Antibiotics: Why your pediatrician may not prescribe them

Prescribing antibiotics is up to your child’s provider. This can feel frustrating when your child is sick. What is the thought process behind prescribing antibiotics?

Your child is in the pediatrician’s office with a fever, and you find yourself asking why the doctor didn’t prescribe an antibiotic. Or, you wonder what’s the harm in trying an antibiotic?

Antibiotics are just one of the many treatments available for kids’ illnesses, but their appropriate use is at the discretion of the provider. This can seem frustrating to a parent whose child is sick. But there’s a reason we judiciously use antibiotics; read on to better understand your pediatrician’s medical decision-making.

What do antibiotics treat?

There are two main culprits behind infections: bacteria and viruses. Antibiotics are medications used to help the body battle bacterial infections by either killing the bacteria or preventing their replication. However, many of the most common medical conditions are caused by viruses, such as:

  • Common cold
  • Cough
  • Bronchitis
  • Sinusitis
  • Stomach flu
  • Some pneumonias

Unfortunately, antibiotics are not effective treatments for any viral infection. Sometimes, symptoms are not caused by an infection at all, but by other processes, such as allergies.

Side effects of antibiotics

It is easy to forget that antibiotics are medicines that have many potential side effects: These include drug-allergy reactions, diarrhea, vomiting and many more that are specific to the antibiotic type, such as heart rhythm issues, teeth damage and cartilage damage.

Not only are antibiotics not helpful to treat many common conditions or viral infections, they actually can cause harm to your child. There are known complications of antibiotic use, including disrupting the natural good bacteria that live in the gut and throat, causing symptoms such as diarrhea and allergies. There are even some studies that show this increases the risk of your child developing chronic conditions such as inflammatory bowel disease (IBD) and asthma. Even more, antibiotic use and disruption of the natural microbiome, or healthy bacteria, makes the gut more susceptible to serious infection such as C. difficile, which causes diarrhea that can be life threatening.

Bacterial resistance: What is it, and what does it have to do with antibiotics?

A very serious and rapidly emerging problem with inappropriate use of antibiotics is bacterial resistance. Bacteria are living organisms with the ability to mutate quickly in order to avoid being killed by antibiotic medication. This has led to many of the more readily available antibiotics becoming useless. The most well-known example is MRSA, or methicillin-resistant Staphylococcus aureus. These bacteria used to be easy to treat with any penicillin drug, but now the Staph aureus bacteria have the ability to avoid being killed by that class of drug.

Resistance is a scary phenomenon in the healthcare industry. “Superbugs” are bacteria that have mutated to be resistant to being killed by multiple antibiotics. And new antibiotics are not being developed fast enough to keep up with the fast pace of emerging resistance.

 Norton Children’s Medical Group, affiliated with the UofL School of Medicine

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How to help your pediatrician understand your child’s current health

So what can you as a parent do to help your pediatrician determine if an antibiotic is needed for your child?

Keep a detailed timeline of when symptoms started, specifics about fevers, and treatments such as Tylenol. Although details such as cough quality (barky, wet, etc.) and color of sputum can be useful, they are not specific to a bacterial infection. A common misconception encountered is that green or yellow sputum means bacterial infection. The color is an indicator of the level of inflammation within the sinuses, but isn’t specific to bacteria. Also, if your child is prescribed antibiotics, they need to finish the full course of antibiotics to keep from developing resistant bacteria. Together, parents and pediatricians can work to develop a treatment plan to help your child heal —  but remember, this may not always include antibiotics.

Mark A. Brockman Jr., M.D., is a pediatrician with Norton Children’s Medical Group – Iroquois.