Antibiotic shots

The Pediatric Insider

© 2010 Roy Benaroch, MD

Julie posted “I recently heard about injectable antibiotics. Maybe I’m the last person around to have heard about them, but I’ve never been offered an injection for myself or for my kids by their pediatrician. The few people I talked to recently about it says their MD offers this routinely and that it takes effect much more quickly. Sounds like a one-time injection would certainly beat 10 days of oral antibiotics. Can you tell us more about this?”

I’ll tell you, but the more I tell you about injectable antibiotics the less you’re going to like them. They’re useful in a few specific circumstances, but usually they should be avoided.

ADVANTAGES

  • They get in, and stay in. No spitting them out, no vomiting them up.
  • They can provide high tissue levels of antibiotic to treat more-serious infections.

DISADVANTAGES

  • They hurt. Boy do they hurt. An immunization is 0.5 ml (that’s 1/10 of a teaspoon); antibiotics are injected often in 2-3 mls, or more. Penicillin injections use an extra long needle and are thick, so they go in slowly and extra-painfully. Ow. Once your toddler gets an injection as painful as one of these, future pediatrician visits can become a nightmare.
  • If there’s a serious allergic reaction, your child is in much bigger trouble.
  • There are only two commonly-available antibiotics for injection, and neither one of them has good activity against many common infections. In other words, though some infections can be treated with injections, many can’t.

MYTHS

  • Injected antibiotics work more quickly– that’s just not true. Most oral antibiotics are just as fast.
  • Injected antibiotics are always stronger. Again, depending on the specific infection, oral antibiotics are just as strong, or sometimes better. For example, skin, bone, and joint infections are much better treated with oral antibiotics than any commonly available injection.

I use antibiotic injections when a child is vomiting, and has an infection that’s going to need antibiotics to get better. Sometimes, an injection should also be used after oral antibiotics have failed to treat an ear infection. Very rarely, I’m forced to use an injection because a toddler-aged child absolutely refuses to take an oral medicine.

I never use injected antibiotics on a whim, or because a parent thinks it will be difficult to remember to give the oral medicine. Serious reactions to these can be deadly, and I am not going to inflict unnecessary pain just for convenience.

Please, please never threaten your child with an injection– “You do what the doctor says, or he’ll give you a shot!” Shots are not a punishment, and we don’t want terrified patients.  Threats like that do not help in any way.

So: an antibiotic shot may seem like a handy tool, but usually the negatives outweigh the positives, and an oral antibiotic is more appropriate. Tell your child he can keep his pants on– there are no shots today!

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29 Comments on “Antibiotic shots”

  1. Stephen Colbert, MD Says:

    I’ll take a shot – of tequilla. Maybe I should keep a small 2 oz glass and an empty bottle of Cuervo re-filled with water in the office, and when a parent threatens a child that the doctor will give them a shot…

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  2. Wendy Says:

    Why did my dr. make my son take the shot and then also have a ten day course? This sucks! We went through the two shots on either leg and the pain (his pain) and then all week oral medication with a 3 year old. What’s up? He also had a small infection from the antibiotic. What a trip.

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  3. Dr. Roy Says:

    Wendy, I couldn’t answer “why” without more specifics. I hope he’s feeling better!

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  4. Jess Says:

    My almost 5 year old daughter absolutely refuses to take her medication orally. She throws up the liquids (repeatedly) until everyone is traumatized and won’t chew the chewables (god I wish they’d make them in gummy form – THAT she’d eat) and they’re too big to swallow and when I cut them up she won’t swallow more than one or two fragments. The one and only other time she needed antibiotics she could not keep them down and ended up so sick she had three grand mal seizures (the neurologists felt it was because her electrolytes were so out of whack and that she likely has a predisposition or underlying disorder). She only drinks water and seltzer. I tried dissolving them in the seltzer but the taste was still too strong and she refused.

    Do they make antibiotic suppositories? What are our alternatives? Do you have any suggestions??? She is incredibly picky about tastes, smells and textures in her mouth and doesn’t eat mushy things we could hide it in or any sweet crunchy things it could get mixed in with (we’re in the process of screening for sensory processing issues).

    Any advice is appreciated.

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  5. Dr. Roy Says:

    Jess, sorry it’s been a struggle. There are no antibiotic suppositories.

    I recommend you avoid antibiotics unless they’re absolutely necessary. There are a few especially-good tasting ones (like Omnicef) that are only given once a day. Ask for the concentration that’s the strongest, so the volume is less.

    You could try: Pour it in a little medicine cup, put it on a table next to your daughter in her room, and tell her she can leave her room when she drinks her medicine. Then be prepared to back up your threat, and leave her there as long as it takes– maybe all day. You will not be able to force her physically, but you can patiently wait until she decides to drink the stuff. It isn’t torture.

    Best of luck!

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  6. Elei Says:

    My 15 month old has been super irritable and just not herself over the past few weeks. After a week of up and down fevers, another spike today and after gradually rejecting solids, she finally 100% rejects anything other than water or breast…I took her to urgent care and was RELIEVED when she tested positive for a UTI. an answer! We were going to do amox, but the ER doc wanted to check with Peds and they suggested the shot. Not having read this post and feeling weary about the thought of how long she’s been living with this ( she also just finished thrush and 6 big teeth have been gradually breaking through over the past few weeks), I was thrilled when he offered the shot. I asked for the 5 day anti biotics that my daughter uses because if her penicillin allergy and he said that he didn’t like to give “strong” and more risky stuff to kids if not necessary. So… was he justified in using the shot, or should I have stuck with the Amox? She is also taking Cephalexin for 7 days. I’m wishing I read this sooner!!!! Your thoughts would be appreciated.

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  7. Dr. Roy Says:

    Elei, good studies and current guidelines suggest oral antibiotics are as good as shots for most UTIs– but it depends on how sick the child was, and since I wasn’t there I really can’t comment on the specific case. I believe the “5 day antibiotic” you mentioned was probably azithromycin, which would not be a good choice for a UTI– not because of any vague “too strong” rationale, but because it doesn’t kill bacterial in the urine well. In most of the USA, cephalexin (Keflex) is an excellent, effective, safe antibiotic choice for UTI treatment.

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  8. My 21 month old won’t take her new oral amox, when we switched to the hardcore stuff she started gagging and vomiting it back up. I don’t want to give her a shot. She went from normal amox (with flavor) to amox with clavulanate potassium (without flavor) because her ear infection wasn’t going away after 3 days of treatment and she developed a fever. Now, i’m wondering if the fever was a virus because her brother developed one the next day.

    2 questions…

    1. TIPS?! I’ve tried mixing it with applesauce and jelly. I’ve tried yogurt. Will adding flavor to the solution make it more palatable? I’ve tried plugging her nose and squirting it between her lower teeth and gums (she opens her mouth and breathes in, then spits). What can I do to get her to take it orally so I can avoid the shot?

    2. Is it better to stop a course of antiboitics after 3 days (i haven’t been able to get her to take the new stuff and it’s been 1.5 days of trying) or is it better to give her the shot and destroy all future visits to the doctor and possibly give a family with allergies and eczema symptoms a REALLY sick little girl?

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  9. Dr. Roy Says:

    Sarah, I’d start by re-assessing whether an an antibiotic of any kind is needed. If it’s a viral infection (or even if it’s a bacterial infection that’s likely to resolve on its own), it may be best to stop trying to give antibiotics at all.

    Tips for kids who hate oral medicines– there are plenty of things to try. One of the best I know is to use an ice-cube tray and half-melt a blob of ice-cream in each section. Then add the antibiotic, mix it up, and refreeze into little antibiotic-laced ice-cream cubes. Yum!

    What’s best for your child depends on your individual circumstances, and I can’t really help you decide that– it’s up to you and her doctor. Best of luck!

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  10. Kristin Says:

    My husband took our 4-month-old in for her 4 month well-baby check-up today (he’s the stay-at-home parent). The Dr. diagnosed her with an ear infection and gave her two shots (one to each leg) and a 10-day course of oral antibiotics. This seems very strange to me, as she had no symptoms whatsoever. I had a four-day weekend for Labor Day, so she fed from the breast that entire time. She is fully breast-fed, from the breast when I’m home and from frozen when I’m not. Now after reading online, I am very concerned that they gave her TWO shots after presenting NO symptoms. Unfortunately, my husband did not ask to see in her ear, or ask questions as to how bad it looked, etc, and the doctor did not elaborate. I could understand if she had a fever, had been irritable, not sleeping well, etc, but she had none of those. Why would they jump immediately to two shots plus oral antibiotics?

    Thank you.

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  11. Dr. Roy Says:

    Kristin, you’re going to ask the people who evaluated her about the specifics of their decision-making. I have no idea about that.

    But re: 2 antibiotic shots: that was probably only because they divided the dose into two injections. In a 4 month old there isn’t much muscle mass for a large-volume injection, so instead they used two smaller injections that totaled up to the correct dose. I’m guessing here, but I think that’s right.

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  12. Jess Says:

    My daughter has been having repeated ear infections for a while now. The doctor gave her one last dose of antibotics and said that the next step would be the shots. If that did not work we would move to tubes inside her ears.

    The shots make me nervous.
    I had tubes in my ears when I was younger. Should I skip the shots and just get tubes in her ears?

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  13. Dr. Roy Says:

    Jess, you ought to talk w/ your pediatrician about your child’s specific circumstances, and whether antibiotic shots versus tubes are the best idea. You can also also for a referral to an ENT (ear nose throat) specialist– they’re the ones who do the surgery to put in the tubes. Best of luck!

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  14. paola Says:

    Dr Roy, there are to antibiotic suppositories. I get them done everytime my son (under 4) needs antibiotics because he refuses to take med. orally. All you have to do is write the prescipition to say suppository formula and they take the prescription to a compound pharmacy and volia! a few hours to set and your ready to go.

    Just thought that more doctors need to get updated on this because many look at me like I have three heads and then when they speak to the pharmacy a light bulb goes off in their heads.

    Usually they do amoxocillin (sp) three times a day for a week but recently my son had a respritory infection and they gave me zinthomax and they got it done. Its the exact same dosage he had to have two suppository’s the first day and then one for four days.

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  15. Dr. Roy Says:

    Paola, I’m sorry to tell you this, but there are no FDA approved antibiotics to be given rectally, and there are -zero- recent published studies showing that these medications can be absorbed rectally. I did find two studies from the 1980’s from Japan, but they were small and uncontrolled, and clearly that didn’t catch on here or in Japan. Using antibiotics in this fashion certainly is creative!

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  16. paola Says:

    I am from Canada so perhaps the FDA is different here but I can assure you that doctors and pharmacies here do write prescriptions for antibiotics in suppository form. It is a very creative way to get your child or even an elderly patient to take medication that can not be taken orally.

    The compound pharmacies are becomming more recognized here.

    Perhaps you can start something in your country to promote this. I know that parents everywhere will be thankful. Just a thought. here are a few links i found that may be of interest.

    http://jac.oxfordjournals.org/content/43/2/177.full

    http://www.pharmacytimes.com/publications/issue/2002/2002-11/2002-11-7018

    http://hmcompounding.blogspot.com/2011/01/pediatrics-rectal-suppository.html

    These studies are much more recent then the 1980’s the oxford journal was dated 2011.

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  17. Dr. Roy Says:

    Paola, thanks for the links– interesting! Still, most of the info is from animal studies, and, notably, different animals seem to have very different absorption of medication rectally. It also seems like the way the suppositories are made can greatly affect how they’re likely to work. More study is needed, and if these are to be widely used, a more-standardized preparation is going to be necessary to ensure that they work as expected.

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  18. laguna99 Says:

    Hi Dr

    I have the same problem that was mention above …. my child is 5 years old and refuse to take the medication ! vomiting spiting …. the last solution is the shots … im not int he states …. in my country we take it as 5 shots one course …. what about the states ? how many ?

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  19. Dr. Roy Says:

    laguna, the exact number of shots depends on the dose and the size of the child (little kids can only tolerate smaller volumes of injected material.)

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  20. Manar Nabil Says:

    Dear Dr. Roy,
    your article is just great and informative, however it made me feel bad because I let my doctor give an injection to my toddler a couple of times. my son is now 2 years old. he had his first injection when he was 16 months old: he had a throat infection (with this white thing on his tonsils) and very high fever that reached 104 f. it was the weekend so the only option was to go to a GP nearby so he convinced me of the shot I visited him twice that day coz i wasn’t sure about it then I gave him that antibiotic (he said its a combination of antibiotic and some other medicine which will make him active and feel better), the next day when I went to my pediatrician he said it was abosultely unnecessary and its just a throat infection that will go away with rest and lots of fluids. anyway I moved to another country and another pediatrician. when my son was 21 months old he had a sore throat with this white matter so the doc said its a bacterial infection (no tests performed) so he needs a shot, he gave him 2 shots in 2 days then a 5 day oral course. after one month he had a throat infection but the doc said it was viral (depending on a blood test) and the absence of this white pus (i dunno what is it called). so he just gave him painkillers, when my son was 23 months old he had aother infection (with the white thing) so the doc said its bacterial and he needs an antibiotic so he gave him 3 shots in three days followed by an oral course. wasn’t this agressive?? I decided not to let any doctor give him a shot since he started to get sick every month since that firstantibiotic shot. a couple of days ago he had fever and throat infection but luckinly his doc said its viral( he did a blood test) so he just gave him painkillers. what do you think about what happened and when shall I stop my doctor from giving an antibiotic injection and when to let him. honestly i’m thinking of going to Med school because not all doctors are trustworthy, its just about the money. and yes that last doctor make me give my son a flu vaccine which i found out to be useless in my sons case (my doctor himself said that flu vaccine has nothing to do with pharyngitis) and I was like : then why did u give it to him !!!!
    I apologize of having this large comment but i was surfing the web to learn more about pharyngitis and tonsilitis and there treatment: gotta do it on my own from now on.
    thanks Doc

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  21. parents10 Says:

    Dr. Roy,
    My 2 years old daughter has been coughing since November last year and between November to January (middle) she went through several different oral antibiotics without any ear infection. But end of January she started to have ear infection, so her doctor put her on new oral antibiotic for 2 weeks. Since she was still coughing after about 2 weeks, I took her to the doctor again for checkup. She found her infection was still there, so decided to give shots and did so 2 days in a row. We went back on Monday and they said it was better. However, she still cough and I took her to an ENT end of February and he found that her ear infection was back and put her on oral antibiotics again for 2 weeks. He also found that her adenoid was bigger and has some sinus infection. He also prescribed her Nasonex for a month. However, she started vomiting and diarrhea after about 7 days later; so, I took her to the Emergency. There they said that she was having this because of the ear infection. So, they gave her antibiotic shot again and this time she received three (two from her regular doctor) of them. But her coughing was never completely gone and we went to the ENT last week and he said everything looks fine( No ear infection!). However, as of today, my daughter is still coughing and as with other time it is gradually getting worst again. Any suggestions?

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  22. Dr. Roy Says:

    parents10, I can’t give you more-specific advice on your individual child’s health issues. That’s not what this blog is for, and it’s not appropriate for me (without any exam or direct knowledge) to speculate.

    Work with your own doctors who’ve seen and examined your child.

    Best of luck!

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  23. Rachael Says:

    Hi Dr.,
    My 14 month old son seems to have low immunity. He is at home (not in daycare etc.) and yet seems to catch some infection once every month. What’s worse is that he just won’t take oral meds … gags and vomits every time we try to give him some med. Doctors here seem to prescribe antibiotics very often and since he won’t take them, I ask doctors to give him a shot instead. Are antibiotic shots the same as oral meds … would they harm him in the long run. Please advice.

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  24. Beth Wood Says:

    My 4 year old grandson was diagnosed with epilepsy & when he caught a virus & was put on antibiotics he had 3 seizures within an hour & a half. The hospital gave him an antibiotic shot which helped for a few days but 3 days later he had 2 more seizures. One @ 3 a.m then another @ 6 a.m. I’m wondering if he needs a different antibiotic.

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  25. Dr. Roy Says:

    It would be best to discuss this specific case with his doctors. But if as you say he “caught a virus,” then he doesn’t need any antibiotics, and antibiotics won’t do him any good. Antibiotics do not affect viruses.

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  26. Corey S. Says:

    Hello Dr.

    My 3 year old son has Strep throat and an ear infection. He was prescribed a 10 day dose of amoxiciian. However, due to the sore throat and well my son being three has refused all attempts of taking the medication. Now this is my youngest of 6 children, we have been through this drill before. So the following morning I call his pediatrician and get him back in to receive the penicillin injection, we have resorted to this once or twice in the past with strep throat on his older siblings and it has always worked great We are aware that penicillin is no the best solution for the ear an infection and may have to breach an alternative for the in coming days.

    However, my 3 year old son is experiencing debilitating pain, it is about 16 hours after the shot and he is refusing to walk has developed a 101.6 temperature and is laying in bed unable to move his legs with out screaming. We have just administered a 325 MG acetaminophen suppository, hoping to manage his pain.

    My question; is there an adverse side affect or allergy we have over looked, or did the nurse miss the correct spot in the upper leg?

    Thank you,

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  27. Dr. Roy Says:

    Corey, you ought to take your son to the doctor for an evaluation. This isn’t something to figure out on the internet.

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  28. savana Says:

    My 11 month old was given her first shot today and is due for the second tomorrow and I’m being told she will need the 10 day regimen also. She started out with a cough that turned into her not wanting to eat or drink except to nurse which, my supply is not what it used to be, then she started having high fevers 103 was the highest and vomiting and then not urinating because she wasn’t drinking. Diarrhea followed. I took her to the hospital, where they gave her fluids through an IV. After a follow-up appointment with the pediatrician, I’m told she has an urinary tract infection and an ear infection. I still don’t know what started the whole thing. That aside, what sorts of infections are treated by these anti-biotic shots and followed up with a 10 day oral anti-biotic?

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  29. Dr. Roy Says:

    Savana, really any sort of bacterial infection could conceivably be treated with an antibiotic injection, tho different antibiotics treat different kinds of bacteria differently. I suppose the most common infections we see in pediatrics are urinary tract infections, pneumonia, and upper respiratory infections like otitis media and sinusitis. There are also skin and bone and joint infections, abscesses, all sorts of things well beyond the scope of the OP.

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