Research shows that about 1 in every 5 pediatric visits for “sick visits” results in an antibiotic prescription. Now not all of those antibiotics are taken; many pediatricians now use the rx pad for “wait and see” or “delayed prescribing” antibiotics. They give a prescription and allow the family to watch and wait — if a child is not getting better, they advise parents to start taking them.

However, in total there are nearly 50 million antibiotic prescriptions written annually in the US. It’s not uncommon that prescriptions for antibiotics are written when children have “colds” or upper respiratory tract infections from a virus. That’s where we all have an opportunity to improve our children’s health. Nearly all of us know it’s good to avoid antibiotics when unnecessary.

Studies indicate that nearly 50% of antimicrobial use in hospitals is unnecessary or inappropriate.
-CDC

In my experience, this issue really isn’t a tug-of-war between parents wanting drugs and doctors wanting to restrict them. Most parents I talk with in clinic don’t want an antibiotic if they can avoid it.

However, recent survey data on adults found that 38% expressed a desire for antibiotics when seeking health care for the common cold. Determining when antibiotics are necessary is the tough part. Recently, a clinical report was published to help pediatricians and parents know when they can avoid antibiotics given unnecessarily. Some of the data from the report included here:

5 reasons to avoid antibiotics when unnecessary

1. Antibiotics can cause side effects. The reason: while you may be giving antibiotics to treat a possible ear infection, once ingested the antibiotics go to every organ in your body thus killing off some of the “good bacteria” living there. Some new research even suggests that bacteria that live in our gut affect our brain activity, mood, and behavior.

2. Bacteria do good. Throughout our lifetime we accumulate a lot of bacteria to the point that of all the cells in and on our body, 90% of our cells are bacterial! These bacteria help keep our bodies happy – assisting in digestion and keeping a good balance of colonies for healthy skin and intestines.

3. Every dose of antibiotics changes us. Each dose of antibiotics kills the normal bacteria that live in our body. The risk of taking antibiotics is not only the side effects (diarrhea, rash, or upset stomach, for example) but the risk that each dose changes who we are. Previous research from 2012 found that antibiotics, particularly when given to infants, may increase risk for chronic disease later on (inflammatory bowel disease).

4. Antibiotics change our environment. Each dose of antibiotics to our children, ourselves, or the animals we eat changes our community’s health in general. The more we use antibiotics that kill off susceptible bacteria, the more we select bacteria for survival that are resistant to known treatments. The consequence over time for us all is more resistant bacteria or “superbugs”– harder to treat infections.

5. Unnecessary antibiotics cost money. When an infection is caused by a virus and we treat with antibiotics, it’s an unnecessary drain on our pocketbook. Simple as that. TLC isn’t free (days out of work, tugs on our heart) but for viruses, our TLC can be one of the most powerful things we provide our children as they heal and recover.

While the development of antibiotics over the last 100 years has certainly helped us cure many diseases, we are only beginning to understand the relationship between our bodies and the bacteria that live within us. Antibiotics can kill many of these bacteria and we are starting to learn about the substantial unintended consequences that can result.
– Dr. Matthew Kronman, pediatrician and expert in infectious disease

5 ways to avoid antibiotics

1. Be an advocate. Whenever you or your child is prescribed antibiotics, ask why they are necessary. Ask about alternatives. Ask if you can “watch and wait” for 24-48 hours to see if you get better first without antibiotics. If not, use necessary antibiotics as they can be wonder drugs when necessary!

2. Ear infections. The first and most important medication for ear infections immediately are pain relievers like acetaminophen or ibuprofen. If your child is under age 2 years, has a “double ear infection,” or is in extreme pain with fever, it’s likely an antibiotic will help. If your child is over age 2 years and symptoms are controlled with pain relievers, you may want to ask about waiting before starting antibiotics. Studies show well more than 50% of ear infections get better on their own without antibiotics! Also, make sure the doctor or nurse seeing your child confirms there is an infection in the middle ear, not just fluid, to meet requirements for an ear infection. Read more about what you can do for your child with ear infections.

3. Sinusitis. Sinusitis is difficult to diagnose in children. When going in for a child’s upper respiratory infection or “cold,” ask your doctor why they think your child has sinusitis. Ask about alternatives to treatment with antibiotics. Antibiotics can be necessary when children have severe sinus symptoms, symptoms of dark mucus with fever for 3+ days, daytime cough or infection symptoms that aren’t improving.

4. Sore throat. If your child has a cold, runny nose, cough, and sore throat, it’s unlikely to be strep throat. However, if your child has been exposed to strep, has fever and an isolated sore throat, head into the doctor for a strep throat swab. If the test is POSITIVE for strep, start the antibiotics. If the strep test is not positive, it’s unlikely you’ll need antibiotics. For sore throat, use ice chips, pain relievers (acetaminophen or ibuprofen), and a humidifier. Smoothies and popsicles, too!

5. Bronchitis. Bronchitis (inflammation in the airways from a cold) and upper respiratory infections are almost always caused by viruses. Antibiotics won’t help. Discuss with your doctor why your child really needs antibiotics if these are the diagnoses given.

Wendy Sue Swanson is a pediatrician who blogs at Seattle Mama Doc.