Does my Child Need an Antibiotic?

There can be many different causes of a childhood illnesses.  Most childhood illnesses are caused by viruses. Colds, stomach bugs, and influenza are viruses.  Most antibiotics are designed to kill bacteria by destroying the cell wall, but viruses don’t have a cell wall.  Antibiotics only work against bacterial infections. Some ear infections, urinary tract infections, some types of pneumonia, some throat infections, and some GI infections are bacterial infections. A good medical history, exam, and sometimes diagnostic testing can help determine if the infection is viral or bacterial in origin. In developing countries, especially in villages, antibiotics may be prescribed more often because there are less diagnostic testing and more immunization preventable bacterial infections. Among healthy, educated, immunized children in the city I see more typical childhood viruses and diagnosable bacterial infections.

Here is why I don’t prescribe antibiotics for viral infections:

1. Antibiotics don’t work for viruses. A body with a healthy immune system has the tools to fight off viral infections. Check out this video: “Does my child need an antibiotic?”
2. Your child could develop an allergy to an antibiotic, making it difficult to find an effective antibiotic that she’s not allergic to in order to treat the bacterial infection next time. 
3. She can get a side effect from the antibiotic such as a rash, stomach ache, or diarrhea.
4. The biggest concern is that antibiotic resistance can develop.  Normal bacteria in our bodies that are exposed, but not killed by an antibiotic can change so that the antibiotic won’t be effective. Antibiotic resistance is a community wide problem that can affect all of us as these antibiotic resistant bacteria spread from person to person.  This article on The Danger of Antibiotic Overuse explains why it’s a bigger problem in developing countries. (In Malawi we don’t have the ability to test for strep throat so have to rely on the medical history and physical exam. Therefore we will prescribe antibiotics for probable strep more often than in a setting that has testing ability.)

To help decrease antibiotic overuse, here is my commitment to you:

1. I or a colleague will take time to hear and document the full history of your child’s illness, trusting you to tell us the symptoms and when they started.
2. I or a colleague will do a full physical exam of your child to look for sources of possible viral, bacterial, or parasite infections. When necessary I will order more diagnostic testing.
3. I will offer advice and/or prescribe medications that can help your child feel better.
4. I will pursue continuing education about best practices for diagnosing and treating childhood infections.
5. I will educate and advocate for childhood vaccines which have significantly reduced the need for antibiotics.
6. I will educate about other preventive health measures such as hand washing, healthy diet, HIV testing and treatment to help prevent infections.
7. When I do need to prescribe an antibiotic, I will do my best to prescribe the correct weight-based dose, duration, and type of antibiotic for the given infection to prevent antibiotic resistance.
8. Time can be one of the most effective diagnostic tools.  Most viral fevers resolve by 3 days and the rest of the symptoms have improved or gone away by 7 to 10 days.  At times, I will prescribe “watchful waiting”, “delayed prescribing”, or “repeat malaria testing” as we see how the illness progresses.  I will stay in touch with you through this time and will refer you to reliable colleagues if needed.

Here is how you can help decrease antibiotic overuse:

1. Keep up with your child’s symptoms and when they started. Test for malaria if fever.
2. Be willing to “watch and wait” if that’s what I prescribe and return or contact me if worsening.
3.  If you return to the clinic for worsening symptoms bring your medical record so my colleagues can see the recorded history.  Let them know that you want an antibiotic only if necessary. 

Together we can help prevent antibiotic resistant infections.