Antibiotics Series #3 – Antibiotics Can Prevent Infections, Especially For Children With Chronic Conditions

In certain circumstances, we give antibiotics to prevent infections. This isn’t something we do for the average child, but for those with chronic conditions that predispose them to bacterial infections, it can be quite effective. For most of these situations, there are clear, evidence-based guidelines about when this prophylaxis should be started and which antibiotics should be used.

How Much Is Too Much?

Some children have frequent infections that require so many courses of antibiotics that it’s generally considered better to take another approach. Common examples are ear infections and strep throat, both of which can be treated with surgical procedures as well as medications. Because surgery isn’t without complications, there are published guidelines to help determine when these procedures may be justified. The general rule for ear tubes is 3 ear infections in 6 months, or 4 in a year. For removing tonsils because of strep throat, it’s even more strict: 7 episodes in a year, 5 each year for 2 years, or 3 each year for 3 years. It should go without saying, but it’s important that these infections be accurately diagnosed. Sadly, that’s not always the case.

Do People Become Immune to Antibiotics?

It’s important to remember that antibiotics don’t treat people, or even diseases; they treat bacteria. Unlike most medications, which are intended to interact with the cells in your body, antibiotics are designed to affect only bacteria. Because of this, their effectiveness relies not on the patient or the disease, but on the specific organism causing the infection. For this reason, people don’t grow “immune” or “tolerant” to antibiotics, but the bacteria that live on or within them certainly may. For people with chronic medical problems who receive frequent antibiotics, this is a very real problem.

Side Effects vs Allergic Reactions

Like any medical treatment, antibiotics have a risk of side effects. These can vary from mild to life-threatening. (Fortunately, the life-threatening ones are rare). Specific side effects depend on the medication, but upset stomach and diarrhea are very common; this is often a result of the antibiotics killing off beneficial bacteria as well. Giving probiotics or yogurt to replenish these living organisms (the “good guys”) can be helpful.

Rashes are also very common, especially with amoxicillin. These are not always dangerous, but are worth a call to your doctor. There’s a chance that the rash could be caused by the infection itself, or that it could be a sign of an allergic reaction or another serious condition.

Another mild, but frequently distressing, side effect is red stools caused by cefdinir (Omnicef). I’ve seen it at work, but I’ve also had a few distressed calls from friends (one of whom was on the way to the ER). It’s not blood–just a pigment from the medication passing through. Nothing to worry about.

Life-threatening allergic reactions (anaphylaxis) are infrequent, but they do happen. Symptoms include rash, vomiting, cough or difficulty breathing, and swelling of the face, mouth, or throat. These reactions would need emergent medical attention, and if you have an Epi-pen…well, this seems like a pretty good time to use it.

Conclusion

Sometimes is seems that we are bashing antibiotics but we are not. We prescribe them frequently, and we’ve cared for numerous patients that may had very, very serious compilations or a die without them. Like any other medical treatment, we have to balance their benefits against their risks (both direct and indirect). We should avoid antibiotics when possible and use them judiciously when necessary.

All this leads to an interesting question–how should parents discuss this topic with their child’s doctor? Probably the most important step is to avoid insisting on antibiotics. As physicians, we struggle to balance good patient care with the ever-increasing demands on our time. If it’s obvious when a mom walks in the door that she isn’t leaving without a prescription, many of us will forego the discussion; it takes a lot less time to write the prescription than to explain why it isn’t necessary.

Another challenge we face is that we want to do something; after all, that’s why you brought your child in. Often, that “something” could be as simple as listening to your story, doing a physical exam, and reassuring you that no antibiotic treatment is necessary (you know, the “just a virus” talk). But we often perceive pressure from parents–whether it’s real or not–to prescribe medications, even when we know it isn’t necessary.

On the other hand, many doctors over-prescribe without any external pressure at all. If you find yourself in this situation, it’s certainly OK to ask (in a non-confrontational way) whether antibiotics are truly necessary. If your doctor is offended by this question or unable to communicate his reasoning, consider finding a new one. One of the best things you can do for your child’s health is to find a pediatrician whose treatment philosophy aligns well with yours, and whose judgment you trust.

Antibiotic Series Posts

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