Like many living things, bacteria are prone to random mutations, including those that can render antibiotics ineffective against them. The more often a child takes an antibiotic, the greater the chance that a resistant strain will colonize in his system. Even if he doesn't develop symptoms himself, he could easily transmit these harmful bacteria to others.
A big part of the problem: Doctors are dispensing these drugs to infants and children far more frequently than they should. A University of Utah study concluded that about one-quarter of pediatric visits that led to antibiotics being prescribed were for respiratory conditions for which these meds were not clearly indicated. Often, pediatricians are simply appeasing parents, who don't want to see their kid suffer and don't realize that the medication has either no effect or a potentially harmful effect. Scientists believe the use of antibiotics in animal feed and the increasing use of antibacterial soaps and other products may also be contributing factors to antibiotic resistance.
There are other reasons to avoid excessive antibiotic use among kids. These drugs can have unpleasant and even deadly side effects, including diarrhea, thrush, and, in some cases, severe allergic reactions. And children who take broad-spectrum antibiotics (meaning those that target a wide variety of bacteria) four or more times before age 2 are 16 percent more likely to be obese by age 5, according to the online edition of JAMA Pediatrics. Researchers suspect that antibiotics may be killing off microbes that impact a child's metabolism. We asked infectious-disease doctors to weigh in on whether kids really need these meds for eight common illnesses.
RX OR NOT? No
A cold is a viral illness that doesn't respond to antibiotics. "If your sick child is getting better, even very slowly, he doesn't need them," points out Sandra Arnold, M.D., professor of pediatrics at the University of Tennessee Health Science Center, in Memphis.
RX OR NOT? Not unless symptoms are severe. In most cases sinusitis subsides without treatment, so your pediatrician might prefer to wait for seven to ten days, says Dr. Arnold. But if the symptoms (which include green discharge, nasal congestion, facial pain, and a sinus headache) are intense and include a fever, she may prescribe antibiotics.
Think before you pour: Antibiotics can cause tummy troubles and have been linked to obesity.
RX OR NOT? Sometimes. Middle-ear infections in kids are often needlessly treated with antibiotics, since 80 percent resolve without them, says Dr. Wilde. The American Academy of Pediatrics recommends waiting two or three days and using a kids' pain reliever for discomfort. However, children 6 to 24 months and older kids with severe symptoms can take oral antibiotics right away, while those with swimmer's ear (an infection limited to the outer-ear canal) can be treated with antibiotic ear drops, which are less likely than oral antibiotics to lead to resistance.
RX OR NOT? Only if it's strep. The majority of sore throats are caused by viruses, with the notable exception of Group A Streptococcus, which can cause pneumonia, toxic shock, and sepsis. While most strep infections disappear on their own, doctors usually prescribe antibiotics to prevent the rare but serious complication of rheumatic fever, an inflammatory disease that can damage the heart. If your child has a sore throat, your pediatrician will likely perform a rapid test for strep (which won't pick up every strain) and do a throat culture, which takes one or two days for results. "It's generally worth holding off on antibiotics until there is a positive result," says Iona Munjal, M.D., director of the Pediatric Antimicrobial Stewardship Program at the Children's Hospital at Montefiore, in New York City.
RX OR NOT? Probably. This inflammation of the membranes lining the inside of the eyelids and whites of the eyes is most often bacterial in young kids, though it can also be caused by viruses, allergies, and airborne irritants. Since pinkeye is highly contagious and there are no rapid tests to determine its origin, doctors tend to prescribe antibiotic eyedrops or ointment, topical treatments that may speed the recovery and are less likely to contribute to resistance than oral antibiotics, notes Seattle pediatrician and Parents advisor Wendy Sue Swanson, M.D., author of Mama Doc Medicine.
RX OR NOT? Rarely. In otherwise healthy children, this illness—an inflammation of the lining of the tubes that carry air to the lungs—is usually caused by a complication from a cold or the flu and is almost never bacterial, notes Dr. Munjal. If your pediatrician suspects a bacterial cause (such as pertussis, or whooping cough), he may culture your child's sputum and if the result is positive, treat the infection with antibiotics.
RX OR NOT? It depends on a child's symptoms. Lung infections can be viral or bacterial, and it isn't easy even for doctors to tell which is which. Most pneumonia in children, though, is viral, says Dr. Arnold. Pediatricians tend to diagnose pneumonia and decide on a course of treatment based on a thorough exam.
RX OR NOT? Yes. One-quarter of all cases of this tick-borne illness occur in kids. If blood tests confirm the presence of tick-borne bacteria (including Lyme and Rocky Mountain spotted fever), your child should go on a two- to four-week course of antibiotics. Early treatment is essential to prevent joint, heart, and neurological damage. Have your child checked ASAP if he exhibits fatigue, has difficulty thinking or speaking, or complains of headaches and nausea—even if you don't spot the telltale bull's-eye rash.
Should your child require antibiotics for a bacterial infection, make sure she takes them exactly as prescribed by the pediatrician. Finishing only some of the medication or skipping a dose because she complains of a tummy ache can leave harmful bacteria in your child's system (which continue to multiply), possibly leading to a recurrence of the infection. Also keep in mind that the weakest bacteria tend to be killed off first, leaving behind the stronger bugs that are more likely to be resistant, notes Anastasia Levitin, Ph.D., of the Keck Graduate Institute, in Claremont, California.
If you're not sure why your doctor has prescribed an antibiotic, speak up. Ask whether it's a broad-spectrum drug (such as amoxicillin, a first-line drug for treating ear infections). If so, find out whether a narrow-spectrum one (such as some types of penicillin) might be an equally effective treatment. Broad-spectrum antibiotics increase the odds of creating resistant bacteria by wiping out good bugs in the gut that help keep harmful ones in check.