All About Antibiotics

Antibiotics -- great advances on the front of modern medicine...or dangerous medications that cause more harm than good? The answer lies somewhere in between. If you're the parent of a child who has suffered from a bacterial infection such as pneumonia or strep throat, you've experienced the benefits of antibiotics firsthand. Seeing your previously listless baby make a dramatic turnaround, or finally getting a full night's sleep after having been awake the past three nights with your fussy, feverish toddler can make you appreciate the value of antibiotics. It might even tempt you to run to your doctor and plead for another antibiotic at the first hint of your child's next illness. Be wary, though, because all that glitters is not gold. Side effects and resistant bacteria have created a double-edged sword with these medicines. Here are the most up-to-date facts about antibiotics to help you avoid misusing these medications.

Antibiotics are medications that either kill bacteria or prevent them from multiplying. They work only against bacteria, not the viruses that cause the majority of sore throats, colds, sinus infections, and bronchitis. Sometimes doctors can tell that your child has a bacterial infection just by examining him, but other times making a diagnosis requires analyzing a culture (grown from a sample taken with a cotton swab). The fact that your child has a fever, has colored mucus, or has been sick for more than a week does not help determine whether he has a bacterial infection or a viral infection. And these symptoms aren't necessarily reason enough to prescribe an antibiotic. For bacterial infections, antibiotics work quickly; symptoms usually improve dramatically within 24 to 48 hours of starting the medicine. Many times, children feel completely well shortly after beginning the antibiotic course. To really beat the bacterial infection, though, it's important that your child finish the entire course as prescribed -- stopping short could cause him to get sick again.

That's an important concept: just because the pink stuff worked for your child's last ear infection doesn't mean that it's the best choice for your daughter's pneumonia. Different antibiotics are designed to fight different types of bacteria. There's some overlap, so doctors can sometimes choose based on taste or dosing schedule. Broad-spectrum antibiotics -- such as cefdinir (Omnicef) and amoxicillin-clavulanic acid (Augmentin) -- target many different kinds of bacteria and are used in special circumstances, such as to treat recurrent ear infections or pneumonia. Narrow-spectrum antibiotics (e.g., amoxicillin and penicillin) target only a few strains of bacteria; these are used to treat conditions such as uncomplicated skin infections, ordinary ear infections, and most strep throat infections. These drugs are also commonly prescribed over broad-spectrum antibiotics because they have fewer side effects and because doctors don't want to allow resistant strains of bacteria to grow. Using a broad-spectrum antibiotic to treat a simple ear infection is like using a bazooka to kill a fly. It will work, but the collateral damage may be worse than the bug you were going after.

These antibiotics are often used for kids. Adults take them, too, but in stronger strengths and not as a liquid.

• Penicillins (Amoxicillin and penicillin g) They're commonly prescribed for simple ear infections and bacterial sinus infections. While they've been traditionally used to treat strep throat, this usage is starting to fall out of favor because penicillins aren't as effective against strep as previously believed. They're well-known for their bubblegum flavor and are given twice a day, usually for 10 days.
• Beta-lactamase inhibitors (Amoxicillin-Clavulanic Acid and Augmentin) These are prescribed for more complicated ear infections or for children with a history of recurrent ear infection. Plus, they're used for more complicated sinus infections and some forms of pneumonia. Because of their chalky consistency, kids usually dislike them. They're given twice a day, usually for 10 days.
• Cephalosporins (Omnicef and Cedax) These are also prescribed for complicated ear infections, for children with a history of recurrent ear infection, and for bacterial sinus infections. They are sometimes used as an alternative to Augmentin, because of more preferable taste and once-daily dosing, but studies have shown that these antibiotics may not be as strong as Augmentin.
• Macrolides (Zithromax) These are prescribed for whooping cough and walking pneumonia and can be given for shorter courses, such as three or five days. A one-time dose is sometimes available. The reviews on taste are mixed.
• Sulfa drugs (Septra and Bactrim) They're used to treat resistant staph infections and urinary tract infections; they can cause rashes on sun-exposed skin.

Sometimes the best antibiotic for your child is the one that tastes the worst. Camouflage the bad taste in a spoonful of something like pudding or applesauce. Putting antibiotics in a baby's bottle, though, is not advisable because it's difficult to guarantee that the baby will drink the entire dose at one time. Most antibiotics are tolerated better if they aren't taken on an empty stomach. And absorption of some antibiotics is actually better, as your doctor or pharmacist will tell you, when they're taken with a fatty food such as ice cream. (Your toddler didn't bribe me to say that!)

In addition, many pharmacies offer special flavoring to make medicine taste better, so ask if that's available when getting your prescription filled. But what if your child still spits out the medication? If she spits it up more than 15 minutes after taking it, wait until the next scheduled dose to avoid double dosing. If it comes up immediately, repeat the dose -- it's unlikely your child's system absorbed any of the medicine. Most pharmacies overfill children's liquid medicine slightly to allow for accidental spills or spit-outs, so if the medicine comes up once or twice, you'll probably have enough to get you through the entire course. If your child spits out the dose repeatedly, though, call your doctor. You may need to get an additional prescription, or your pediatrician may switch the antibiotic.

Six-month-olds range greatly in size, so drug dosages are based on a baby's weight, not his age -- the smaller the baby, the greater the impact of a missed or inaccurate dose. Most of the time your instructions will be given in milliliters (or cc's). Five milliliters (or 5 cc's) technically equals one teaspoon, but don't use a teaspoon to determine the amount, because your dose could be off. Instead, use a medicine syringe labeled with milliliters or cc's to be certain that you're measuring out the right amount.

When it comes to antibiotics, what doesn't kill them makes them stronger -- literally. Prescribing antibiotics for colds is useless and dangerous. They won't kill the viruses causing the colds. Even worse, when the bacteria that live on our skin, in our noses, and all around us are exposed to antibiotics, they can transform into "supergerms" that are able to dodge antibiotics in the future. Think of it as giving your playbook to members of the opposing team. The more they study it, the better they'll be at outwitting you in the next game. Something similar happens every time you stop a few days short of completing a full course of antibiotics. You've taken enough to keep the bacteria at bay but not enough to completely kill them. In the process, you've strengthened their ability to fight against the medication.

You've probably heard a lot about a type of staph infection -- officially known as methicillin-resistant Staphylococcus aureus (MRSA) -- that is resistant to a class of common antibiotics that includes methicillin and penicillin. The most harmful strain of MRSA can strike hospitalized patients and can overwhelm the immune system of already-sick patients. There are only a few antibiotics that can treat more serious MRSA infections such as these. MRSA that occurs outside of healthcare facilities, known as community-acquired MRSA, is occurring more often. It usually isn't life-threatening, though it can cause unpleasant skin infections, such as boils and abscesses. MRSA that spreads through communities through skin-to-skin contact with open wounds can be treated with broad-spectrum antibiotics even though the narrow-spectrum ones don't work. Still, prevention is key: the best defense against these superbugs is good hand washing and hygiene, which includes promptly cleansing and bandaging cuts and scrapes.

From 1 to 10 percent of the American population have penicillin allergies (the most common antibiotic allergies), but less than 0.01 percent of people actually experience life-threatening allergic anaphylaxis to penicillin. The most common indication of an antibiotic allergy is a rash. However, rashes that develop while you're taking an antibiotic are often part of the illness itself and not an indication of an allergic reaction to the medication.

Because rashes are a symptom of many childhood illnesses, it can be confusing when one appears, especially if it coincides with the start of an antibiotic course. To make matters more difficult, antibiotic-induced rashes can look like nearly anything (bumpy red splotches, clusters of small dots, hive-like and swollen skin, etc.), and they can develop at any point in the course of taking the medicine -- even after a week or more. You should always contact your pediatrician if your child develops a rash while taking an antibiotic. She'll help you determine if an allergy is the cause, so your child can avoid that antibiotic in the future.

As you've now learned, you shouldn't fear using all antibiotics, and, just the same, you shouldn't blindly assume you'll need them every time your child gets sick. When antibiotics are used judiciously, they're important tools to fight illness, especially when you know the ins and outs of these medications.

Antibiotic-related side effects are often mild and can be treated with home or over-the-counter remedies.

• Diarrhea Probiotics, such as acidophilus and lactobacillus (the "good" bacteria that we need in our digestive tract), are naturally occurring in yogurt; so while babies are on antibiotics, if they're old enough to eat dairy products, it's a good idea to give them yogurt. Probiotics also come over the counter in capsule form, so you can open them up and sprinkle them onto baby food or into bottles, as directed by your doctor.
• Diaper Rash Yeast infections can develop, because antibiotics don't just kill the bad bacteria, they also kill the good bacteria that keep yeast away. Taking probiotics can lessen the likelihood of a yeast-related diaper rash.
• Discoloration of Stool or Urine Red discoloration is common. Be careful not to confuse it with blood. Ask your physician if this will be an expected side effect. No treatment is required for it.
• Sun-Sensitivity Rash Using sunscreen or avoiding sunlight is recommended with certain antibiotics.

Copyright © 2008. Used with permission from the January 2008 issue of American Baby magazine.

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