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Where are my antibiotics?

Question of the Week

By

Updated June 26, 2011

Q. My son has had a green runny nose for three days. I took him to a new Pediatrician today and for the first time, I left without a prescription for an antibiotic. Doesn't he need an antibiotic to clear up his sinus infection? How come my last doctor always gave us a prescription?

A. No, he likely doesn't need an antibiotic to get better. If he simply has a green runny nose for three days, even if he also has a cough and fever, that is probably just a cold and it will get better on its own.

It can help to understand why he doesn't need antibiotics if you realize that a cold is just a viral infection and antibiotics don't work against viruses. Your child simply needs time to get better on his own.

It also helps if you understand the natural progression of a cold, which usually starts off as a clear runny nose, perhaps with a fever and cough or a green or yellow runny nose, and then, after 3-5 days of worsening, your child will slowly get better over the next 7-10 days.

There are times when your child may need antibiotics when he has a cold, like if he has a secondary bacterial infection, such as an ear infection or pneumonia. If he continues to worsen after 5 days of cold symptoms and has a persistent fever, then that can be a sign that it is turning into a sinus infection, and antibiotics may also be needed.

If your previous doctor always gave you a prescription for an antibiotic, even when your child just had a cold, he or she was likely overusing antibiotics and prescribing them when they weren't necessary.

But won't antibiotics help him get better faster?

No. This is one of the common myths that help contribute to the overuse of antibiotics. While many parents now realize that their child will get over their cold symptoms on their own, they still may believe that they will get better even faster with an antibiotic. This is simply not true. Antibiotics don't work against viruses.

Antibiotics also won't help to prevent him from developing an ear infection or sinus infection when your child has a cold, so starting an antibiotic early or 'just in case' is usually not a good idea either.

Here is a good way to think about it:

Pediatrician: I think little Johnny has a cold and he should get better in about 7 days.

Mom and Dad: But what if you give us an antibiotic? How long will it take him to get better then?

Pediatrician: About a week.

Are there any dangers to using antibiotics when they aren't needed?

In addition to wasting money and putting your child at risk for side effects of taking an antibiotic, such as diarrhea and allergic reactions, taking an antibiotic unnecessarily also makes your child more likely to develop infections with bacteria that are resistant to commonly used antibiotics.

When a bacteria develops resistance, it means that it has come up with a way to counteract the antibiotic or keep it from working, so that the bacteria can keep growing and your child's infection worsens or lingers.

The other problem occurs when a child is prescribed an antibiotic for a cold and then he isn't getting better after a few days. What do you do then? Since we expect antibiotics to begin working in 2-3 days, if the child isn't getting better, he is usually changed to another stronger antibiotic. And then when he does get better 2-3 days later, everyone thinks it was the antibiotic that worked, when instead, he likely just got better on his own.

Is resistance really a problem?

Yes. And it is becoming an increasingly bigger and more serious problem. According to the CDC, 'antibiotic resistance has been called one of the world's most pressing public health problems.'

Has your child ever needed more than one or two antibiotics to fight an ear infection or sinus infection? If so, then it is likely because the first antibiotics didn't work and the bacteria causing your child's infection had developed resistance.

And as more antibiotics are used, especially when they are used when they aren't needed, the problem of resistance will increase. Fortunately, a lot of education of parents and doctors has been done in recent years to cut back on the overuse of antibiotics.

What else contributes to the overuse of antibiotics?

Although doctors often blame parents who demand antibiotics when their children are sick, and parents blame doctors who don't educate them enough about whether or not an antibiotic is really needed, we are all partly to blame.

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