9 Conditions That Do (or Don't) Need Antibiotics
Does your child really need an antibiotic? Our guide will help you find the answer.
Like many living things, bacteria are prone to random mutations, including those that can render antibiotics ineffective against them. That means the more often a child takes an antibiotic, the greater the chance that a resistant strain will colonize in their system. Even if they don't develop symptoms themselves, they could easily transmit these harmful bacteria to others.
Read on to learn about antibiotic resistance, and which common illnesses might benefit from antibiotics and which ones don't.
How Antibiotic Resistance Happens
A big part of the problem: Doctors are dispensing antibiotics to infants and children far more frequently than they should. A 2019 study in the British Medical Journal found that 23% of antibiotic prescriptions were unnecessary.
Often, pediatricians are simply appeasing parents, who don't want to see their kid suffer and don't realize that the medication has either no effect or a potentially harmful effect. A 2019 study in the American Society for Microbiology found that use of antibacterial products, like soaps containing triclosan, reduced antibiotic efficacy by as much 100-fold, and may contribute to bacterial persistence in health care settings.
Further, the World Health Organization (WHO) urges farmers not to use antibiotics in animal feed because of its contribution to antibiotic resistance.
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Other Reasons to Limit Antibiotic Use
There are other reasons to avoid excessive antibiotic use among kids, including the risk of side effects, allergies, and an increased risk of some health conditions.
Side effects
Antibiotics can have unpleasant side effects. According to the American Academy of Pediatrics (AAP), side effects like rashes, nausea, diarrhea, and stomach pain occur in one in five children who take antibiotics.
Allergic reaction
Antibiotic allergy symptoms can include rash, hives, and anaphylaxis (a life-threatening reaction). While up to 10% of the U.S. population reports an allergy to penicillin, according to 2019 research in the Journal of American Medical Association, penicillin allergy wanes over time, with 80% of people developing tolerance after a decade. Researchers recommend penicillin skin testing to determine if those with a moderate risk can tolerate the medication.
Increased risk of some health conditions
Some research has also found an association between antibiotic use and obesity. For example, a 2019 study published in the journal Gut found that antibiotic use in the first 2 years of life was associated with a childhood obesity diagnosis. Researchers suspect alterations in the gut microbiome may be to blame.
Another 2019 study in World Journal of Pediatrics found that any antibiotic use between 2 and 3 years of age did not predict overweight or obesity at age 5. However, four or more courses of antibiotics between 2 and 3 years was associated with obesity at age 5.
In addition, early antibiotic exposure has been associated with some immunological, metabolic, and neurobehavioral health conditions. In a 2021 Mayo Clinic Proceedings study, researchers evaluated 14,572 children to see if antibiotic exposure before 2 years of age was associated with childhood onset health conditions. Researchers found significant associations with an increased risk of the following:
Asthma
Allergic rhinitis
Atopic dermatitis
Celiac disease
Overweight and obesity
Attention deficit hyperactivity disorder (ADHD)
All that said, you shouldn't fear taking antibiotics if needed. When used judiciously, they're important tools to fight illness, especially when you know the ins and outs.
Which Common Health Issues Require Antibiotics?
We asked infectious disease doctors to weigh in on whether kids really need meds for nine common health issues.
Common cold
Antibiotics are never helpful.
A cold is a viral illness that doesn't respond to antibiotics. If your sick child is getting better, even very slowly, they don't need them, points out Sandra Arnold, M.D., professor of pediatrics at the University of Tennessee Health Science Center, in Memphis.
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Sinus infection (sinusitis)
Antibiotics are sometimes helpful if symptoms are severe.
Most runny noses are due to the common cold, says Michael B. Grosso, M.D., medical director at Huntington Hospital, Northwell Health, in New York. "However, if your child has a runny nose and day-and-night coughing, and is not getting better after ten to 14 days, it could be bacteria sinusitis." Other symptoms include green discharge, nasal congestion, facial pain, and a sinus headache.
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Ear infection
Antibiotics are sometimes helpful.
"Some ear infections can be caused by viruses," says Amna Husain, M.D., a pediatrician and founder of Pure Direct Pediatrics, in Marlboro, New Jersey. In those cases, antibiotics wouldn't help. Instead, health care providers might recommend putting a warm cloth on the affected ear or taking acetaminophen or ibuprofen to deal with the pain.
According to the Centers for Disease Control and Prevention (CDC), severe middle ear infections or infections that last longer than a few days need antibiotics right away. For a mild middle ear infection, health care providers often recommend watchful waiting to see if symptoms improve over a few days before prescribing antibiotics.
The routine Hib vaccine can also protect against Haemophilus influenzae. According to the CDC, this bacterium is responsible for 5-10% of ear infections. So this vaccine could help prevent some infections.
Sore throat
Antibiotics are always helpful if it's strep.
Icky but true: Most kids walk around with strep living dormant in their throat, says Dr. Grosso. While most sore throats are caused by viruses, pain shouldn't go ignored, especially if it comes without cold symptoms (like a cough or a runny nose) or if your kid also has a headache or a tummy ache.
According to WHO, untreated strep throat can lead to rheumatic heart disease (permanent damage to valves in the heart). So it's a good idea to get medical advice when your child has a sore throat.
Related:Strep Throat Signs Every Parent Should Know
If your child has a sore throat, your pediatrician will likely perform a rapid test for strep (which won't pick up every strain) and do a throat culture, which takes one or two days for results. "It's generally worth holding off on antibiotics until there is a positive result," says Iona Munjal, M.D., director of the Pediatric Antimicrobial Stewardship Program at the Children's Hospital at Montefiore, in New York City.
Pink eye (conjunctivitis)
Antibiotics are probably helpful.
This inflammation of the membranes lining the inside of the eyelids and whites of the eyes is most often bacterial in young kids. However, it can also be caused by viruses, allergies, and airborne irritants.
Pink eye is highly contagious and there are no rapid tests to determine its origin. Therefore, health care providers tend to prescribe antibiotic eyedrops or ointment, topical treatments that may speed the recovery. These are less likely to contribute to resistance than oral antibiotics, notes Seattle pediatrician and Parents advisor Wendy Sue Swanson, M.D., author of Mama Doc Medicine.
Bronchitis
Antibiotics are rarely helpful.
In otherwise healthy children, this illness—an inflammation of the lining of the tubes that carry air to the lungs—is usually caused by a complication from a cold or the flu and is almost never bacterial, notes Dr. Munjal. If your pediatrician suspects a bacterial cause (such as pertussis, or whooping cough), they may culture your child's sputum and if the result is positive, treat the infection with antibiotics.
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Pneumonia
Antibiotics are sometimes helpful.
Pneumonia can be caused by bacteria or viruses and comes with symptoms such as a cough that produces mucus, as well as vomiting, diarrhea, or fever. If your child is recovering from a cold, they might develop a secondary bacterial infection, such as bacterial pneumonia.
Walking pneumonia is very common in kids and typically stems from the bacterium Mycoplasma pneumoniae. A lab test can determine which one your child has, helping a health care provider decide on a course of treatment.
Lyme disease
Antibiotics are helpful.
Since kids love playing outside, many tick-borne illnesses occur in kids. If blood tests confirm the presence of tick-borne bacteria (including Lyme and Rocky Mountain spotted fever), your child will need antibiotics. According to the CDC, Lyme is usually cured after a two- to four-week course of antibiotics.
Early Lyme disease treatment is essential to prevent joint, heart, and neurological damage. Have your child checked ASAP if they exhibit fatigue, have difficulty thinking or speaking, or complain of headaches and nausea—even if you don't spot the telltale bull's-eye rash.
Urinary rract infection (UTI)
Antibiotics are always helpful.
"These are fairly common in the first year of life," says Dr. Grosso. Symptoms can include vomiting, poor feeding, or diarrhea. Pain while peeing because of a UTI generally happens later in childhood.
What to Know About Taking Antibiotics
Should your child require antibiotics for a bacterial infection, make sure they take them exactly as prescribed. Finishing only some of the medication or skipping a dose because of a tummy ache can leave harmful bacteria in your child's system (which continue to multiply), possibly leading to a recurrence of the infection.
Also keep in mind that the weakest bacteria tend to be killed off first, leaving behind the stronger bugs that are more likely to be resistant, notes Anastasia Levitin, Ph.D., of the Keck Graduate Institute, in Claremont, California.
Related:How to Select a Pediatrician
If you're not sure why a health care provider prescribed an antibiotic, speak up. Ask whether it's a broad-spectrum drug (able to kill a wide range of bacteria). If so, find out whether a narrow-spectrum one might be an equally effective treatment. Broad-spectrum antibiotics increase the odds of creating resistant bacteria by wiping out good bugs in the gut that help keep harmful ones in check.
In addition, probiotics are made up of the good bacteria healthy bodies need. When your child takes antibiotics, these can get killed along with the bad bacteria. Therefore, the AAP recommends eating foods high in probiotics when taking antibiotics, like yogurt, kimchi, kefir, and sauerkraut, or talking to a health care provider about taking a probiotic supplement.
