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Why Don't Antibiotics Work Anymore?

Question of the Week

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Updated June 13, 2014

Q. With recent ear and sinus infections, my son has had to be on 2 or 3 different antibiotics to get rid of each infection. Why don't antibiotics work anymore? And does it matter which antibiotic my child takes?

A. Antibiotics are medicines that help to fight bacterial infections. There are different reasons why an antibiotic might not work for an infection, including that the wrong antibiotic was prescribed (for example, Suprax is good at fighting urinary tract infections, but not indicated or very effective against skin infections like impetigo), the bacteria that is causing the infection has developed resistance to the antibiotic, or your child may just have a virus, which don't respond to antibiotics anyway.

What is resistance? According to the CDC:

Antibiotic resistance occurs when bacteria change in some way that reduces or eliminates the effectiveness of drugs, chemicals, or other agents designed to cure or prevent infections. The bacteria survive and continue to multiply causing more harm.

In more simple terms, when a bacteria becomes resistant to an antibiotic, it just means that it has come up with a way to keep the antibiotic from working against it.

Because of resistance, the choice of which antibiotic to use becomes very important, as some antibiotics are more effective than others against resistant bacteria.

Which antibiotic should your child take? In 1999, members of the drug-resistant Streptococcus pneumoniae Therapeutic Working Group1, which was convened by the CDC, recommended that for ear infections:

  • Oral amoxicillin should be used first, but a double dose (80 to 90 mg/kg/day) may be needed
  • If the child isn't better after three days of antibiotics, then he may need to be changed to an alternative antibiotic, such as:
    • oral amoxicillin-clavulanate (Augmentin)
    • oral cefuroxime axetil (Ceftin)
    • or intramuscular (a shot) ceftriaxone (Rocephin)
Other antibiotics that may be good choices include cefpodoxime (Vantin) and cefdinir (Omnicef), which tastes good and can be used just once a day. If your child was on a regular low dose of amoxillin, trying again with a high double dose might also be effective.

If your child has been on antibiotics recently, starting with an alternative antibiotic may also be a good idea.

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