When is it really necessary to give your child antibiotics?

You have a crying child who has a fever and who wakes up more often than usual at night. Maybe they also pull on an ear. You make an appointment with your pediatrician, who examines your child and confirms your suspicion: He has an ear infection.

The pediatrician prescribes an antibiotic, which you know will be a bottle of bubblegum-flavored pink syrup that you will need to keep in the refrigerator. Perhaps you have memories of taking the same drug yourself as a child.

You and your pediatrician are eager to end your child’s suffering. Also, you might worry about having to take days off to care for your child. Until their fever goes away, they won’t be able to go to school or daycare. Everyone involved is invested in helping your child feel better as soon as possible.

This scenario – a prescription for antibiotics for a child’s ear infection – happens 10 million times a year in the United States

Antibiotics are often considered harmless because they usually cause few side effects (unless someone is allergic to a specific antibiotic). It may not even occur to you that there might be a downside to filling your child’s prescription, but there are a few reasons to pause before doing so.

The overuse of antibiotics – primarily in farm animals, but also in humans – has led to the evolution of drug-resistant bacteria, which pose a major threat to global health. According to the Centers for Disease Control and Prevention2.8 million drug-resistant infections occur in the United States each year, 35,000 of which result in death.

The immediate side effects of antibiotics are usually mild, with diarrhea being one of the most commonly reported symptoms. As antibiotics work to attack the bacteria causing your child’s infection, they also attack other bacteria living in and on your child’s body. This collection of microbes, whose number scientists estimate in the trillionare collectively known as the human microbiome, and a growing body of research reveals the many ways they affect our health.

Dr. Martin J. Blaser is the Henry Rutgers Professor of Human Microbiome at Rutgers University. He studied the impact of early childhood events on the development of the human microbiome.

“A baby’s microbiome is acquired at birth and matures at exactly the same time the baby develops,” Blaser told HuffPost.

Babies pick up bacteria in the birth canal and in breast milk, which also contains prebiotics, or what the bacteria consume to multiply.

“If the microbiome is disturbed early, for example by antibiotics, it may not develop normally, and many studies now show an increased risk of later disease,” he said.

A study that Blaser co-authored showed that one or more courses of antibiotics during the first two years of life increased the risk of asthma, allergies, eczema, celiac disease, obesity and ADHD.

Of course, no one is suggesting that we stop using antibiotics altogether. “There are important situations in which the use of antibiotics is absolutely necessary – saving lives,” Blaser said.

But he thinks doctors should exercise caution when prescribing them to children. “We need doctors to examine children carefully and decide who is needed,” he said.

The CDC estimates that 28% of all antibiotic prescriptions in the United States each year are unnecessary. That’s a total of 47 million unnecessary courses of antibiotics.

In the case of an ear infection, it may be viral instead of – or in addition to – bacterial, which means that antibiotics will be of limited use. A study found that viruses were involved in 70% of ear infections in children.

So how does a parent know if their child’s illness really needs antibiotic treatment?

Don’t be afraid to ask, pediatrician Jen Trachtenberg told HuffPost. It is “perfectly acceptable for parents to ask, ‘Is an antibiotic really necessary?’ or ‘Why exactly are you prescribing the antibiotic to my child?’ »

Trachtenberg added that parents also need to temper their expectations of getting a prescription whenever their child is sick.

“Often parents are hoping for a quick fix with a prescription drug so a child gets better faster and gets back to school,” she said. “But in fact, most illnesses are viral and require supportive care and symptomatic relief like fluids, rest, fever, or painkillers.”

Yet, in a case like strep throat, where a test shows the infection is bacterial and leaving it untreated could lead to other problems, antibiotics are needed.

Dr. Janine Zee-Chenga pediatrician practicing in Indiana, told HuffPost, “The reason for using antibiotics for strep throat is to prevent the disease from progressing to scarlet fever and then to rheumatic fever. Rheumatism Acute joint disease is a serious condition that can cause long-term heart damage and even death.

Other common infections that can be bacterial and sensitive to antibiotics include: bacterial conjunctivitis (pink eye), impetigo (a skin infection), bacteremia (a bacterial blood infection) and bacterial pneumonia.

Sinus infections and urinary tract infections may also require antibiotic treatment, but Zee-Cheng notes that these can be difficult to diagnose in children. Obtaining a “clean” urine sample from a child in diaper, for example, presents a real challenge.

For some infections, such as strep throat, tests are available to determine if bacteria are present. In other cases, such as ear infections, your doctor will determine whether the infection is likely bacterial or not based on their examination and your child’s symptom history.

As for the treatment for this common ear infection? The CDC says it can go both ways – antibiotics might help. They also might not be necessary. It’s not always a black and white question, so your opinion matters.

Zee-Cheng means a study showing that 78-85% of ear infections heal on their own and that 75% of antibiotic prescriptions for ear infections are unnecessary.

She added, however, that “infected fluid behind the eardrum can affect hearing,” which is something to consider “in young children whose speech is still developing.”

If you prefer to avoid antibiotics for an ear infection, there are several options you can discuss with your doctor. One is “watchful waiting”. It just means that you wait two or three days to see if your child’s symptoms get better on their own. If not, at that time your pediatrician may prescribe an antibiotic.

Similarly, you and your pediatrician could opt for a “delayed prescription,” meaning the doctor would write the prescription, but you would wait two or three days before filling it to see if the condition resolves on its own. .

Note that these guidelines apply to healthy children, not those who are immunocompromised or have other health conditions. Your child’s doctor would take this into account.

“Antibiotics are used for so many types of infections and in so many different scenarios,” Zee-Cheng said. Each child’s case is individual, but parents should also feel comfortable asking questions.

“It’s so important to have a conversation with your pediatrician about what the antibiotic is treating and the benefits of using it, weighed against the decision not to use it. Parents should ask these questions to better understand what that the drug treats, but also because it allows parents to ensure that the prescriber can justify treatment and is not writing an unnecessary prescription,” she said.