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!