Harvard Health Blog
By Claire McCarthy, M.D.
Out of all the visits children make to health care providers, 1 in 5 result in a prescription for antibiotics. That’s about 50 million prescriptions a year. But here’s the worrisome part: 10 million of those prescriptions are for respiratory illnesses that antibiotics aren’t likely to help. Basically, 1 in 5 of those 50 million prescriptions shouldn’t have been written in the first place.
This is a real problem. Antibiotics can be lifesaving and should absolutely be used when they are needed — but they are not without risks and problems. They can cause side effects, such as vomiting, diarrhea or allergic reactions. By killing off bacteria that grow naturally in the body, they can lead to other health problems. Also, the more we use antibiotics, the more bacteria figure out how to outsmart them, leading to antibiotic resistance. If we want our antibiotics to work at all, we are going to have to use them less.
Now, obviously patients don’t write prescriptions. Ultimately, the medical profession is responsible for this problem. But patients and families can make a difference. It helps when families don’t ask for or expect a prescription — and it helps when families ask questions anytime an antibiotic is prescribed.
Take this quick quiz to check your antibiotic smarts
Question: (True or false) Any time the doctor says your child has an ear infection, you should leave the office with a prescription for antibiotics.
Answer: False. Turns out that most ear infections get better without antibiotics. In some circumstances, such as in young infants, severe infections, or children with immune system problems, antibiotics are necessary. But for most healthy children, all that is really needed is some acetaminophen or ibuprofen for pain, some time, and some TLC.
Question: Which of the following set of symptoms means your child has sinusitis?
A. A cough for a week, with fever at the beginning and not since
B. Green nasal discharge and cough for four days, fever to 101
C. Both of the above
D. None of the above
Answer: D. The common cold, caused by a virus, can give you cough, fever, and green nasal discharge — and antibiotics are not only unnecessary, they won’t do a thing. Antibiotics should only be considered if:
–There is nasal congestion and cough, preferably with fever, that has lasted for 10 days or more (it still may be a cold, your doctor needs to examine and be sure)
–There is new fever, congestion, and cough after a cold seemed to be getting better
–There is high fever (103 F or more) and severe congestion and cough for three days
Question: Your child has a bad sore throat and fever. You take your child to the doctor, who says that the throat is very red and has pus, but doesn’t find anything else that worries her. What should happen?
A. You should get antibiotics, because pus means there must be a bacteria
B. You should get a strep test and antibiotics
C. You should get a strep test, but no antibiotics unless the rapid strep test or culture comes back positive.
Answer: C. Turns out that pus doesn’t necessarily mean there are bacteria. Some of the nastiest throat infections are caused by viruses — which, again, antibiotics don’t treat.
Question: (True or False) Since sometimes colds can lead to ear infections or sinusitis or pneumonia, it’s a good idea to take an antibiotic to prevent that from happening.
Answer: False. While it’s really understandable to want to “be on the safe side” and ward off a bacterial infection, most colds don’t lead to bacterial infections — and if you are in touch with your doctor, you should be able to pick up the signs of anything that needs to be treated by antibiotics.
To learn more about smart use of antibiotics, check out these resources from the CDC and the American Academy of Pediatrics.
(Claire McCarthy, M.D., is a faculty editor at Harvard Health Publications.)