There are a few hot topics that routinely get debated in pediatrics. Whether or not to use antibiotics is very close to the top of the list. (Vaccines are definitely number 1.) There are people in the camp of always wanting antibiotics and there are people in the camp of never wanting antibiotics. Luckily, many are in between and trust the advice of their doctor. Doctors have (ideally) a good understanding of when antibiotics are needed and when they aren’t. When used appropriately, antibiotics are an important part of treating bacterial infections and are many times life saving. Below is a list of myths/questions that I hear from parents on a regular basis followed by my response. Trust me, your pediatrician will thank you if you are armed with this information.
Antibiotics will help the cold get better faster.
Antibiotics are designed to kill bacteria. The common cold is always caused by a virus and therefore will not get better with antibiotics. Some people feel that antibiotics helped their child’s cold resolve more quickly in the past, but that was most likely due to timing. Colds will typically resolve within 7-10 days. Usually around the same time they were taking antibiotics during the last illness. Also, each presentation of the common cold varies so some illnesses may only be a few days while others last the typical amount of time or longer.
Antibiotics will prevent the cold from turning into something worse.
Cold viruses don’t turn into bacteria. However, children with a viral infection are susceptible to secondary bacterial illnesses like ear infections, sinus infections or pneumonia. Giving antibiotics during a cold does not prevent these bacterial infections from occurring. In fact, inappropriate use of antibiotics contributes to global antibiotic resistance. Furthermore, there is always a risk of side effects when giving any medication. I never recommend medication that isn’t necessary because of these risks.
Just prescribe a Z-pack (or substitute your favorite, like Amoxicillin). It always works.
Antibiotics are not created equally and bacteria are not created equally. Each classification of antibiotics is made to kill specific types of bacteria in different ways. For example, E. coli is very different than pertussis and therefore different antibiotics are needed for each. With each type of infection, there are clear guidelines and preferences for how to treat based on which bacteria is known to cause that infection and how to kill it. Therefore, a Z-pack (Zithromax) is not appropriate for all infections.
Antibiotics make it harder to fight infection and/or change the immune system.
As stated above, antibiotics are made to kill bacteria. The make-up of our immune cells is not the same as that of bacteria so antibiotics cannot alter the immune system. While I think that our immune system is wonderful and amazing, it can’t fight everything. Some infections have to be treated to prevent further complications or death. Some parents desire natural immunity and want the body to fight an infection on it’s own which in some cases, like uncomplicated ear infections or most viral infections, that is the standard of care. But if that were adequate we wouldn’t have infection-related deaths or a need for antibiotics at all. In fact, the reason we treat strep throat is to prevent Rheumatic Fever in the future. The reason we treat febrile urinary tract infections is to prevent kidney damage. When in doubt, ask your doctor about all the possible treatment options for your child. If you have a concern about the natural flora of the GI tract, you can give probiotics during your child’s antibiotic course.
My child will become resistant to antibiotics.
Antibiotic resistance refers to a state in which the bacteria has altered itself so it can no longer be killed by a specific antibiotic. A person can be infected with resistant bacteria but the person is not resistant themselves. Bacteria become resistant when infections are treated partially, so always finish a course of antibiotics prescribed by your doctor. Bacteria also become resistant from overuse of antibiotics so don’t pressure your doctor into prescribing unnecessary antibiotics for your cold! (See myth #1.)
On a side note, the majority of antibiotics used in this country are actually in the agriculture industry, so to help the cause, buy organic meats and dairy in which the animals are raised without antibiotics.
If you have questions about your illness or your prescribed therapy, ask your doctor.