Antibiotics In Children: Facts And Fiction

By Jeff Cersonsky, MD, FAAP

Antibiotics became widely and successfully used during World War II.  While they helped wounded soldiers prevent and fight infections, their domestic use meant many bacterial infections could finally be treated.  Bacterial meningitis, bacterial pneumonia, ear infections, syphilis, wound infections, etc., no longer meant unrelenting pain, deafness, or death.

Unfortunately, we have taken a good thing too far.  This class of "miracle" drugs has been so misused and abused that they are no longer as effective as they used to be for many strains of bacteria.  The bacteria are threatening to take the upper hand.

To be sure, antibiotics can and should be used for many bacterial illnesses. In the misguided belief that every illness or infection MUST have a medication, however, we have jumped to antibiotic usage when, in some cases, "wait and see" allows the body to fight on its own.  Also, antibiotics cannot be accurately and responsibly prescribed over the phone because symptoms (such as earaches) may have a cause (such as simple fluid in the ears) that does not warrant antibiotic usage.

Let's explore eight myths I've frequently heard about antibiotics:

1) Antibiotics are harmless.

Antibiotics are truly wonder drugs when they are appropriately used.  They do, however, carry some risk.  Antibiotics can cause severe allergic reactions, serum sickness, diarrhea, colitis, aplastic anemia, and other side effects.  But the most important problem with misuse of antibiotics is the development of new strains of bacteria resistant to most antibiotics.

2) If a child has a high fever, he or she needs an antibiotic.

Many viruses (roseola, enteroviruses, etc.) can cause very high fevers.  Fever is the body's response to illness, not necessarily due to bacterial infection.  Antibiotics are only useful with bacterial illnesses.  Treatment of viruses with antibiotics is not necessary and is worthless because viruses are not sensitive to antibiotics.  The height of the fever does not necessarily correlate with the need for antibiotics, but fevers over 104oF (40oC) or any fever in an infant under two months require a doctor's evaluation to exclude a severe infection.

3) A "stronger" antibiotic is more likely to cure an infection.

The stronger the antibiotic, the more chance of side effects.  The trick is to find the correct antibiotic for the infection present (which is frequently an educated guess) without resorting to the stronger ones with their potential for side effects.  Also the more we use "broad-spectrum" antibiotics (those that cover the most bacteria), the greater the chance that "super-bacteria" develop resistant to many antibiotics.  Infectious disease specialists are quite alarmed that continual misuse of antibiotics by doctors and patients will result in bacteria that can outwit any antibiotic, perhaps with deadly consequences.

4) If a specific antibiotic has been ineffectual in previous ear infections, it will not work for the current one.

Each infection is new, so the odds that an antibiotic will work will not change even when that same antibiotic was ineffective for prior infections.  For instance, if Amoxicillin does not work as a first-line treatment for three successive ear infections, it still has an 80% chance of working for the fourth.

5) Bronchitis is a potentially severe infection and needs antibiotics.

Bronchitis in children is (a) asthma, (b) viral, or (c) not truly bronchitis, (i.e., a misdiagnosis).  In the first two cases, no antibiotics are necessary (although asthmatic bronchitis or asthma may certainly be severe requiring multiple asthma medications).  In the third case, the correct diagnosis could require antibiotics (as in bacterial pneumonia) or not (as in a bad cold).

6) Thick green nasal discharge means there is a bacterial infection needing antibiotics.

The greenness of nasal discharge is related to the amount of moisture in the secretions and is not correlated with sinus, ear infections, or strep throat (essentially the only bacterial upper respiratory infections) as shown in numerous studies.  I've seen some patients who were diagnosed with an "upper respiratory infection" and put on antibiotics because of a green discharge from the nose, but an "upper respiratory infection" is, in reality, a cold virus and does not warrant antibiotics.

7) The flu requires an antibiotic.

Influenza, a viral respiratory infection occurring primarily in winter, is not bacterial and does not respond to antibiotics.  Antiviral drugs are used in special circumstances (e.g., immunodeficiencies) and antibiotics are sometimes necessary to treat secondary bacterial pneumonia, an uncommon complication of influenza.

8) Amoxicillin has been used so much that it is no longer effective.

Amoxicillin remains a very effective, safe, and inexpensive antibiotic and is the drug of choice for ear infections, urinary tract infections, Lyme disease in younger children, and many other illnesses.

Antibiotics are simple to take, easy to buy, and widely used.  We need to respect their value by not misusing them, thereby making it more likely that they can continue to do the job when we truly need them.