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Antibiotics and Kids: When Are They Actually Necessary?

Blog Antibiotics and Kids: When Are They Actually Necessary?

Dr. Elaine Cox, the medical director of infection prevention at the Riley Hospital, discusses when antibiotics are necessary for children.


As a parent, you’ve probably witnessed the miraculous turnaround that antibiotics can bring to a child suffering from illnesses such as strep throat.

On the flipside, these meds, which fight bacterial infections, have been the target of some controversy because of the growing resistance to antibiotics. “Germs are smarter than we give them credit for,” says Elaine Cox, MD, the medical director of infection prevention at the Riley Hospital for Children at IU Health. “Microbes are able to mutate and, with repeated exposure, can become resistant to a specific antibiotic or even an entire class of antibiotics.”

Exposure to antibiotics—sometimes even just one time—can make bacteria smarter. It’s like the microbes study their enemy and then can find ways to overcome him. “Other things that contribute to germ resistance is getting the wrong drugs or taking them for too long or too short of a duration, because having exposure to something you didn’t need or inadequate doses can breed antibiotic resistance,” says Dr. Cox. Here are answers to some of the most common antibiotic questions.

What are the different types of antibiotics?

Antibiotics fight only bacteria and not viruses. However, antibiotics are often prescribed for illnesses such as ear infections, which may be viral rather than bacterial, or the common cold, which won’t help because it is also often caused by a virus. Different kinds of antibiotics tend to be more effective for different illnesses.

Here are some of the different classes of antibiotics commonly prescribed to kids and the illnesses that they typically treat.

  • Penicillins They're usually pink and given twice a day over the course of 10 days to treat ear infections and sometimes bacterial sinus infections.
  • Cephalosporins A common example of an antibiotic in this class is Cefdinir. It’s usually prescribed for ear or sinus infections if penicillin proved ineffective, and it typically given as a once-a-day dose for five to 10 days.
  • Beta-lactamase inhibitors They’re usually given for 10 days, and are often prescribed for kids with reoccurring ear infections, serious sinus infections, and some types of pneumonia.
  • Macrolides Zithromax falls into this class, and these meds can be prescribed for shorter, three-day doses to treat illnesses such as whooping cough and strep throat.
  • Sulfa drugs Other names for this class of antibiotics are Septra and Bactrim, often given for staph and urinary track infections for about 10 days depending on the illness.

How can you tell if your child has a bacterial or a viral infection?

In most cases, you can’t. “About 50 million antibiotic prescriptions are written each year, and about half of them are not necessary as the illnesses are actually viral rather than bacterial,” says Dr. Cox.  Diagnosis can be tricky because your doctor can’t tell if the germs are viral or bacterial just by looking. “Antibiotics won’t help with viral illnesses, which go away when they’re ready to go away,” says Dr. Cox.

Dr. Cox recommends the “wait and see” approach to help minimize unnecessary exposure to antibiotics, where you wait to fill an antibiotic prescription to see if a child’s symptoms either don’t improve or get worse within 48 hours.

Once you give your child antibiotics, your child’s symptoms should improve within 24 to 48 hours. If they don’t improve in this time, the issue could be viral. If you’re waiting longer to give your child antibiotics, follow the rule of threes: Viral infections usually start for three days, peak in intensity for three days, and then usually improve in the following three days.

What rules should parents follow when offering antibiotics?

According to Dr. Cox, the three tenets of taking antibiotics are: Take the right drug, at the right dose, for the right amount of of time. “The good thing is that medical advances such as rapid diagnostics help us quickly know what an infection is so we can properly treat the illness,” says Dr. Cox. “When you give kids antibiotics, you need to be sure you finish the entire dosage and don’t save any, because an organism that’s under-treated can mutate and become resistant.”

What are some potential side effects?

“Most children do just fine on antibiotics, but there are many different side effects experienced by a smaller number of children, such as diarrhea, yeast infections, and rashes,” says Dr. Cox. “The dilemma with rashes is that sometimes viruses can give you a rash too, so its hard to tell if a rash is being caused by an allergic reaction to the antibiotic or by a virus, which can limit your child’s treatment options in the future.”

If, however, your child experiences other allergic signs such as swelling on her face or hives, you should take her back to the doctor. If your child is wheezing or having difficulty breathing and dizzy, this could be a sign of a severe allergic reaction and you should take her to the ER.

Note how your child responds to antibiotics so that you can tell your doctor the next time she is in need of a prescription. Also, keep in mind that if your child has adverse reactions to a specific antibiotic, such as amoxicillin, she may also have reactions to other antibiotics that fall into the same class, such as penicillins.

-- By Holly Corbett

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