Keep your child safe from antibiotics

The Pediatric Insider

© 2014 Roy Benaroch, MD

Here are some facts:

Antibiotic use is the direct cause of the rise of untreatable superbugs that are killing people.

Antibiotic use is also the cause of most cases of C diff colitis in kids, a potentially life-threatening, difficult-to-treat gut disorder. Antibiotics have also been linked with recurrent wheezing  in infants and inflammatory bowel disease. They can also trigger allergic reactions that can be severe or life-threatening. (I was going to link to photos of Stevens Johnson Syndrome, but decided not to be cruel. Go ahead and Google at your risk. Don’t say I didn’t warn you.)

Here’s some more facts:

Most infections in children are caused by viral infections. This includes all common colds, most coughs, most sore throats, most nasal congestion, and most fevers. It includes most bronchitis, most pneumonia, and most wheezing. Croup, laryngitis, tonsillitis, upper respiratory infections—they’re all viral. They are caused by viruses.

There is no circumstance where any antibiotic medication helps anyone with a viral infection get better. They don’t make viral infections go away faster, and they don’t prevent the development of later bacterial infections. They just don’t work.

Even “bacterial” infections often don’t need antibiotics to get better. Most ear infections will resolve without antibiotics, and good studies have shown that antibiotics, overall, are not effective in treating sinus infections.

So: the potential for great harm. And no upside. If you’ve got an accurate diagnosis of a viral infection, you know that the antibiotics aren’t going to help. Zero benefit. Some real risk. You’d think this would be a no-brainer kind of decision.

And yet, every single day I feel this struggle with some parents who just want antibiotics. It’s really strange, in a way— I listen to the story, I do a careful exam, and if possible I get a confident diagnosis. I talk about what will help the child feel better, and red flags to look out for to contact us if things get worse. And I get back a stare. “Can’t I just get an antibiotic?” or “He needs an antibiotic for his sinus” or “My doctor just gave me an antibiotic. He has the same thing.”

It’s our own fault, I know. Doctors have been way too quick to write antibiotic prescriptions. It’s much faster to whip out the prescription pad than talk about viruses and bacteria. And, more nefariously, writing antibiotic prescriptions creates a culture of dependency that guarantees future business. Patients, at least some of them, seem more satisfied if they just get a magic antibiotic prescription. Why anger people, why fight it, why not just give out the pills and move on to the next patient? Happy parents, happy cash register.

Besides: I know there’s a good chance they’ll go right to the QuickieClinic in the drug store across the street and get their peniwondercillin prescription anyway. (And then I’ll be the one called with the weird allergic reaction or when Junior didn’t get better because he needs a “stronger” antibiotic. QuickieClinic doesn’t offer 24/7 access to their doctor. They don’t offer any access to any doctor. But I’m getting off topic here.)

Why fight it? Because I’m your kids’ doctor. I’m not here to make you happy, or give you what you think you need. I’m here to try to get an accurate diagnosis and to do the best thing for my patient. I’m here to give solid advice about how to help your kiddo feel better, and to tell you when to worry, and when not to worry. I will not always get it right, but I’m going to try my best every time, even when that means I’m not giving you the prescription you want. And I’ll be here to help when things take an unexpected turn, because symptoms and diagnoses change. I can’t guarantee when your child will get better, but I’ll do my best to do the things that can genuinely help.

You want a burger your way? Go to Burger King. You want a quick antibiotic prescription? Go to the retail clinic in the drug store, or one of those docs or practitioners who see 60 kids a day. You want someone to use their professional skills and judgment to help your child? Find yourself physicians who’re stingy with the prescription pad.

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9 Comments on “Keep your child safe from antibiotics”

  1. Sonia Says:

    I saw an ad for Frontline on PBS, they will be airing a documentary on this exact subject: uncut able superbugs in post antibiotic era. I’ll be watching it and making sure my entire family watches it as well as they believe that antibiotic cures it all *SMH*

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  2. jack Says:

    Well said! Seems like they forget that you are the one that went to medical school and have been seeing patients for 20 years or so.

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  3. As a patient, I don’t push for antibiotics at all and yet, I seem to get them. I’ve even expressed my hesitation about antibiotics for ear infections and yet I get them. I don’t have a medical degree so I’m left to assume that the antibiotics that my children get are warranted. Probably hard for doctors to watch and wait too. Would be nice if our system were set up for patients with something that’s probably viral to get an automatic follow-up if they want or need it. If insurance companies structured benefits to not be punitive for that, I’ll bet you would have a lot few patients feeling like they wanted something immediately.

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  4. Dr.M Says:

    People do the same thing with their pets. It’s very irritating.

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  5. araikwao Says:

    Thanks Dr Roy, love your work. The guidelines for Ab use here (Australia) are perhaps a bit more lenient, and they are recommended for use in kids with systemic symptoms. Do you give them (or do AAP guidelines recommend giving Ab’s) for the febrile, lethargic, under-2yo who is off his food?

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  6. Dr. Roy Says:

    araikwao, the wide availabiilty and uptake of vaccines to prevent invasive bacterial illness (esp pneumococcal and H influenzae B) have made “occult bacterial infections” very, very rare in otherwise healthy, vaccinated children. Kids still need a careful history and physical exam, perhaps with some directed testing depending on the situation (eg strep test, flu test, urine test for UTI) but rarely are antibiotics used unless there is objective evidence of a specific bacterial infection.

    The exception would be children with special health care needs (immune compromise, unvaccinated/undervaccinated, or babies less than 2-3 months of age.) For those children, we’re much more likely to give antibiotics up front, even while tests are pending, especially if the child appears ill or lethargic.

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  7. araikwao Says:

    Sorry, I was probably a bit unclear, I meant those systemic features in addition to signs of OM..

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  8. Dr. Roy Says:

    araikwoa, yes, we’d routinely prescribe antibiotics for a child less than 2 with an ear infection + signs of systemic illness (including acting ill, or appearing lethargic.) I don’t think many people would be stingy with antibiotics with a child who is actually sick. The controversy seems to be over children with ear infections who aren’t sick. Most of them improve without antibiotics anyway… and since they’re not sick in the first place, why use antibiotics at all?

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  9. MJ Says:

    My 11 month old baby ended up with a severe case of systemic hives, swelling, and high fever which developed after the 2nd course of antibiotics in 2 months. We never figured out the diagnosis. ER said erythema multiforme; the pediatrician said hives; my research indicates serum sickness-like reaction. In any event, we now know he can never have penicillin again. In retrospect, I think the first course of antibiotics was warranted – he had a bad ear infection with a bullous. The second was just for some “wheezy sounds” in his chest after a cold. Probably not necessary.

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