Antibiotics aren't a magic cure all

Parents expect almost miraculous cures when they take their sick child to the doctor. Why? The introduction of penicillin, the first really effective antibiotic 70 years ago, was a wonder drug that worked overnight.

Soldiers would be dying of pneumonia or a horribly infected leg. They would recover after 3 injections of penicillin and after 7 days they would be all better. Unfortunately, penicillin doesn't work well for pneumonias or wound infections anymore because of antibiotic overuse and growing bacterial antibiotic resistance.

It's important to understand that antibiotics aren't always the answer, and are intended to fight bacterial infections. Taking them for viral infections, such as a cold, most sore throats, acute bronchitis and many sinus or ear infections will not cure the infection, or keep others from getting sick, and may cause unnecessary and harmful side effects.

Working a weekend at Thomas Jefferson University Hospital earlier this month, I saw all the children admitted into pediatrics, and advised the emergency department and the pediatrics residents. Most of the patients who came in with a high fever did not have a readily available cure since they had viral, not bacterial infections: adenovirus, respiratory synticial virus (RSV) and influenza B. There are a few antiviral drugs, but they are not as effective as antibiotics and are mostly used to prevent spread of the disease.

Giving an antibiotic to someone who does not need it, creates at least 3 problems according to the Centers for Disease Control and Prevention:

  1. It increases the ability of germs to resist the effects of antibiotics and such antibiotic resistance is “one of the world’s most pressing public health threats.”
  2. Even when used properly, antibiotics can cause serious side effects such as allergic reaction, stomach pain and new diseases from resistant bacterial or fungal overgrowth, such as yeast vaginitis, diaper rash, and potentially fatal diarrhea.
  3. As simple antibiotics get less useful, the price of treatment skyrockets since doctors need to use more exotic antibiotics. My mother had to take 6 antibiotic pills (one daily) for pneumonia. Even with an older patient discount, they cost almost $25 per pill versus $5 for 30 penicillin tablets.

So what can you do when the doctor tells your child “just has a virus?” Try to make your child feel the best they can:

  1. Do not worry about eating, but do worry about drinking. As long as your child is urinating every few hours, they are well hydrated and they will shed their illness as quick as they can. A few ounces of any liquid every hour will work, even milk.     
  2. If they have a fever or pain, acetaminophen (Tylenol) or ibuprofen (Advil, Motrin) can be given every 4 to 6 hours. The dose depends    on weight, so ask the doctor’s office what is the correct dose for your child. These medicines do not improve cold and cough symptoms.
  3. In general, cold and cough medications are a total waste of money and can make you child irritable and/or sleepy. Pediatricians do not recommend them at all for children under 6 years and do not think they do much for children 6 and above.
  4. For a cough for children after their first birthday, 1 to 2 teaspoons of dark honey every 4 to 6 hours works better than any commercial cough suppressant. Children under 1 year of life can get very ill from honey. For those children who can suck on a cough drop, these lozenges are also effective, but remember children cannot run around with a cough drop because they can swallow it down their windpipe.
  5. A persistent cough may be wheezing from asthma. Ask your practitioner listen to your child if the cough does not go away.

-       Gary A Emmett MD FAAP