"Read GERM PROOF YOUR KIDS cover-to-cover or use it as a handy reference guide to look up specific germs, diseases, or treatments affecting your own child." Marianne Neifert, M.D. (Dr. Mom®), pediatrician, bestselling author of Dr Mom: A Guide to Baby and Child Care and Dr. Mom’s Parenting Guide: Commonsense Guidance for the Life of Your Child; columnist for Parenting magazine, nationally renowned speaker and mother of five.

Fever | Ear Infections | Strep Throat | Antibiotics | Vaccines

ANTIBIOTICS

When does my child need antibiotics, and when doesn’t she?

The simplest answer to this question is that your child needs antibiotics only when she is infected with bacteria (one specific class of germs) that:

1. Cause unpleasant or uncomfortable symptoms; and/or
2. Are potentially harmful to your child; and/or
3. Are potentially harmful to others who might come in contact with your child.

It’s important to realize that both you and your doctors have a role in deciding when to use, and when not to use antibiotics. It’s up to your doctor to decide if one or more of the three criteria above are met. If they are not, it’s up to you to understand the doctor’s decision to not recommend antibiotics, and to not insist on receiving them.
That brings us to understanding when your child does not need antibiotics. Again, 3 simple criteria; your child does not need antibiotics when he:

1. Is infected with a virus germ; and/or
2. Has bacteria germs on his skin, in his mouth, or elsewhere that are not a risk for causing harm
3. Is only mildly ill and the true germ cause of the illness is not known

Most of your kids’ infections do not require antibiotics because they are due to viruses. These viral infections that do not require antibiotics include, among many others, the common cold, some ear infections, most cases of pinkeye, the flu, bronchiolitis, croup, the stomach flu, “mono”, chickenpox, and cold sores/fever blisters.
Sometimes bacteria are found in specimens from your kids, but are there only because the germs accidentally found their way into the specimen being tested. The germs might have come from the skin or elsewhere where they are harmless, but now that they are in the specimen being tested they are potentially mistaken for true infections. This can happen with throat cultures, urine cultures, and others; antibiotics are not needed for these germs.

Many mild illnesses for which the germ cause is unknown don’t need treatment; a great example is fever. More than 97% of fevers in young kids are not due to bacterial infections and don’t need antibiotics. Other mild illnesses that might prompt unnecessary antibiotic treatment include “sinusitis” when defined simply as sinus pressure or short term colored (usually green or yellow) drainage; bronchitis (sometimes a bacterial disease in adults, but rarely in children); fluid behind the eardrum without other evidence for actual infection; and most cases of traveler’s diarrhea.

What are the risks to my child of antibiotics?

The risks to your child in taking antibiotics that he doesn’t need are all tied to the side effects of the medicines. Even though the benefits of antibiotics usually far outweigh the risks, that’s only true if there are any benefits to be had at all. If antibiotics are appropriately used to treat true bacterial infections, the benefits of recovering from the infections outweigh the relatively small risks of side effects. If, on the other hand, the infection being “treated” with antibiotics is viral, any risks are too many and by definition outweigh the benefits – which are none.

Antibiotic side effects can be grouped into 4 categories: allergic reactions, gastrointestinal upset, undesirable interactions with other medicines, and a miscellaneous group of side effects that includes making future infections harder to treat in your child and in other children. Bacteria become conditioned to antibiotics and can become resistant to them. 

Copyright 2007, Dr. Harley A. Rotbart.
Guidelines for Parents from the new book, Germ Proof Your Kids – The Complete Guide to Protecting (without Overprotecting) Your Family from Infections (ASM Press, 2008).

Read Dr. Rotbart’s GERMBlog for frequent updates on important germ issues for your kids