Babies and Antibiotics

When should you give antibiotics to babies? And are they safe to give to your little one?
Alexandra Grablewski

When your little one is sick, it's natural to want your pediatrician to give her something that will make her feel better fast, like an antibiotic. These prescription medications are extremely effective at killing bacteria. But depending on your baby's symptoms and illness, they may not be the right choice. "Antibiotics are only effective against bacteria, which means they're useless against viral ailments like the flu and colds," says Iona Munjal, M.D., director of the Pediatric Antimicrobial Stewardship Program at The Children's Hospital at Montefiore Medical Center in Bronx, New York. We talked to the experts about how and when antibiotics can help a baby.

When do babies need antibiotics?

Babies need antibiotics only if they are suffering from these common childhood ailments:

High Fever. "A fever indicates that the body's immune system is fighting off germs," says Dr. Munjal. This is a good thing, but temperatures that spike too high (100.4° for babies younger than 3 months; 102° for ages 3 to 12 months) may signal a more serious bacterial infection. If this is the case, antibiotics such as ampicillin or cefotaxime, or both, may be required.

Pneumonia. It's difficult to determine whether the cause of this lung infection is viral (perhaps due to an upper respiratory infection) or bacterial. Symptoms of pneumonia usually start with fever, coughing, shortness of breath, and/or vomiting. Because infants have a higher risk of complications from pneumonia, including death, pediatricians often prescribe antibiotics such as amoxicillin, ampicillin, and penicillin, even if they aren't positive that it's a bacterial infection.

Pertussis (whooping cough). Antibiotics are most effective when started within the first week or two of this respiratory disease, when early symptoms include a mild cough or fever, before the signature whooping cough begins. Azithromycin is typically the first choice for treating pertussis; other options include clarithromycin and erythromycin.

Ear infections. If your older child has an ear infection, your doctor may wait 7 to 14 days to see if it clears up without treatment. But infants are the exception. "A baby can't tell you how much pain he's in or if he's feeling worse, which is why most pediatricians prescribe an antibiotic like amoxicillin," says Allison Bartlett, M.D., a pediatric infectious disease specialist at La Rabida Children's Hospital in Chicago. Signs your baby may have an ear infection include ear tugging or pulling, excessive irritability or crying, sleeping difficulties, and high fever.

Urinary tract infections. These infections occur when fecal or other bacteria enter the bladder or kidneys. Fever is typically the only sign of a UTI in an infant, but some other symptoms can include irritability, vomiting, or diarrhea. "A urine culture can confirm the diagnosis and identify which bacteria are causing the infection," says Dr. Bartlett. "This helps the doctor choose the best antibiotic to target those specific bacteria."

Other infections. Infants rarely develop strep throat (which involves symptoms of fever, sore throat, and trouble swallowing) or sinus infections (or excessive nasal congestion along with a fever or cough) that require antibiotics.

Is it safe to give antibiotics to infants?

Like all medications, antibiotics can cause side effects or other problems such as:

Allergic reactions. Only about five out of 100 children are truly allergic to antibiotics. Most develop hives or red, swollen, itchy welts. "Compared with hives, a rash is much less severe and is more likely related to a viral infection, not a medication response," says Dr. Munjal. Still, you should let your doctor know if your baby develops a rash while taking antibiotics. "Treating the rash with an allergy medication like Benadryl usually isn't necessary," says Dr. Munjal.

Side effects. About one in 10 children experience side effects from taking antibiotics. The most common are diarrhea, nausea, and stomach pain. "In addition to targeting bad bacteria, antibiotics kill off healthy bacteria in the gut. This can lead to stomach upset or diarrhea," says Dr. Munjal.

Antibiotic resistance. As more antibiotics are used through the years, certain medications may become less effective at killing certain bacteria. This is known as antibiotic resistance, and it's a key reason that doctors are more cautious these days about prescribing antibiotics only when absolutely necessary.

How quickly do antibiotics start to work?

Most children start to feel better within 48 to 72 hours of starting treatment, but it is important to give the medicine for the prescribed length of time even if your child seems better. Stopping medication early can cause the infection to return. "A doctor may then need to prescribe a stronger antibiotic because the bacteria has built up resistance to the first medication, making the germs harder to kill," says Dr. Bartlett.

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