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You Had Me At “Antibiotics”

By Scott Hamilton, MD
October 13, 2022
Hamilton Blog Headshot Updated 12.21.21

This week's guest columnists are Carrie Guidry, MD and Priscilla Tutu, MD, Family Practice residents at Ochsner University Hospital & Clinics.

The leaves are changing, and the air is (maybe) getting crisp. Soon, we'll be indoors with friends and family for the holidays. Kids will also be having recess and PE inside. With all that mixing, kids WILL get sick from family or schoolmates who are coughing up mucus and smearing it about. When that happens, what will help them get better?

Sometimes parents hope for antibiotics, but they're not the first thing physicians consider. When kids aren’t prescribed one, despite explanations why, there's occasionally confusion. Parents may head elsewhere, but multiple visits can result in unnecessary prescriptions or tests to appease frustration.

As doctors, we are trained to “Do No Harm.” One part of that is to only order tests and treatments that will help patients and not hurt them. If blood tests won't help make a diagnosis, we won't order them. If antibiotics won't help, we will not prescribe them to avoid allergic reactions and minimize the rise of antibiotic resistant bacteria.

This careful use of medication is called “antibiotic stewardship.” For over 10 years, professional organizations like the American Academy of Pediatrics have encouraged doctors and other practitioners to prescribe antibiotics only when necessary. This movement has grown into a broader campaign called “Choose Wisely.” Pediatrics and other specialties are urging practitioners to not just prescribe antibiotics carefully, but also avoid unnecessary testing and prescribing other medications that won't be useful. Readers can visit to see what your kid's doctor should (and should NOT) be doing, and see what other specialties are recommending too.

Antibiotics or not? That's the question many parents and doctors fret about when children get sick. It's distressing to see them coughing their heads off or hear their rattling breathing. When kids get fevers, they're listless and don't eat. Parents just want them better. For generations, antibiotics have enjoyed a reputation as cures for the worst illnesses. So why not give them?

Most pediatric infections are caused by viruses, microscopic bio-machines that infect human cells. They cause most vomiting/diarrhea, head and chest colds and fevers. ANTIBIOTICS DON'T KILL VIRUSES, ONLY BACTERIA. PERIOD. Over time, a child’s immune system will clean viruses out, and they become well.

Other viral illnesses include the infamous RSV (Respiratory Syncytial Virus). Green-yellow mucus - surely that's bacterial and needs an antibiotic. Nope. Sinus infections – the vast majority are viral. Even ear infections are often viral and go away without antibiotics.

So which infections may need antibiotics? Strep test positive? Time for penicillin. Coughs that last longer than 14 days, or sinus infections lasting longer than 10? Maybe. Pneumonia often needs antibiotics, but diagnosing it is complicated. Kids with fevers lasting longer than 4 or 5 days may need tests to decide if antibiotics might help. Finally, urinary tract infections are bacterial, but practitioners often misinterpret urine tests. 

As much as we love antibiotics, they can cause diarrhea, yeast infections or allergic reactions. Most worrisome is “antibiotic resistance.” Doctors fear a day when antibiotics will become useless and people will start dying of bacterial infections that we can still cure today. We've managed to stay ahead of far.