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When Are Antibiotics OK for Kids?

A pediatrician discusses antibiotic use in children

Child taking medicineThe advent of penicillin in the 1940s has saved millions of lives. Illnesses that were once considered life-threatening — such as pneumonia, strep throat and scarlet fever — are now entirely manageable thanks to penicillin and other antibiotics.

Why, then, does there seem to be so much conflicting information about the use of what has been called a "wonder drug"? For a parent with a sick child, the mixed messages from researchers and the media can be particularly perplexing. 

Karen Lui, MD, a pediatrician at Rush University Medical Center, sheds some light on the issue.

Q: Why does there seem to be increasing hesitancy regarding the use of antibiotics?

Lui: I don't think any physician likes to use antibiotics if they don't need to. Because of the overuse of antibiotics and bacteria becoming more resistant to them, we have had to use much higher doses. This increases the risk of side effects like upset stomach and diarrhea, which create additional discomfort on top of the illness the child is already going through.

Eventually, a patient may need a stronger class of antibiotic because bacterial strains become resistant. Also, some children might be allergic to antibiotics, and we don't know whether they are until we try.

Q: There is research, including a study regarding ear infections, that suggests times when it’s beneficial to treat children under the age of 2 with antibiotics right away. Why is there a difference in how you might treat a 2-year-old compared to a 3-year-old?

Lui: For children under 2 years old, it's harder to figure out what the underlying issue may be. They can't tell us what's really causing them discomfort.

Also, for kids who are younger, it's sometimes tough to administer a thorough ear exam; their ear canals are so small, and they might be scared and crying for the entire office visit, so the ear is already red from crying. So if symptoms of ear infection or another infection are the only signs we have, we will treat the child with an antibiotic.

In addition, younger children tend to get sicker faster than older children; therefore, we worry about other diseases that can cause complications, like mastoiditis — when an ear infection spreads to the skull — so we err on the side of caution and use an antibiotic.

However, a 3-year-old might be able to tell us exactly where the discomfort is located. For kids older than 2 years old, we usually give parents the option of first trying ibuprofen or ear drops to help reduce pain. If the child still has symptoms after about 48 hours, then antibiotics are given stronger consideration.

That also applies to other infections, such as those affecting the sinuses and throat. For sinus infections, I might first suggest pain relievers, a humidifier and a nasal rinse. A humidifier can also relieve the hoarseness that comes along with a throat infection; gargling with warm salt water can reduce inflammation, too.

Q: What can parents do to prepare for a visit with a physician and the potential use of antibiotics for their sick child?

Lui: I would suggest doing your best to keep track of the course of the illness. When did symptoms start, and how high has the fever been? Based on a history, we can sometimes determine whether to use antibiotics sooner rather than later.

If the child has had a fever for longer than two or three days, then we err on the side of treating with an antibiotic, as opposed to if the child had a low-grade fever for a day. Good communication between the parent and the doctor helps everyone involved decide on what they're comfortable doing next.