Antibiotics: When Do They Help

Antibiotics are strong medicines that can kill bacteria. They have saved many lives and prevented bad outcomes. These drugs do not kill viruses. They only work on bacteria. Every day, doctors must decide if a child's infection is viral or bacterial. Here's how they do it:

Bacterial Infections. Much less common than viral infections. Antibiotics can help. Bacteria cause:

  • Most ear infections
  • Most sinus infections not sinus congestion
  • 20% of sore throats which are Strep throats
  • 10% of pneumonia a lung infection

Viral Infections. Most infections in children are caused by a virus. Antibiotics do not help. Viruses cause:

  • 100% of colds. Note: unless they turn into an ear or sinus infection. This happens with 5 to 10% of colds.
  • 95% of new coughs. Note: asthma can also start with a cough.
  • 95% of fevers
  • 80% of sore throats
  • 90% of pneumonia. Note: most cases in children are caused by a virus.
  • 99% of diarrhea and vomiting
  • Note: There are a few anti-viral drugs that can treat viral infections. An example is Tamiflu used for severe influenza.

Cold Symptoms that are Normal

Parents sometimes are worried about common cold symptoms. The symptoms below are not signs of bacterial infections. Nor, are they a reason to start antibiotics.

  • Green or yellow nose discharge. This is a normal part of getting over a cold. It is not a clue to a sinus infection.
  • Green or yellow coughed up phlegm. This is a normal part of getting over viral bronchitis. It is not a sign of pneumonia.
  • High fevers. High fevers more than 104° F or 40° C can be caused by a virus or bacteria.

Side Effects of Antibiotics

All antibiotics have side effects. Some children taking these drugs can get side effects. Examples are diarrhea, nausea, vomiting, or a rash. Loose stools occur because the drug kills off the good bacteria in the gut. If your child gets a rash, it can be from the drug. Your doctor has to decide if the rash is an allergy or not. The biggest side effect of overuse is called antibiotic resistance. This is when the germs are no longer killed by the drug. That's why we only use antibiotics if your child really needs one.

Giving Antibiotics for Viral Infections: What Happens

If your child has a virus, an antibiotic won't get rid of the fever. It will not help the other symptoms. The drug will not get your child back to school sooner. It will not get you back to work any faster. If your child has side effects from the drug, he will feel worse.

What You Can Do

  • Save antibiotics for bacterial infections when your child really needs them
  • Don't pressure your child's doctor for an antibiotic
  • Treat your child's cold and cough symptoms with home treatment that works
  • Keep in mind that fever is fighting the infection. It also boosts the immune system to prevent future infections.

Bacterial Infections: Antibiotics can help and will be prescribed

Bacterial infections are much less common than viral infections. Bacteria cause:

  • Most ear infections (but they only happen to 5% of children with a cold)
  • Most sinus infections (but they only happen to 5% of children with a cold)
  • 20% of sore throats (Strep throat infections)
  • 10% of pneumonia (bacterial lung infection)

Viral Infections: Antibiotics do NOT help

Viruses cause most infections in children including:

  • Colds present for less than 2 weeks, unless they turn into an ear or sinus infection
  • Coughs present for less than 3 weeks, unless they develop a bacterial pneumonia
  • 95% of fevers
  • 80% of sore throats
  • 90% of pneumonia (most pneumonia in children is viral)
  • 99% of diarrhea and vomiting

Cold Symptoms that are Confusing but Normal

These symptoms are sometimes mistaken as signs of bacterial infections and a reason for starting antibiotics:

  • Green or yellow nasal discharge. Green or yellow discharge is usually a normal part of recovery from a cold, rather than a clue to a sinus infection.
  • Green or yellow phlegm (sputum). This is a normal part of viral bronchitis, not a sign of pneumonia.
  • High fevers. A high fever (over 104 F or 40 C) can be caused by a virus or a bacteria.

Side Effects of Antibiotics

All antibiotics have side effects. Unless your child really needs an antibiotic, there is no reason to risk the side effects of the medicine. Some children taking antibiotics develop diarrhea, nausea, vomiting, or a rash. The diarrhea usually occurs because the antibiotic has killed off the healthy intestinal bacteria. And if your child gets a rash, us must decide if the rash is an allergic reaction to the drug or not. The biggest side effect of overuse is increasing resistance to the antibiotics.

Giving Antibiotics for Viral Infections: What Happens?

If your child has a viral illness, an antibiotic will not shorten the course of the fever or help the other symptoms. Antibiotics will not get your child back to school or you back to work sooner. If your child develops side effects from the antibiotic, he will feel worse instead of better.

What You Can Do

  • Save antibiotics for diagnosed bacterial infections when your child really needs them
  • Don't pressure your child's doctor for a prescription for an antibiotic
  • Treat your child's cold and cough symptoms with home remedies that work
  • Remember that fever is fighting the infection and producing antibodies to prevent future viral infections.
Barton D. Schmitt, M.D.Copyright 1994-2014 Barton D. Schmitt, M.D.