How do i know if my child needs antibiotics

Does your child need antibiotics?

Speaking of Health

Tuesday, April 28, 2015

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For parents, it can be hard to tell whether your child’s illness requires antibiotics or if there are other ways to effectively treat their symptoms. In order to prevent overuse of these drugs, it’s important to know which situations can use home remedies instead of antibiotics. The more you treat your child with antibiotics, the more likely they are to get sick with an antibiotic-resistant infection in the future.

Ear infections

If your child has an ear infection, consider using over-the-counter pain relievers in place of antibiotics. Children’s ear infections usually improve within two to three days, especially for kids who are two years or older. If your child’s health doesn’t improve within a few days, it would be wise to take them in to see their provider.

Experts recommend antibiotics for an ear infection in the following instances:

If your child is six months or younger
If your child is between six months and two years old and has moderate to severe pain
If your child is two years or older with severe symptoms

If your child has ear tubes and develops an ear infection, you should try using antibiotic eardrops instead of oral antibiotics. Eardrops are more effective than oral antibiotics in this case because the tubes allow the antibiotics to travel straight into the middle ear, where most infections are located. Eardrops are also not as likely to cause resistant bacteria as oral antibiotics.

However, you should ask for oral antibiotics if your child’s infection doesn’t get better with the eardrops. If your child is severely ill, it may be better to use oral antibiotics instead of the eardrops.

Cold, flu and other respiratory infections

Don’t use antibiotics to treat your child’s cold, flu and most other respiratory infections. Viruses cause most respiratory infections, and antibiotics do not treat viruses; antibiotics fight bacteria. Instead, offer your child warm liquids, such as tea or soup. These can have a soothing effect and loosen mucus. Over-the-counter saline nasal drops or saline spray can also help loosen nasal mucus. Try running a cool-mist humidifier in the child’s room or steam from a hot shower for additional relief.

Strep throat and cough

Bacteria cause strep throat. However, most children with the symptoms of strep throat actually have a virus. You should ask for a strep throat test before turning to antibiotics to cure your child’s symptoms. Ice cream, frozen fruit pops or cold beverages may help soothe a sore throat. Older children can try gargling salt water or sucking on throat lozenges. Always encourage your child to get enough rest so their bodies have a chance to recover.

Consider getting antibiotics for your child when a cough

persists for 14 days or more. Antibiotics are also necessary if a doctor diagnoses your child with a bacterial infection, such as strep throat.

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When Kids Need Antibiotics | UC Davis Medical Center

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When Kids Need Antibiotics

Checkup on Health

It’s important that parents don’t push doctors to prescribe antibiotic treatment. Instead, ask your doctor for advice on how you can help your child feel better.

By Michael C. Lucien, M.D., M.P.H.

Imagine that your child has had three days of a cough, fever, runny nose and feeling just plain sick. You bring her into the doctor’s office in the hopes of receiving something to make her well. Not long ago, many doctors would have handed over a prescription for a broad-spectrum antibiotic. Maybe it would work. Conventional wisdom held that even if it didn’t, at least no harm would be done. And no matter what the treatment, the patient would probably be better in a few days.

Conventional wisdom has changed. No longer can doctors be so cavalier about dispensing antibiotics. Such practices are now known to be a real danger not only to the individual who was unnecessarily given antibiotics, but to the entire community.

Dr. Lucien is a pediatrician at UC Davis Medical Center in Sacramento.

Because of the overuse of antibiotics over the years, bacteria are increasingly becoming drug-resistant and much more difficult to manage. Some strains of bacteria are now resistant to almost every antibiotic now available.

The Centers for Disease Control estimate that up to half of antibiotic prescriptions written in doctor’s offices are unnecessary. They are now urging physicians to change their prescribing habits.

Some responsibility for the solution to the problem must rest with the general public. Greater understanding is key. The flu and most colds, as well as most coughs and sore throats, are due to viruses, which antibiotics are completely ineffective in fighting. Antibiotics are only useful against bacterial infections.

Which illnesses need antibiotics?

In-room misters and over-the-counter remedies against pain, fever, cough and congestion can help relieve symptoms and allow your child to get a good night’s sleep.

Are antibiotics ever the right solution to common childhood ailments? Of course. It’s still important to see your doctor when your child is sick for longer than a few days, especially if symptoms are serious or worsening. Here is what your doctor considers when it comes to prescribing antibiotics:

Common colds never need antibiotics. Even those accompanied by fever and a yellow or green discharge are usually caused by viruses. You can expect symptoms to last for up to ten days. However, if a sinus infection caused by bacteria is suspected, your doctor will carefully make a decision whether antibiotics are the best choice based on symptoms and a physical examination.
Sore throats generally do not need antibiotics. The main exception is for “strep throat,” when streptococcal infection is the cause. This can be determined in most doctors’ offices with a quick throat swab.
Coughs are usually caused by viruses and do not often require antibiotic treatment. By listening to the lungs, the doctor can determine if pneumonia, which is a lung infection often caused by bacteria, is present. This requires antibiotics.
Ear infections have traditionally been treated routinely in this country with antibiotics. Now we realize that about 80 percent will get better without treatment in seven to 14 days. If the child is not sick or in pain, many doctors now recommend waiting to see if the infection clears up by itself.

Listening important

An important preventive measure you can take against bacterial infections is immunizing against streptococcus pneumoniae.

In-room misters and over-the-counter remedies against pain, fever, cough and congestion can help relieve symptoms and allow your child to get a good night’s sleep. It’s important that parents don’t push doctors to prescribe antibiotic treatment. Instead, ask your doctor for advice on how you can help your child feel better. In-room misters and over-the-counter remedies against pain, fever, cough and congestion can help relieve symptoms and allow your child to get a good night’s sleep.

When your doctor does prescribe antibiotics, it is essential to use them properly. Unless your doctor advises otherwise, use all the pills according to the schedule provided.

Never save up pills after your child is feeling better so that they can be used for another child or a future illness. Taking only a partial course can lead to the growth of resistant, and much more dangerous, strains of bacteria.

Preventative measures

An important preventive measure you can take against bacterial infections is immunizing against streptococcus pneumoniae. These infections are the most common invasive bacterial infections in children in the U.S., causing pneumonia, meningitis and blood infections. At one time, streptococcus was easy to treat with penicillin. The overuse of antibiotics has made it resistant to many drugs, and it is now responsible for 40,000 deaths annually.

Immunization against strep pneumoniae is recommended for all children, aged two months to 23 months. People over 65 years or who have a chronic illness should also be immunized with pneumococcal vaccine.

When to give antibiotics to children

Antibacterial drugs should only be used for infections caused by bacteria.

In a hospital with severe and life-threatening infectious diseases (for example, meningitis - inflammation of the meninges, pneumonia - pneumonia, etc.), the responsibility for the correct choice of medicine lies entirely with the doctor, who is based on patient observation data (clinical picture) and on the results of special studies.

For mild infections that occur in "home" (outpatient) conditions, often the parents themselves ask the doctor to prescribe an antibiotic. Is it correct?

Runny nose and bronchitis

In case of acute rhinitis (runny nose) and bronchitis, antibacterial drugs are not indicated. In practice, everything happens differently: for one or two days of fever and cough in a child, parents, as a rule, do not give the baby antibacterial drugs. But then they begin to fear that bronchitis will be complicated by pneumonia, and decide to use antibiotics. It is worth noting here that such a complication is possible, but it practically does not depend on the previous intake of antibacterial drugs. The main signs of the development of pneumonia is the deterioration (further increase in body temperature, increased cough, shortness of breath). In such a situation, you should immediately call a doctor who will decide whether to adjust the treatment.

If the condition does not worsen, but does not improve significantly, then there is no obvious reason for prescribing antibacterial drugs. However, it is during this period that some parents break down and start giving drugs to their children "just in case".

It should be especially noted that a very popular criterion for prescribing antibacterial drugs for viral infections - maintaining an elevated temperature for 3 days - is absolutely not justified. The natural duration of the febrile period in viral respiratory tract infections in children varies greatly, fluctuations are possible from 3 to 7 days, and sometimes more. A longer preservation of the so-called subfebrile temperature (37.0-37.50C) is not necessarily associated with the development of bacterial complications, but may be the result of completely different reasons. In such situations, the use of antibiotics is doomed to failure.

A typical sign of a viral infection is a persistent cough against the background of an improvement in general condition and normalization of body temperature. It must be remembered that antibacterial drugs are not antitussives. Parents in this situation have ample opportunities for the use of folk antitussives.

Cough is a natural defense mechanism and the last of the symptoms to disappear. However, if a child has an intense cough for 3-4 or more weeks, it is necessary to look for its cause.

Otitis

In acute otitis, antibiotic therapy is different, since the probability of a bacterial nature of this disease reaches 40-60%. Given this, until recently, antibacterial drugs were prescribed to all patients.

As practice shows, acute otitis is characterized by intense pain in the first 24-48 hours, then in most children the condition improves significantly and the disease goes away on its own. After 48 hours, symptoms persist in only a third of small patients.

There are interesting calculations showing that if antibacterial drugs are prescribed to all children with acute otitis media, then they can provide some help (reduction of the febrile period and the duration of pain) only to those patients who should not have had an independent quick recovery. Only 1 child out of 20 can be like this.

What will happen to the other 19 children? When taking modern drugs of the penicillin group, such as amoxicillin or augmentin, nothing particularly terrible will happen. 2-3 children may develop diarrhea or develop skin rashes that will quickly disappear after stopping the drugs, but recovery will not accelerate. As in the case of bronchitis, the appointment of antibacterial drugs for otitis media does not prevent the development of purulent complications. Complicated forms of otitis with the same frequency develop both in children who received and in those who did not receive antibacterial drugs.

To date, a new tactic of prescribing antibacterial drugs for acute otitis media has been developed. It is advisable to prescribe antibacterial drugs to all children under the age of 6 months, even with a dubious diagnosis of acute otitis media (it is not so easy to find out that it is the ear that hurts a small child).

At the age of 6 months to 2 years, with a dubious diagnosis (or mild course) of acute otitis media, the appointment of antibiotics can be postponed, limited to monitoring the child - the so-called expectant tactics. Naturally, during observation, children should be given painkillers and, if necessary, antipyretics. If within 24-48 hours his condition does not improve, then it is necessary to start antibiotic therapy.

Of course, in this case, higher demands are placed on parents. First of all, you need to discuss with your doctor when to give antibiotics, and clarify what signs of the disease you should look out for. The main thing is to be able to objectively assess the dynamics of pain, its increase or decrease, and notice the appearance of new signs of the disease in time - cough, rash, etc. Parents should be able to contact the doctor by phone, and also have a written prescription for an antibiotic.

In children older than 2 years, waiting and observing for 48 hours is the preferred tactic, except in cases of severe (temperature above 390C, intense pain) of the disease.

Inflammation of the lungs

When pneumonia is diagnosed or this pathology is seriously suspected, the antibiotic therapy tactics differs from the two previous cases.

Certain age groups of children are characterized by some features of the prevailing pathogens. So, at the age of 5-6 years, according to some researchers, up to 50% of cases of pneumonia can be caused by viruses. At an older age, the likelihood of a viral nature of pneumonia is significantly reduced and the role of bacteria (pneumococci) in the development of pneumonia increases. However, in all age groups, pneumococcus is a common causative agent of this disease, which causes a severe course of the disease. That is why pneumonia is an unconditional indication for antibiotic therapy.

to whom, when and how to take

Enroll

April 16, 2021 read 7-10 minutes

When they are prescribed, is it worth being afraid of side effects and why can the result be unexpected? We tell you what doctors think about antibiotics.

Do not repeat at home

An antibiotic is a powerful drug and should always be prescribed by a doctor. For more than two decades, many pharmacies, in an effort to increase revenue, freely sold prescription drugs, except for narcotic and psychotropic drugs. This led to the fact that many doctors forgot how to draw up prescription forms, writing out prescriptions on notebook sheets, without even stamping them. And patients bought antibacterial, they are also antimicrobial, drugs for self-treatment. The control has been tightened only in the last two years.

“Even before I started working at the Fantasy Children's Clinic,” says pediatrician Viktoria Alipova, “a child was brought to the appointment who complained of pain in the abdomen and a violation of the stool. The anamnesis showed that the boy had been treated with antibiotics 12 times over the past year for every cold, including SARS, when such drugs are useless. The first time the antibiotic was prescribed by a doctor, and then the mother of the child acted by analogy. It was enough to cancel the drug, and the problem with the intestines would have returned to normal. Children can take antimicrobials in the form of syrups or suspensions even from birth, but only according to the indications that are determined by the doctor. Many doctors prescribe such drugs for any reason.”

Antibiotics have many side effects. First of all, they destroy the intestinal microflora: diarrhea, vomiting appear, colitis, liver and kidney dysfunction, and allergies are possible. In such cases, probiotics or other drugs that normalize the functions of the gastrointestinal tract are often prescribed in parallel. However, urologist Rinaz Kamaletdinov says that the clinical guidelines do not indicate that such drugs can stabilize the intestinal microflora against the background of antibiotic therapy. And in each case of illness, only a specialist can decide on the type of therapy:

“Antibiotic treatment should be carried out by a doctor,” says Dr. Kamaletdinov. - Even in case of recurrence of similar symptoms, you should not take the pills left over from the previous illness. You can also consult a doctor online or by phone. Different types of antibiotics are used in urology, most often fluoroquinolones, especially levofloxacin. Often you have to change the pharmacological group, dose, duration and schedule of administration. For example, a patient with bacterial prostatitis caused by E. coli received one type of antibiotic. Treatment requires 28 days, but on the 3rd week the symptoms returned. It turned out that a second infection appeared in the body, and E. coli developed resistance to the drug. I had to additionally prescribe a drug of a different spectrum.

Is it possible to defeat resistance

Over time, the bacteria adapt by producing genes that protect against the effects of antibiotics. If a person becomes infected with such bacteria, it is much more difficult to treat him. This process is on a planetary scale, and the doctors themselves are to blame for the problem. Often they thoughtlessly use broad-spectrum antibiotics, which, like carpet bombing, destroy the microflora of the mucous membranes.

“It’s easier to prescribe an antibiotic to a child with a high fever or an unconscious ICU patient and not worry about further treatment,” complains therapist and medical blogger Philip Kuzmenko. “The doctor simplifies his work by shooting ‘from a cannon at sparrows’, achieves the patient’s recovery, but at too high a price.”

The next time a recovered person is afflicted with the same disease, the old remedy may not work because the bacteria have learned to resist it. In this arms race, microbes have a clear advantage. There will always be bacteria against which even the latest generation of drugs will be powerless.

“Self-treatment with antibiotics is the murder of our grandchildren and great-grandchildren,” Dr. Kuzmenko is convinced. “Every day I receive letters that inexperienced or incompetent doctors prescribe antibiotics for ARVI. Mortality from influenza does not exceed 2-3%, and from a bacterial infection for which there is no cure, it reaches 50%. Personally, in the first year of practice, I prescribed antibiotics often, then less often, and almost never in the 4th-5th year. There are 3 groups of so-called antibiotics of choice or first line: penicillins, macrolides and cephalosporins. These drugs are prescribed in case of a threatening situation even before an accurate diagnosis is confirmed. It is a myth that pneumonia at an early stage can be "listened to", and in some cases the patient may not even reach the pharmacy. Therefore, empirically, from a variety of antibiotics, “broad-spectrum” drugs were selected that act on 20–25 species of bacteria.”

When are antibiotics needed?

Antimicrobial drugs are indicated only in extreme cases of acute course of the disease: with pneumonia, tonsillitis, acute pyelonephritis, purulent otitis, meningococcal infection and in case of very high temperature with suspected sepsis. With rhinitis, bronchitis, laryngitis and many other diseases, you should not take antibiotics. However, Russian treatment protocols provide for such a possibility.

“Bacterial otitis media or sinusitis is much more effective to treat with intranasal steroids and nasal irrigation,” says Oleg Abramov, otolaryngologist at GMS Clinic. — Practice has shown that 80% of acute diseases do not require antibiotics. If, nevertheless, I prescribe them, then these are drugs of the penicillin group, ceftriaxone, clindamycin. But never right away. With bacterial rhinosinusitis, when a runny nose has not gone away for more than 10 days since the onset of a cold, for another 5 days I try to solve the problems by other means. If that doesn't help, I prescribe an antibiotic. It is extremely important to observe the duration of the intake, since the disease is insidious. After the disappearance of symptoms, the drug should be taken for another 5 days. And for example, with pneumococcal infection, the standard dosage does not cope with the bacteria, and the dose of the antibiotic must be doubled.

In most diseases, antibiotic therapy does more harm than good.

“Over 7 years of practice, I have observed about 700 thousand people with a cold and no more than 10 pneumonia,” says Philip Kuzmenko. - In one case, pneumonia was caused by a superbug - a microbe that is extremely resistant to most known antibiotics. We tried many drugs, but none worked, and the patient did not survive.”

If a disease is suspected for which antibiotics are needed, doctors immediately begin antibiotic therapy, but they must make sure the diagnosis is correct and, if necessary, adjust the treatment. Pneumonia can be confirmed by x-ray of the lungs; in other cases, blood or urine is usually taken for culture, determining which selective antibiotic the microbe is sensitive to. But, unlike X-ray, bacterial seeding takes a significant amount of time. “The analysis of blood or discharge from the urethra in our clinic requires 3-5 days,” says Rinaz Kamaletdinov. “The most modern laboratories cope in 1-2 days.”

According to Philip Kuzmenko, bacterial culture is relevant in a hospital setting, but in an outpatient setting it is neglected for many reasons. But Oleg Abramov believes that, in accordance with Western standards of treatment, bacterial culture has no proven diagnostic effectiveness, and he never prescribes it.

Some doctors do not take into account that any acute condition of the disease is converted into a chronic one by antibiotics. The immune system is suppressed by these drugs, failing to develop the necessary antibodies that would avoid the subsequent chronic stage of the disease.

But doctors do not see the danger in getting unnecessary antibiotics with poultry or livestock. For the treatment of animals, the same penicillin, tetracycline, chloramphenicol are indeed used, but being digested, they lose their aggressive medicinal properties, and they enter the human body already harmless.

Antibiotics needed in rare cases of exacerbation:

pneumonia
sore throats
meningitis
purulent otitis media
acute pyelonephritis and cystitis
cases of prolonged and very high fever

Take antibiotics only when prescribed by a doctor who chooses a specific drug, dosage, duration and schedule of administration
Antibiotics have many side effects
Bacteria develop resistance to most antibiotics. A drug that works once may not work the next time

Pediatric otorhinolaryngologist Otorhinolaryngologist / ENT Surgeon

Source ePharmacy

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