Parents need to know that using antibiotics when they are not the right medicine will not help and may even cause harm to children.
Antibiotics are medicines used to treat infections and they target bacteria, not viruses. Before prescribing an antibiotic, your child's doctor will find out if it is the right medicine to treat your child's infection.
In this article, the American Academy of Pediatrics (AAP) answers common questions about the use of antibiotics. Talk with your child's doctor if you have other questions and see 10 Common Childhood Illnesses and Their Treatments for more information.
1. My child has a really bad cold. Why won't the doctor prescribe an antibiotic?
Colds are caused by viruses. Antibiotics are used specifically for infections caused by bacteria. In general, most common cold symptoms—such as runny nose, cough, and congestion—are mild and your child will get better without using any medicines.
Many young children—especially those in child care—can get 6 to 8 colds per year.
2. Don't some colds turn into bacterial infections? So why wait to start an antibiotic?
In most cases, bacterial infections do not follow viral infections. Using antibiotics to treat viral infections may instead lead to an infection caused by resistant bacteria. Also, your child may develop diarrhea or other side effects.
If your child develops watery diarrhea, diarrhea with blood in it, or other side effects while taking an antibiotic, call your child's doctor.
3. Isn't a nose draining yellow or green mucus a sign of a bacterial infection?
Yellow or green mucus in the nose does not automatically mean that antibiotics are needed. During a common cold, it is normal for mucus from the nose to get thick and to change from clear to yellow or green. Symptoms often last for 10 days. Sinusitis is a term that means inflammation of the lining of the nose and sinuses. A virus or allergy can cause sinusitis and in some cases, bacteria can be the cause. There are certain signs that bacteria may be involved in your child's respiratory illness.
If your child has a common cold with cough and green mucus that lasts longer than 10 days, or if your child has thick yellow or green mucus and a fever higher than 102°F (39°C) for at least 3 or 4 days, this may be a sign of bacterial sinusitis.
If your child has developed bacterial sinusitis (which is uncommon), an antibiotic may be needed. Before an antibiotic is prescribed, your child's doctor will ask about other signs and examine your child to make sure an antibiotic is the right medicine.
See The Difference Between Sinusitis and a Cold.
4. Aren't antibiotics supposed to treat ear infections?
Many true ear infections are caused by viruses and do not require antibiotics. If your pediatrician suspects your child's ear infection may be from a virus, he or she will talk with you about the best ways to help relieve your child's ear pain until the virus runs its course. At least half of all ear infections go away without antibiotics.
Because pain is often the first and most uncomfortable symptom of ear infection, your child's doctor will suggest pain medicine to ease your child's pain. Acetaminophen and ibuprofen are over-the-counter pain medicines that may help lessen much of the pain. Be sure to use the right dose for your child's age and size. In most cases, pain and fever will improve within the first 1 to 2 days. There are also ear drops that may help ear pain for a short time. You can ask your child's doctor if your child should use these drops. Over-the-counter cold medicines (decongestants and antihistamines) don't help clear up ear infections and are not recommended for young children.
Your child's doctor may prescribe antibiotics if your child has fever that is increasing, more severe ear pain, and infection in both eardrums. See Ear Infection Information, Middle Ear Infections, and Your Child and Ear Infections.
5. Aren't antibiotics used to treat all sore throats?
No. More than 80% of sore throats are caused by a virus. If your child has sore throat, runny nose, and a barky cough, a virus is the likely cause and a test for "strep" is not needed and should not be performed. Antibiotics should only be used to treat sore throats caused by group A streptococci. Infection caused by this type of bacteria is called "strep throat."
Babies and toddlers under 3 rarely get it strep throat, but they are more likely to become infected by streptococcus bacteria if they are in child care or if an older sibling has the illness. Although strep spreads mainly through coughs and sneezes, your child can also get it by touching a toy that an infected child has played with.
If your child's doctor suspects strep throat based on your child's symptoms, a strep test should always be performed. If the test is positive, antibiotics will be prescribed. See The Difference between a Sore Throat, Strep & Tonsillitis and When a Sore Throat is a More Serious Infection.
6. Do antibiotics cause any side effects?
Side effects can occur in 1 out of every 10 children who take an antibiotic. Side effects may include rashes, allergic reactions, nausea, diarrhea, and stomach pain. Make sure you let your child's doctor know if your child has had a reaction to antibiotics in the past.
Sometimes a rash will occur during the time a child is taking an antibiotic. However, not all rashes are considered allergic reactions. Tell your child's doctor if you see a rash that looks like hives (red welts); this may be an allergic reaction. If your child has an allergic reaction that causes an itchy rash, or hives, this will be noted in her medical record.
7. How long does it take an antibiotic to work?
Most bacterial infections improve within 48 to 72 hours of starting an antibiotic. If your child's symptoms get worse or do not improve within 72 hours, call your child's doctor. If your child stops taking the antibiotic too soon, the infection may not be treated completely and the symptoms may start again.
8. Can antibiotics lead to resistant bacteria?
The repeated use and misuse of antibiotics can lead to resistant bacteria. Resistant bacteria are bacteria that are no longer killed by the antibiotics commonly used to treat bacterial infection. These resistant bacteria can also be spread to other children and adults. It is important that your child use the antibiotic that is most specific for your child's infection rather than an antibiotic that would treat a broader range of infections. If your child does develop an antibiotic-resistant infection, a special type of antibiotic may be needed. Sometimes, these medicines need to be given by IV (vein) in the hospital.
9. What are antiviral medicines?
Influenza (flu) is a viral infection that can cause cold symptoms for which an antiviral medicine will work. An antiviral medicine may be prescribed for children that are at higher risk of becoming severely ill if they get the flu. For most other viruses causing cough and cold symptoms, there are no antiviral medicines that work or are recommended.
10. How can I use antibiotics safely?
Give the medicine exactly as directed. See Medication Safety Tips and Using Liquid Medicines.
Don't use one child's antibiotic for a sibling or friend; you may give the wrong medicine and cause harm.
Keep antibiotics and other prescription medicine in a secure place. Count and monitor the number of pills you have and lock them up. Ask your friends, family members, and babysitters to do the same.
Dispose leftover antibiotics and other prescription medication. Return leftover prescriptions to a hospital, doctor's office, or pharmacy. Many counties now offer "take-back" events to collect unused medication. For more information, see Promote Safe Storage and Disposal of Opioids and All Medications.
Have More Questions?
If you have any questions or concerns about appropriate care for your child, please discuss them with your pediatrician. While it may be tempting to go to a nearby after-hours clinic if your child is ill, your pediatrician knows your child best, has your child's medical records, and is the best place to start for advice. Ask your pediatrician how he or she would like to be contact when the office is closed.
In fact, the AAP does not recommend retail-based clinics, tele-health services outside of the medical home, or acute care services without pediatric expertise for children younger than 2 years. See Urgent Care: Is It Worth the No Wait? for more information.
Preventing the Flu: Resources for Parents & Child Care Providers
Principles of Judicious Antibiotic Prescribing for Bacterial Upper Respiratory Tract Infections in Pediatrics (AAP Clinical Report)
The Diagnosis and Management of Acute Otitis Media (AAP Clinical Guideline)
Last Updated 11/15/2019 Source Antibiotics and Your Child
(Copyright © 2019 American Academy of Pediatrics)
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