Antibiotics are wonderful, sometimes life saving, weapons in the treatment of infectious disease.  Unfortunately, they do not cure all infections, can cause unpleasant reactions and are often expensive.  In addition, the more an antibiotic is used, the less effective it will be for future infections.  The following discussion provides some background on the decision making process for when and how antibiotics are prescribed.

All children get sick, but most illnesses are fortunately mild. Whereas the average adult has only one sickness with fever every 5 to 10 years, the young child has 5 to 10 each year.  As a result, we frequently evaluate children with fever.  Because both viruses and bacteria cause fever but only bacteria respond to antibiotics, distinguishing between the two is crucial.  Here are the tools we use to evaluate children with infection.

History and physical examination

When a child’s symptoms and examination shows no signs of pneumonia, tonsillitis, sinusitis, ear infection, urinary infection, or meningitis, we have eliminated the majority of the infections which require an antibiotic.

Lab Tests

The blood count can help to tell if a serious infection is present, and whether it is bacterial or viral. An examination of the urine will show if an infection of the kidneys or bladder is likely. Chest x-rays may be necessary to further evaluate a suspicion of pneumonia.

What’s Going Around?

Knowing what types of infection are common at a given time of year helps us to decide if your child needs an antibiotic.  For example, in late summer we often see a viral throat infection called herpangina.  This condition improves in 2-3 days without the help of medication.  On the other hand, winter is a time when strep throat is more common.

Some final comments on antibiotics

If we find only signs of a viral infection and your child does not appear too ill, we usually recommend symptomatic treatment for fever and other symptoms while the immune system fights off the infection on its own.  Parents sometimes request an antibiotic to “keep the child from getting sick” or to “nip it in the bud.”  If your child does not have a bacterial infection, antibiotics will be of no benefit and may cause unwanted side effects or allergic reactions.  Increasing concern over antimicrobial resistance, (i.e., bacteria becoming immune to antibiotics), demands that we be judicious in prescribing.

Sometimes parents will ask for an antibiotic to be called out over the phone.  It is contrary to our policy to call out an antibiotic without evaluating your child.  It is not that we disagree with your diagnosis.  We want to be sure of your child’s condition and prescribe the most appropriate treatment possible.