Even the most common problems in antibiotic treatment do not have simple solutions. Choosing one antibiotic drug from among several candidates entails balancing the benefits and the detriments associated with each. One challenge of deciding which one to use is that we are typically not sure exactly what we are treating. We take an educated guess about the most likely culprits and choose a drug that tends to kill them.
What We Do Know
We know that the majority of ear infection in children is caused by Bacterial infections. The most common types are Streptococcus pneumoniae (also called pneumococcus), Haemophilus influenzae, and Moraxella catarrhalis. So when we diagnose a child with an ear infection we choose a reasonable antibiotic. The same goes for pneumonia, urinary tract infection, skin abscesses or any other bacterial infection. Occasionally we are wrong and we have to change to a different medication.
The Goal of an Antibiotic
The goal of antibiotic therapy is to eradicate bacteria at the site of infection. If our initial choice does not work we will often transition to a different antibiotic. Depending on how you divide them up, there are now somewhere around 15-20 different classes of antibiotics, most of which contain several similar drugs. Each class works in a unique way to kill bacteria or stop them from reproducing. Some work by destroying the bacterial cell wall; others target the machinery responsible for producing DNA or proteins, which are necessary for reproduction. The “mechanism of action” of each antibiotic is what determines how effective it will be against a particular microbe–if it has any effect at all. This is why a particular antibiotic may work very well for one infection, while having no activity at all against another. So as you can see sometime the stair step approach with each subsequent antibiotic being stronger than the first has to be the answer.
IV vs. Oral Antibiotic
Research has proven that sometime doctors prescribe antibiotics delivered intravenously, while new research suggests oral antibiotics can be as effective, with fewer complications. IV antibiotic are often considered stronger but that is not necessarily the case either. One advantage is IV antibiotics especially in pediatrics is that kids can’t spit them out. So while oral medication is perfectly fine for most situations, IV antibiotics are sometimes the only option to treat a particular infection.
A Diagnosis by Taking a Blood Culture
A blood culture is a laboratory test to check for bacteria or other microorganisms in a blood sample. Most cultures check for bacteria. It is sometimes important for your physician to know exactly what bacterium is causing an infection. This information can be found by taking a sample for culture and try to grow the bacteria in the lab. Once it is figured out exactly which bacteria is causing the infection the ideal antibiotic can be given to the kill the responsible organism.
How Long Infections Should Be Treated?
Seven to ten days is the “Goldilocks number”: It’s not so brief a span that the bacterial infection will shake it off, but it’s also not long enough to cause an adverse reaction. However there is compelling evidence for several infections that shorter courses are equally effective. Life threatening or deep seated infections or unusual infections like tuberculosis can require much longer courses.
When Should Antibiotics be Used
Antibiotics are strong medicines used to treat infections, including life-threatening contagious diseases. But antibiotics can cause more harm than good when they aren’t used the right way. You can protect yourself and your family by knowing when you should use antibiotics and when you should not. Sometimes even your physician is not sure if an infection is bacterial or not. In these cases assuming the child isn’t extremely ill a watch and wait approach is almost always appropriate. Antibiotic do not treat viral infection and even a bacterial infections can resolve on its own. Strep throat and ear infections are examples of common illnesses that are almost always treated with antibiotics. Cold symptoms are almost always caused by viruses. A fever lasting 5 days or longer deserves a doctor’s visit. Fever in an infant less than 2 month old with difficulty breathing and dehydration are reasons for urgent evaluation. Beyond that any time you are concerned about your child’s health give your doctor a call they will be happy to help.
Next we’ll discuss how antibiotics are sometimes used to prevent infections.
Antibiotic Series Posts
- Antibiotics Series #3 – Antibiotics Can Prevent Infections, Especially For Children With Chronic Conditions
- Antibiotics Series #2 - Choosing the Correct Antibiotic for Your Child's Illness
- Antibiotics Series #1 - How Antibiotics Kill Bacteria But Can Become Resistant Overtime
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About Pediatrics of Florence
We believe that children are more than just “little adults.” They have unique personalities, challenges, and life circumstances and we have made every effort to make our offices and care as “kid friendly” as possible. We have an aquatic theme in the waiting rooms (separated for sick and well children) as well as themed examination rooms. All of our physicians are Board Certified Pediatricians and members of the American Academy of Pediatrics and our nurse practitioners are all licensed Pediatric Nurse Practitioners and are available to see both well and sick children.
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