When Should or Shouldn’t an Antibiotic Be Prescribed?

What is the big deal about antibiotics? So many times we treat children whose parents just came from their doctor with similar symptoms as their child, stating they just got a prescription for an antibiotic so they would like their child to get one to get better faster. Or, parents bring a child in concerned about a fever and ask for an antibiotic, usually disappointed that they did not receive an antibiotic prescription. We would like you to know some facts about antibiotics and why we do or do not prescribe them.

There are two main types of germs: Bacteria & Viruses

Bacteria are single-celled microorganisms that cause diseases like syphilis, tuberculosis, meningitis, and pneumonia, but some bacteria, like staphylococcal species, live in harmony with other microorganisms (an example of this is yeast, which exists on our skin). When these “good” bacteria are out-of-balance, there is the risk of “infection” by the one that has overgrown. The immune system as well as the other bacteria and flora in the area of infection cannot balance or fight off the invading new organism, thus it is an “infection.” In this case, a medicine directed specifically toward that type of germ or bio organism (thus the term “antibiotic”) is needed to control or kill that organism before it makes the body very ill.

Viruses are a different type of germ, much less easy to kill and not sensitive to antibiotics. They require an “antiviral” to kill them. Most viruses that cause run-of-the-mill head colds, diarrhea, and vomiting, however, are self-limited. This means that our bodies do a great job of fighting them off and becoming stronger against them each time we are exposed. Children tend to catch a viral infection (a cold or diarrhea) from daycare or school. Little children seem to catch more per year, and, as they get older, they show symptoms less and less, even though they are still exposed to the same germs. This is because our immunity recognizes the germs with each exposure and our bodies fight them off.

Symptoms that an illness is usually viral are:

  1. Sore Throat: Most are viral, only strep throat needs an antibiotic.
  2. Colds: Most children with thick or green mucous do not have sinusitis. Yellow or green mucous is just inflammatory cells and only if prolonged or severe would this infection need antibiotics.
  3. Ear Infections: If asymptomatic and there is fluid in the ear, it is most likely sterile and does not need antibiotics.
  4. Cough or Bronchitis: Most is viral. Children rarely need antibiotics for this.

How Antibiotics Work & Antibiotic Resistance

Antibiotics are chemicals made specifically to break open, maim, dissolve a cell wall, or interfere with cell wall synthesis or replication of the cell, so that it dies. Now, bacteria can also become resistant to an antibiotic, especially when it sees an antibiotic repeatedly. When these medicines are used inappropriately (during a viral infection, cold, or fever without a source), they can learn to grow stronger each time. They eventually become resistant so that there is only limited or no antibiotic to kill these pathogens.

There is a big name out there called MRSA, methacillin resistant staph. Staph is normal flora on our skin, but over the last few years it has become the dreaded germ that has been known to start boils, folliculitis, deep skin infections, pneumonias, meningitis, and bone infections. Because of the overuse of antibiotics, this germ has become reisitant to most antibiotics and has become the dreaded ‘flesh eating’ bacteria. It is VERY difficult to treat, and it develops new resistance daily.

If a body has a bacterial infection, it needs help either with an antibiotic or, if the infection is small or superficial enough, hot compresses or local lancing to let out the pus. Sometimes a viral infection leads to a bacterial infection (influenza makes lots of secretions in the lungs that can easily get bacteria in them and the bacteria overgrow and cause worse infections; sinusitis can develop from a cold that has never quite cleared up). Preventing these with an antibiotic during a cold does not work and can lead to resistance in your normal germs. The worst thing one can do is to take only a few of the antibiotic prescribed. This teases the bacteria; it doesn’t kill them, it only maims them, and then they grow back stronger or resistant. Fever is an indicator that the body is fighting off a foreign particle, it does not automatically mean your child has an infection that needs an antibiotic.

It is wrong to give your child antibiotics if the infection is only viral, for the reasons listed above. You should always keep your doctor informed of worsening symptoms so we can know when or if there is a secondary infection starting to show up after a viral illness has been present. Such symptoms include a prolonged infection or worsening of symptoms when the illness should be getting better, or a very irritable child that isn’t responding to you in a normal way.