When antibiotics are needed and when they are not
Parents are often very confused on why an antibiotic is not prescribed when their child is clearly ill. Here are the common questions or statements I often hear in my practice:
- I took my child to the urgent care/emergency room, and they were diagnosed with a virus but not put on an antibiotic.
- My child has a really bad cold. Why will you not prescribe an antibiotic?
- The nose is draining green now, so they need an antibiotic.
- Can we just give an antibiotic to prevent this turning into a bacterial infection?
So, why are antibiotics prescribed? Antibiotics are given for bacterial illnesses, which include the following: strep throat caused by Group A Streptococcus; walking pneumonia caused mycoplasma pneumoniae; and UTI’s caused by E.coli. These are some of the more common bacterial infections we see in pediatrics, though there are others.
An antibiotic is not effective for an illness caused by a virus. There are multiple different viruses, some of the most common being mononucleosis, RSV, influenza A and B, and COVID.
The majority of the illnesses that children have are caused by viruses. If your child is diagnosed with a viral infection and given an antibiotic, it will not prevent a bacterial infection or resolve the viral infection. Antibiotics are not effective against viruses; antibiotics are given if you have a bacterial infection, not to prevent a bacterial infection.
Another important reason not to give an antibiotic when it is not needed is the prevention of antibiotic resistance. Antibiotic resistance occurs when bacteria change and are no longer responsive to antibiotics. This occurs when antibiotics are inappropriately prescribed, therefore allowing the bacteria to change and become less responsive to the antibiotics.
When bacteria become resistant to antibiotics, the infections they cause can be difficult or impossible to treat. In some cases, they can even be deadly, according to the National Institute for Health (NIH).
It’s also worth noting that yellow or green mucus in the nose does not mean antibiotics are needed. During a common cold or viral infection, it is normal for mucus from the nose to get thick and to change from clear to yellow or green. Actually, this most often is from a viral infection, which can last for 10-14 days, according to the AAP (American Academy of Pediatrics).
The symptoms for both a bacterial infection and viral infection can be the same, and in office testing can help us to determine if an antibiotic is needed. For both viral illness and bacterial infections, common symptoms are headaches, cough, runny nose, fevers, sore throats and, at times, body aches, nausea and vomiting.
A simple search indicates that the vast majority of childhood illnesses are caused by viruses, with estimates suggesting that around 80-90 percent of all children’s illnesses are viral in origin, while only 10-20 percent are bacterial. So, if your child has a viral illness, an antibiotic will not be needed or indicated for good evidence-based medicine.
Treatment for viral illnesses include symptomatic care like increasing fluids, using Tylenol and Motrin, cool mist humidifiers and rest.
I hope this has been informational and helpful as we are going into the sick season for children. Have a great holiday season, wash your hands, cover your mouth when coughing, and be safe!
