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Antibiotics: Using Them Safely
Antibiotics are an important type of medicine. When used correctly, they can cure infectious diseases and save lives; but when used incorrectly, they can be harmful. Since many antibiotics are given to young children, it’s crucial that parents use them safely.

What causes common childhood illnesses?
Young children typically get 6-10 contagious diseases each year. Infants and toddlers are particularly susceptible to illnesses because they put their hands and objects (which can carry germs) into their mouths, and their immune systems are not yet fully developed to protect them from illnesses.

Contagious diseases are caused by different types of germs, usually viruses and bacteria. The most common illness—the common cold—is caused by viruses. Most of the other common childhood illnesses—ear infections, sore throats, coughs, and diarrhea—can be caused by either viruses or bacteria, but approximately 80% are caused by viruses.

When are antibiotics necessary?
It is important to make the distinction between viral and bacterial illnesses because the recommended treatment is different:
  • Bacterial infections can be cured by antibiotics (e.g., amoxicillin, sulfamethoxazole, erythromycin).
  • Viral infections usually get better on their own within a week. The body’s immune system fights off viruses successfully. Antibiotics do not help with viral infections.
It can be difficult to tell the difference between a viral infection that doesn’t need antibiotics and a bacterial infection that does. It is the job of your doctor to make the diagnosis and prescribe the proper treatment.

Sometimes the symptoms may suggest that an illness is more likely viral vs. bacterial. Generally, children with viral illnesses are only mildly ill, and with rest and fluids they start feeling better within 2-3 days. If your child is more severely ill, doesn’t feel better within 2-3 days, or is getting sicker, be sure to call your doctor. Also, if your infant under 3 months of age is sick, call the doctor right away since infants can get sicker faster than older children.

Let’s look at some examples:
  • If your child has a cold or the flu, does she need antibiotics? No, colds and flu are caused by viruses and get better on their own within 7-10 days. Antibiotics do not help.
  • If your child has yellow or green nasal mucus, does he have a sinus infection and need antibiotics? No, yellow or green mucus usually occurs 5-7 days after the start of a cold and is a sign that the body’s immune system is fighting off the virus and the infection is ending. Only rarely, when the green mucus lasts for more than 14 days, a bacterial sinus infection may be the problem and antibiotics may be needed.
  • If your child has an ear infection, does she definitely need antibiotics? No, recent studies show that most ear infections are viral and 80% of children get better on their own without antibiotics. Depending on your child’s age, medical history, symptoms, and physical exam, the doctor may or may not prescribe antibiotics.
What’s the harm in giving antibiotics, just in case?
Like all medicines, antibiotics can have harmful side effects. Side effects of antibiotics include upset stomach, diarrhea, rashes, and rarely, allergic reactions that can even be life-threatening.

Another serious consequence of improperly using antibiotics is the development of more dangerous “resistant bacteria.” When we take antibiotics, many bacteria are killed, but some resistant bacteria survive. The more you take antibiotics, the greater your chance of developing resistant bacteria. Over time, resistant bacteria can multiply and cause infections that are more difficult to treat, and can also spread to other people in the family and community. If you or your child gets sick with resistant bacteria, it can cause a serious health problem.

Unfortunately, the prevalence of resistant bacteria has skyrocketed due to the overuse and misuse of antibiotics worldwide. Currently, there are some bacterial infections that cannot be cured by any antibiotics.

How can we use antibiotics safely?
1. Only give your child antibiotics when they are prescribed by the doctor. If the doctor says that your child has a viral infection and doesn’t need antibiotics, don’t give them.

2. Take the medicine exactly as the doctor prescribed. If the antibiotics are to be given three times a day, do not give them twice or four times; and if you are supposed to give a teaspoon, don’t give less or more. If the doctor says your child needs the antibiotics for 10 days, give them for the whole time, even if your child starts feeling better after a few days—this is a sign that the antibiotics are starting to fight off the bacteria, but stopping the antibiotics can allow resistant bacteria to grow and a worse infection can return. If any medicine is leftover after the course is finished, discard it.

3. Never share or take leftover antibiotics. Antibiotics should only be taken by the person for whom they were prescribed and for the specific illness at the specific time. They may be useless or harmful for another person or another infection at different time.
Follow other measures to prevent contagious diseases:
  • Make sure you and your children are up-to-date on your immunizations. Immunizations can prevent many serious infectious diseases.
  • Wash your own and your children’s hands frequently, especially after diapering/toileting and wiping noses; and before preparing food and eating. Use liquid soap, scrub for 10 seconds, and rinse under running water.
Are antibacterial soaps necessary? No. These have not been shown to reduce illness any better than regular soap, and they may also promote the growth of resistant bacteria.
Karen Sokal-Gutierrez M.D., M.P.H. Pediatrician