The antibiotics conversation every parent ends up having

Talking about antibiotics with your child’s healthcare provider requires understanding that while these medications save millions of lives each year by killing harmful bacteria, they are ineffective against viruses such as colds, flu, and most sore throats and gastrointestinal infections.

Bacteria are living one-cell organisms, and although most are harmless and even beneficial to your little one’s health, some, like E. coli, staphylococcus and streptococcus, can cause serious infections. 

Viruses, on the other hand, are tiny particles of genetic material that can enter the body, hijack host cells, and make copies of themselves, but they are not technically alive, and antibiotics have no effect on them.

The pros of antibiotics

“Antibiotics can be the answer when your child has a bacterial infection such as pneumonia, strep throat, whooping cough, urinary tract infections and some sinus infections,” says Grotto Bay-based paediatrician Dr Susan Annandale.

They may also be prescribed for certain ear infections: if your child is six months or younger, six months to two years with moderate-to-severe symptoms, or older than two with severe symptoms (a fever over 39⁰C, pain lasting more than two days). Antibiotics may be advised too if your child has a condition that makes it harder to heal, such as cleft palate, Down syndrome, immune disorders, or a cochlear implant.

The cons of antibiotics 

“Caution is needed when prescribing antibiotics, especially for a child under the age of three, as they can have side effects, including rashes, nausea, diarrhoea, stomach pain and allergic reactions, and at a very young age, a predisposition to asthma,” says Dr Annandale. 

Signs of an antibiotic allergy include itchy hives (raised red welts), skin rashes, swelling of the lips or face, wheezing, and fever, usually within minutes of exposure. Severe reactions (anaphylaxis) can follow, with difficulty breathing. This is a medical emergency. 

The greatest problem with antibiotics, however, is that if they are overused or misused, bacteria can build resistance to them, as the strongest survive and multiply, passing on their resistance. Antibiotic-resistant infections are harder to treat, last longer and lead to more serious illnesses that may require hospital stays, Dr Annandale says. A child can carry resistant bacteria for up to 12 months, spreading them in the family and the community.

Antibiotics also destroy beneficial bacteria in the body, which can allow harmful bacterial strains such as Clostridium difficile (C. diff) to grow and spread, causing infections difficult to control. “Antibiotics also predispose to fungal overgrowth,” adds Dr Annandale. “The good bugs keep fungal overgrowth under control. Because antibiotics can’t distinguish between good and bad bugs, they kill all.”

The solutions

If your healthcare provider prescribes antibiotics, ask if the infection is bacterial, or if there is another reason. Discuss the benefits and risks. Tell them if your child has taken antibiotics recently, which can affect the likelihood of resistance. “Antibiotics can in most cases not be given ‘prophylactically’, to prevent infection – this also predisposes to antibiotic resistance,” Dr Annandale says.

Ask if there is an alternative, such as ‘watchful waiting’ – waiting 48-72 hours to see if symptoms improve on their own before beginning antibiotics. Request recommendations of the best ways to help relieve your child’s discomfort while the infection runs its course, such as using infant acetaminophen or ibuprofen (from 6+ months old) to reduce pain. “Not all episodes of fever require antibiotics,” says Dr Annandale.

If antibiotics are prescribed, give them exactly as directed. Always finish the full course, even if your child is feeling better, as this can leave behind stronger bacteria that cause the infection to return. Never share medications or use leftovers antibiotics from a previous illness – the antibiotic prescribed for one child or one infection may not work for another.

“Prevention is always best, so keep your little one’s immune system strong by providing a healthy diet,” Dr Annandale says. Ask about supplementing it with probiotics during a course of antibiotics and for two weeks afterwards to support your little one’s gut microbiome. 

Help them to get enough sleep, which is key for a healthy immune system. Babies and toddlers need about 11 hours a night and a nap. 

Make sure they are up to date with vaccinations (see the Department of Health childhood vaccination schedule). “Immunisations are of extreme importance, and there are now several against bacteria: Haemophilus, Meningococcus, Pneumococcus,” says Dr Annandale.  “Also take your child for an annual flu shot from when they are six months old, and ensure adults in the family and caregivers have their shots too.”

Childhood immunisations and flu shots are available at Clicks clinics, visit Clicks Clinics online https://clicks.co.za/clinicBooking

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