Does your child really need an antibiotic? That's what you should ask yourself every time they’re sick, now that drug resistance has become a serious health threat. Our guide will help you find the answer. 

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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 their system. Even if they don't develop symptoms themselves, they could easily transmit these harmful bacteria to others.

child getting medicine with syringe
Credit: Shutterstock

A big part of the problem: Doctors are dispensing antibiotics 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 rare 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. 

All that said, you shouldn't fear taking antibiotics if needed. When used judiciously, they're important tools to fight illness, especially when you know the ins and outs. We asked infectious disease doctors to weigh in on whether kids really need meds for nine common health issues.

Common Cold

Antibiotics are never helpful.

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.

Sinus Infection (Sinusitis)

Antibiotics are sometimes helpful if symptoms are severe.

Most runny noses are due to the common cold, says Michael B. Grosso, M.D., medical director at Huntington Hospital, Northwell Health, in New York. "However, if your child has a runny nose and day-and-night coughing, and is not getting better after ten to 14 days, it could be bacteria sinusitis." Other symptoms include green discharge, nasal congestion, facial pain, and a sinus headache. 

Ear Infection

Antibiotics are sometimes helpful. 

"Some ear infections can be caused by viruses," says Amna Husain, M.D., a pediatrician and founder of Pure Direct Pediatrics, in Marlboro, New Jersey. In those cases, antibiotics wouldn't help. Instead, docs might recommend putting a warm cloth on the affected ear or taking acetaminophen or ibuprofen to deal with the pain. The routine Hib vaccine can also protect against Haemophilus influenzae, a bacterium responsible for ear and other more serious infections

Sore Throat

Antibiotics are always helpful if it's strep.

Icky but true: Most kids walk around with strep living dormant in their throat, says Dr. Grosso. While most sore throats are caused by viruses, pain shouldn't go ignored, especially if it comes without cold symptoms (like a cough or a runny nose) or if your kid also has a headache or a tummy ache. Untreated strep can lead to rheumatic heart disease (permanent damage to valves in 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.

Pinkeye (Conjunctivitis)

Antibiotics are probably helpful. 

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.

Bronchitis

Antibiotics are rarely helpful 

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), they may culture your child's sputum and if the result is positive, treat the infection with antibiotics.

Pneumonia

Antibiotics are sometimes helpful.

Pneumonia can be caused by bacteria or viruses and comes with symptoms such as a cough that produces mucus, as well as vomiting, diarrhea, or fever. If your child is recovering from a cold, they might develop a secondary bacterial infection, such as bacterial pneumonia. Walking pneumonia is very common in kids and typically stems from the bacterium Mycoplasma pneumoniae. A lab test can determine which one your child has, helping the doctor decide on a course of treatment.

Lyme Disease

Antibiotics are helpful.

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 they exhibit fatigue, have difficulty thinking or speaking, or complain of headaches and nausea—even if you don't spot the telltale bull's-eye rash.

Urinary Tract Infection (UTI)

Antibiotics are always helpful.

"These are fairly common in the first year of life," says Dr. Grosso. Symptoms can include vomiting, poor feeding, or diarrhea. Pain while peeing because of a UTI generally happens later in childhood.

What to Know About Taking Antibiotics

Should your child require antibiotics for a bacterial infection, make sure they take them exactly as prescribed by the pediatrician. Finishing only some of the medication or skipping a dose because 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 (able to kill a wide range of bacteria). If so, find out whether a narrow-spectrum one 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.

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