Q: My 4-year-old has had fever and a runny nose for one week with thick, yellow mucous and a cough. His throat culture was negative and my pediatrician does not want to give him antibiotics. I have been into the office twice in the last week and I just left my doctor another message. Why does he insist on giving me such a hard time? Why won’t he just prescribe the antibiotic so my baby will get better?!!!
A: Believe it or not, this question has a very simple answer. Antibiotics do not fight infections caused by viruses. Period. End of story. Antibiotics are one of the greatest inventions of our time and have saved a countless number of lives but if your child does not have a bacterial infection, the antibiotic will do nothing. Really. In fact, it may give your child some nasty side effects but it will not treat the illness. I could really end this article right here but that would be a very short column so I will write a little more about why we do not give antibiotics to every sick child.
Trust Your Pediatrician
Trusting your pediatrician is critical to getting the best possible care for your child and a good night’s rest for yourself (and I will assume that you do trust him or you would find a new doctor). If you have seen him twice in the last week and also spoken to him over the phone, and he is not recommending antibiotics, then you can actually feel reassured that your son does not need them. The reason is most likely because your child has a viral illness that will resolve on its own and does not require antibiotic treatment. I know waiting can be extremely difficult when you have a sick child. It is so hard for us to see our kids struggling and we all love when there is an immediate cure. However, one of the main reasons doctors don’t give antibiotics when it isn’t necessary is because we want them to still work when a child actually does have strep or another bacterial infection. Unnecessary use of antibiotics can cause antibiotic resistance and then they won’t work when we really need them (more about that later). Remember why doctors go into pediatrics… because we enjoy working with kids and we want to help them. If you ask any adult doctor, they think we are all nuts because dealing with kids (and their parents) is way more difficult than dealing with adult patients. We decided to dedicate our lives to taking care of children (despite getting peed and vomited on most days) and we want nothing more than to help children feel better. If your doctor is not prescribing antibiotics after listening to all of your concerns and thoroughly examining your child, then antibiotics are not the appropriate treatment for your child’s illness.
If your child has been diagnosed with a virus please remember the following:
Antibiotics
– will not cure the infection
– will not help your child feel better
– will not keep others from getting sick (or get your child back to school faster)
– may cause unnecessary and sometimes harmful side effects
– may contribute to antibiotic resistance, which is when bacteria are able to resist the effects of an antibiotic and continue to cause harm (an increasing problem due to antibiotic overuse and a very big part of the reason I am writing this article).
Adverse Effects
I would like to restate that antibiotics are one of the greatest inventions of our time. I love antibiotics and use them often but only in situations when I feel they are needed. When your doctor tells you your child has a virus he is not telling you that your child is not sick. He is telling you your child does have an infection, as you suspected when you brought him into the office, but that infection is not bacterial and antibiotics will not help.
Why not try them anyway?
As great as antibiotics are, they do sometimes come with side effects. As anyone who has taken a Z pak can tell you, antibiotics often cause some abdominal discomfort and diarrhea. Usually it is minimal, and probiotics help to lessen or eliminate these side effects, but it can sometimes be more severe. Imagine how miserable a 15-month-old who already has a viral infection will feel with stomach cramps and a raw bottom from diarrhea. This is why whenever antibiotics are used it’s best to weigh the benefits of the medication against the risk of side effects. If the medication will make a very painful ear feel better faster, it probably outweighs the risk of diarrhea. If a child has a cold caused by a virus, why introduce the risk of diarrhea as a whole new miserable problem if we know the antibiotic won’t help anyway?
Let’s keep in mind that there are other less common but more serious adverse effects to using antibiotics. A child can have an allergic reaction, which can range from hives to something much more serious like difficulty breathing or painful ulcerations of the mucous membranes of the mouth, causing difficulty eating or drinking and requiring hospitalization for hydration.
Antibiotic resistance has increasingly become a huge a problem in this day and age and is actually very scary. Bacteria that are repeatedly exposed to certain antibiotics become resistant to those medications and are harder to kill. Most of us have heard of, or actually dealt with, MRSA which is Methicillin-Resistant Staphylococcus Aureus. MRSA is any strain of the bacteria Staph Aureus that has developed, through natural selection, resistance to beta lactam antibiotics-penicillins and cephalosporins. Since MRSA is more difficult to treat, it is more dangerous than Staph that are susceptible to standard antibiotics. Fortunately, most MRSA is treatable with Bactrim or Clindamycin but there are strains that have developed resistance to these antibiotics and require treatment with an even stronger antibiotic called Vancomycin. There are now strains that have even developed resistance to Vancomycin. You can see where this is going. Though we are still fortunate enough to have found antibiotics to treat these very resistant strains, there could potentially come a point at which we cannot fight a resistant bacteria and that would be catastrophic. Resistance (and there is resistance among other bacteria as well) is due to antibiotic overuse. If we use antibiotics when it is not necessary we are promoting resistance, plain and simple and very scary.
(This article was written one week before it was printed. During that week a bacteria that is completely resistant to all antibiotics was found to be causing a urinary tract infection in an otherwise completely healthy woman in Pennsylvania. She is now consulting with the Center for Disease Control as there is absolutely no way to treat her, endangering her kidneys and her life. This is the catastrophic result of the unnecessary use of antibiotics.)
More Facts About Antibiotics That I Promise Are True
– Green/yellow nasal discharge and phlegm is not a sign that your child has a bacterial infection requiring antibiotics. As the body’s immune system fights off infection, mucus can change color. This is normal and does not mean your child needs antibiotics. Please, I beg you, do not start out your visit to the pediatrician by saying “I brought Chani in because her nasal discharge has turned green and I know she has sinusitis and needs an antibiotic.” This is most likely not the case.
– Believe it or not, most sore throats are not caused by strep. The majority of sore throats are caused by viruses. You also cannot tell if a child has strep from the way their throat looks. Strep can present with minimal redness of the throat and viruses can present with white patches in the throat and swollen tonsils, so looking down your child’s throat with a flashlight does not give you a definitive diagnosis. He needs to have a throat culture. That being said, if your child is not in extreme discomfort, it’s best to wait a day or two to come into the office. More often than not, kids who come in too early will have a negative rapid strep and throat culture and will need to come back again. Nothing bad will happen to your child if they go a day or two with a sore throat, even if it is strep. (On the flip side do not ignore symptoms of strep for more than a few days as untreated strep comes with its own set of issues—but that is for another article.) Make sure you give your child Tylenol or Motrin for fever and keep them comfortable.
– The common cold can last for as long as 10 days. If your child has a runny nose and cough for over a week it does not necessarily mean he has bronchitis and requires Zithromax. If your pediatrician examines your child and says antibiotics are not needed please trust the choice you made in selecting him or her as your physician and trust in their medical knowledge and desire to do what is best for your child.
– Fever is a natural response by the body to both bacterial and viral illnesses. Fever develops when your child is fighting the virus or bacteria. Fevers can get high with viral infections, so do not be surprised if your child, diagnosed with a virus, develops a fever of 105. Make sure you have Tylenol and Motrin in the house (it’s okay to alternate the two for fever) and that you have discussed appropriate dosing for your child with her pediatrician. The most common reason Tylenol or Motrin “is not working” is that the dosage of medication is not adequate.
– Despite everything that I have just said, there may be situations where a child starts out with a cold or a viral infection and then develops a secondary infection, a new bacterial infection after a virus. An example of this would be a child with croup whose cough and fever seems to be resolving but after two days develops ear pain. That child should go back to see his pediatrician because he may need antibiotics for his ear. If your child seemed better for a few days and then develops new symptoms or starts to deteriorate again then do not hesitate to take him back for another visit.
A Few Last Things
– Please do not try to convince your pediatrician or the office staff to prescribe antibiotics over the phone. I completely understand how difficult it is to bundle up a sick child and bring him into the office but it is bad medicine to prescribe antibiotics to a patient who has not been examined. Of course, there could be extenuating circumstances and there may be a situation in which your doctor may have to prescribe over the phone, but as a general rule you really want your child seen by a doctor before he or she is started on medication.
– Please do not give your febrile child the leftover Amoxicillin you found in the back of your bathroom drawer. Even if your child does need an antibiotic, all antibiotics are not the same and someone else’s leftover medication may be the wrong type, and may delay correct treatment allowing bacteria to continue to grow.
– Please do not stop your child’s antibiotic early because they seem to be getting better or you want “to save some for next time.” It’s important to treat a bacterial infection for the appropriate amount of time in order to completely eradicate the infection.
– One very important request: When you come in to see your doctor with a sick child and your doctor diagnoses him with a virus, please, please do not push for antibiotics or try to find another way to get them. If your doctor says he doesn’t need them, he really doesn’t need them. Remember, we are all on the same team. We do what we do because we want to make children feel better (and because we get to give out really cool stickers).
Nina Epstein is a pediatrician at Metropolitan Pediatrics in Teaneck, NJ. She is a big fan of antibiotics but wishes they could cure teen-girl drama. If you are the mother of boys and have no idea what she is talking about, congratulations. If you are the mother of girls, good luck to us all.
By Dr. Nina Epstein
