Should Children Take Antibiotics?
A child develops a sore throat or an ear infection - and soon a bottle of
"pink medicine" promises to make everything better. Many parents
demand antibiotics when their children develop a yellow or green nasal
discharge. They also believe that antibiotics facilitate return to day care. The
result of such inappropriate use of antibiotics has been a significant increase
in drug-resistant bacteria.
The emergence of bacterial strains that are increasingly resistant to
antimicrobial agents is causing a growing national and international concern.
The Centers for Disease Control and Prevention (CDC) estimates that about 110
million courses of antibiotics are prescribed each year – and that half of
those prescriptions are unnecessary.
HOW DO ANTIBIOTICS WORK?
First: antibiotic drugs attack bacteria,
Second: antibiotics do not cure a cough. In fact, many patients cough for
two to three weeks due to bronchial hyper-responsiveness – and not because
Penicillin kills bacteria by attaching to their cell walls – and then
destroying a key part of the wall.
Erythromycin and tetracycline work by binding to the ribosomes of the
bacteria. Ribosomes are structures within a cell that manufacture proteins.
Binding to the bacterial ribosomes impairs the production of important
HOW IS A DENTAL INFECTION TREATED?
The most important step in treating a dental infection is removing the
source and cause of the infection. This often means: removing (extracting)
the offending tooth. Extracting the offending tooth has the additional
benefit of providing a way to drain accumulated pus.
Any accumulated pus needs to be drained from the infected area. Sometimes,
this means that advanced (surgical) drainage procedures will be needed.
Antibiotics are of secondary importance in treating a dental infection,
and antibiotics are not automatically used to treat dental infections.
Antibiotics are used for treating infections involving: rapidly progressive
swelling, diffuse swelling, a medically compromised child, or an infection
that has invaded the extraoral (fascial) spaces.
Penicillin remains the antibiotic of choice for mild or early dental
infections because of its low cost, low toxicity, and its narrow spectrum of
action against aerobic streptococci. Clindamycin is the antibiotic of choice
in the hospitalized dental patient.
If a child with an infection is dehydrated, IV fluids may need to be
If a child's temperature exceeds 101 degrees F, hospitalization might be
required. Most dental infections in children can be prevented by obtaining
regular dental checkups, and by prompt treatment of any dental caries.
Posttreatment antibiotics should be prescribed for patients who have
clinical infection, particularly when the infection is associated with
WHAT IS THE TREATMENT FOR STREP THROAT?
All cases of sore throat need supportive care to increase a child’s
comfort and reduce the risk of dehydration.
Strep throat is the only form of pharyngitis for which antibiotics should
Penicillin is the treatment of choice for strep (GABHS) throat. A dose of
20mg/kg/day PO is taken three times daily for 10 days. Once-daily
amoxicillin 750mg PO for 10 days may also be effective. Treatment with
antibiotics for GABHS pharyngitis should be started within 9 days of
infection to prevent the possible development of rheumatic fever. A child
who has been taking antibiotics for 24 hours for GABHS is no longer
WHY IS ANTIBIOTIC USE OUT OF CONTROL?
Patients want antibiotics, and physicians oblige.
A great portion of the antibiotics prescribed (in outpatient settings) is
incorrectly given for viral illnesses, or for bacterial infections which
spontaneously resolve themselves. Nevertheless, patients want antibiotics
because they want a “cure”
for their problems.
Physicians are pressured to see more patients in less time when they work
in a managed-care system. As a result, they sometimes appease their patients
by prescribing unnecessary
Almost 50 percent of physicians’ office visits for colds and upper
respiratory tract infections, and 80 percent of visits for acute bronchitis
are treated with antibiotics. Unfortunately, antibiotics have absolutely no
effect on viral diseases such as the common cold.
PROBLEMS CAUSED BY OVERUSE OF ANTIBIOTICS:
There has been an increase over the last 20 years in antibiotic resistance
among common bacterial causes of infections.
Antibiotics eradicate not only disease-causing organisms, but also the
protective normal bacterial flora.
increase the risk of death, and are often associated with prolonged hospital
Other potentially harmful effects of over-prescribing antibiotics include:
allergic reactions, adverse reactions, and drug-drug interactions.
When someone takes an antibiotic, the drug kills the defenseless bacteria,
leaving behind (selecting) those which can resist.
"Selective pressure," caused by overuse of antibiotics, results
in the survival of bacteria that are resistant to the original therapy.
pressure" occurs when an antibiotic decreases the number of normal
bacteria – allowing resistant bacteria to proliferate. The renegade
bacteria then multiply, and soon they become the predominant microorganism.
Bacteria become resistant in one of three ways:
spontaneous DNA mutation,
taking-up DNA from resistant bacteria, or
assimilating a plasmid
(a small circular strand of resistance genes).
HOW CAN WE REVERSE ANTIBIOTIC RESISTANCE?
We can start with common infection control procedures, such as
hand-washing and immunization.
Parents should wash raw fruit and vegetables thoroughly to remove
resistant bacteria as well as antibiotic residues.
Physicians should become more familiar with prescribing the right
antibiotic for the right reason.
Physicians should prescribe "narrow spectrum" antibiotics (which
target specific bacteria), so that resistance will be restricted.
Physicians should withhold antibiotics when their use is not warranted.
They should instead provide more education, empathy, and alternative
treatments to patients who mistakenly demand antibiotics.
Antibiotics are almost never necessary for treatment of the common cold,
cough, or bronchitis in children.
Children should complete the full course of any antibiotic therapy, and
parents should not "save" medication for later use.
A panel of World Health Organization consultants has recommended the
gradual discontinuation of antibiotics when used as growth promoters in
animals. Improved farm hygiene could go a long way to enhance the physical
growth and development of livestock.
An article in American Family Physician reviews the topic of
antibiotic overuse. It provides steps that a physician can take before
prescribing an antibiotic. The article also lists the CDC/AAP principles of
judicious antibiotic use.