasant side effects. Some kids develop diarrhea or stomach aches. If your child develops a rash while taking antibiotics, which is very common with viral illnesses, than your child may inappropriately labeled as having a “drug reaction or allergy” which would prohibit any use of a potentially useful antibiotic in the future. Additionally, most antibiotic regimes are twice a day for 7-10 days – this can be a big hassle, especially if you child does not like to take medications!
What can I do to prevent the need for my child to take antibiotics?
There are several things related to a child’s diet and environment that can help prevent the need for antibiotics. Regarding your child’s diet:
- Breastfeeding for at least 4-12 months can reduce the incidence of ear infections by half. Breastfeeding allows maternal antibodies to pass through in milk to prevent the baby from disease and also exercises the jaw muscles which may help to keep eustachian tubes open (these tubes drain fluid from the middle ear).
- Avoid solids until 4-6 months of life. This will decrease the risk of any food allergies that may lead to a higher incidence of ear infections. Also, avoid foods that your child may be allergic to (some children have milk or soy based food allergies).
- Older children should get a balanced diet and plenty of sleep to keep their immune system working at its best.
Environmentally, eliminating second hand smoke will dramatically decrease the incidence of ear infections by 50%. Although ear infections are not contagious, the cold that may lead to an ear infection is. Therefore children in day care tend to have a higher incidence of ear infections than those who are not (almost 5X). However, that should not be a reason to keep your child out of day care. When choosing a daycare, avoid day cares that are overcrowded. If there is a strong family history of ear and sinus infections, choose a day care with fewer than six children. Good hand washing, good hygiene, and not sharing cups and utensils will also help the prevention of many bacterial and viral illnesses.
We hope you appreciate our conservative approach to antibiotic use; we only have the best interest of your child at heart. By saving antibiotics for times when your child really needs them, we can help prevent individual and community wide resistance to these important, lifesaving medications.