Antibiotics: When Do Kids Really Need Them?

Antibiotics: When Do Kids Really Need Them?

According to a study published in the Sept. 15, 2014 online edition of Pediatrics journal, “Pediatricians prescribe antibiotics about twice as often as they’re actually needed for children with ear and throat infections.”

This may not be new information to many of us. As study author Dr. Matthew Kronman, assistant professor of infectious diseases at Seattle Children's Hospital described, “I think it’s well-known that we prescribers overprescribe antibiotics. Our intent [with this study] was to put a number on [how much].”

Researchers from the University of Washington and Seattle Children’s Hospital confirmed that the more than 11 million antibiotic prescriptions written each year for children and teens is possibly unnecessary. This excess not only fails to eradicate viral illnesses in kids, it actually facilitates the dangerous evolution of antibiotic-resistant bacteria.

Despite these studies, we continue down this path of antibiotic overuse as a default treatment. In reality it is fairly hard to differentiate between viral and bacterial infections—particularly in the beginning stages of illness—as the symptoms can be very similar.

“As we found out, there’s really been no change in this [treatment approach] over the last decade,” Kronman added. “And [physicians] don’t have easily available tools in the real-world setting to discriminate between infections caused by bacteria vs. viruses.” 

Bacterial vs. Viral Infections

To set the record straight, antibiotics kill the production of bacteria. Therefore, they are only useful in treating bacterial infections, not viral. In many cases, when a parent brings their sniffling, coughing, child with a sore throat and fever in to see the doctor, it’s simply too early to determine if the illness is bacterial or viral. Yet, parents have been conditioned to expect antibiotics as treatment. If the infection is viral, the antibiotic will be ineffective. Even worse, it will contribute to the increasing issue of antibiotic-resistant diseases. 

A 2013 American Academy of Pediatrics (AAP) Committee on Infectious Diseases recommended that pediatricians carefully evaluate kids with ear infections, runny noses and sore throats before prescribing antibiotics. The committee sited a Center for Disease Control (CDC) and Prevention study that states at least 2 million Americans get infected with antibiotic-resistant bacteria each year and at 23,000 die. Any antibiotic use—appropriate or not—contributes to the risk of resistance.

The AAP committee outlined strict criteria for pediatricians to follow when deciding if antibiotics are warranted. For instance, toddlers with severe pain and infections in both ears will most likely benefit. But, in most cases, milder symptoms will go away on their own with the aid of a pain reliever and fever reducer like acetaminophen. Antibiotics should only be used for runny nose and cough when the symptoms are severe, have been around for an extended period of time (more than 10 days) or are continually getting worse. With sore throats, pediatricians should test for strep when specific symptoms exist before prescribing antibiotics.

The committee also recommended that parents question the use of antibiotics encouraging them to ask their pediatrician if the medication is absolutely necessary and if there are any other treatments to try first.

5 Common questions about antibiotics

1. Can some colds turn into bacterial infections? In most cases, bacterial infections do not follow a viral infection. Treating a viral infection with an antibiotic will not necessarily improve the illness and could lead to some uncomfortable side effects from the medication including diarrhea.

2. Is yellow/green draining mucus a sign of bacterial infection? No, common colds, which are viral, also have yellow/green colored mucus often for up to 10 days. Inflammation of the sinus, or sinusitis, can occur with allergies, bacterial and viral infection. Bacterial infection should be suspected if the cough and green mucus lasts longer than 10 days and is accompanied by a higher fever of 102°F for at least 3 or 4 days straight.

3. Should antibiotics be used to treat ear infections? More than half of all ear infections will go away without antibiotics. If there is no severe pain accompanied by high fever, observation and mild pain reliever are recommended. Ear drops may also help with the pain temporarily. Decongestants and antihistamines in general will not help clear an ear infection and are not recommended for young children.

4. Should antibiotics be used to treat sore throats? More than 80 percent of sore throats are caused by a virus and are accompanied by a runny nose and cough. Antibiotics should only be used on group A streptococci or “strep throat” which is more common in school-aged children older than 3 years old.

5. Do antibiotics cause any side effects? Yes. One in ten children who take antibiotics can experience side effects including rash, allergic reaction, nausea, diarrhea or stomach pain. Let you pediatrician know if your child experiences any side effects.

Additional resources:

How do antibiotics work?

Antibiotics for sore throat, cough or runny nose

Guidelines for Antibiotic Use