Antibiotics

Since the discovery of penicillin in the late 1920s, antibiotics have been an important part of our ability to treat illness in children.

These medications, along with the introduction of various vaccines, have helped to dramatically reduce the incidence of many serious and life-threatening infections. However, as with any other treatment method, there are risks as well as benefits to prescribing medication, and the decision of whether or not to treat patients with antibiotics depends on a variety of factors.

As we begin to approach the Fall and Winter seasons — in other words: the sick seasons — I thought it might be helpful to look at some of the great and not-so-great aspects of antibiotics. And why, sometimes, the best medicine is “observation.”

As a shout-out to Clint Eastwood and Sergio Leone’s epic western, I’ll present this info as The Good, the Bad, and the Ugly…

The Good

Antibiotics are substances that have been found through experiments (or sometimes through accidents!) to inhibit the growth of microorganisms. They’re typically discussed in relation to bacterial infections (as opposed to viral infections, which antibiotics do NOT treat, as I’ll explain later). Because many of these medications have been around for decades, we have a lot of data on how well they work and how safe they are.

We have extensive profiles on what antibiotics are typically good for particular organisms, and when we combine that knowledge with what organisms tend to cause a particular illness, we’re able to prescribe antibiotics that have a very high chance of successfully treating an infection. Also, because of the length of time these medications have been around, many are available in generic forms that cost less.

Most infections only require a short course of antibiotics — generally 10-14 days. The side effects for many of these substances tend to be minimal. Most children, in fact, will not have ANY side effects, with some of the more common ones being minor symptoms such as diarrhea, nausea, or rash.

We’re very fortunate to have these medications available to us in a variety of locations, at virtually any time day or night.

The Bad

As can see, there are a variety of good things and potential benefit from antibiotics. However, as with most treatments, there are risks or less desirable effects as well. Fortunately, most of these are minor.

Some antibiotics require that you remember to take them up to four times every day to keep recommended drug levels in your body. (I’m lucky to remember to shut my garage door, so four times a day seems like a lot!). Many of them also have a “less-than-desirable” taste/odor, especially in liquid forms, that can make it extremely difficult to administer to a young child (think: feeding an 18-month-old vegetables).  While side effects are typically rare and mild, some children can develop more severe responses, such as allergic reactions that require evaluation by a medical provider.

And, as I mentioned earlier, antibiotics have NO effect on viral infections. Their shape/structure is very different from bacteria, so antibiotics have no effect.  Unfortunately, many of the infections we see in the office are caused by viral infections, so we can’t use antibiotics to treat them. The good news on that front, however, is that the overwhelming majority of children will recover on their own with just supportive care.

The Ugly

Now, after reviewing the benefits and risks of prescribing antibiotics, you might think, “Why not prescribe an antibiotic IN CASE it’s a bacterial infection or to PREVENT a bacterial infection from occurring?”

Well, a given type of bacteria can have several different strains (or, versions of the same organism). These different strains are normally very similar, except for one or two small changes, which often have no significant effect. However, sometimes these changes make the bacteria more resistant to a particular antibiotic, leading to the phenomenon “antimicrobial resistance.”

Now, while these changes occur randomly in nature, they typically occur slowly. Over the last few decades, however, as more patients have been exposed to antibiotics, we’ve been seeing increases in resistant strains.  Because we’re repeatedly inhibiting the growth of sensitive strains by prescribing repeated doses of antibiotics, opportunities arise for resistant strains to increase in number and to outgrow other strains.

In other words, as a child is prescribed antibiotics for repeated ear infections, there is an increasing chance that he/she will get an ear infection with a resistant strain of the bacteria that will not respond to the usual antibiotic.  The child will continue to have symptoms and will require a different antibiotic (usually a stronger antibiotic, with more significant potential side effects). Over time, some children can develop infections that are resistant to several different antibiotics.

But don’t panic! The good news is that not every type of bacteria tends to develop resistant strains despite repeat antibiotic treatments (strep throat, for example).  Even more good news is that with careful, well-thought-out use of antibiotics, the risk of developing resistant strains over time is still very low. But it’s for this reason that we refrain from prescribing antibiotics when we have a high suspicion for viral infection and your child is overall doing well. Not only is an antibiotic unlikely to provide any benefit in this case, but it also has the potential to adversely affect his/her health in the future.

So as you can see, the decision of whether to give you child an antibiotic involves a delicate balance of risk vs benefit, involving a host of factors (symptoms, how sick, duration, past history, age, etc).  Sometimes, it’s as simple as looking at the ear. Other times, after reviewing everything at hand, we feel that prescribing an antibiotic is not the best care we can provide. With every encounter we have with you and your child, our mission is to give you a thorough and accurate evaluation with a treatment plan dedicated to your child’s best interests.

As always, if you have any questions about this topic or anything related to the health of your child, don’t hesitate to ask. That’s why we’re here!