Antibiotics are the most commonly prescribed medication for children, according to the World Health Organisation (WHO). But while they have saved millions of young lives when correctly used for bacterial infections, they are also often wrongly prescribed for viral infections, against which they are powerless. And the WHO notes that they can cause drug toxicity and harm a child’s gut organisms and enteric immune system.
A study in the American Academy of Pediatrics found that around 11.4million unnecessary antibiotic prescriptions are written for children and teens each year in the US. And there’s a similar problem here. Dr Kuven Naidu, a specialist physician in Gauteng, reports that although the South African guideline for the primary healthcare level recommends that antibiotics not be given for uncomplicated acute bronchitis, almost 60% of patients under the age of 5 presenting with acute bronchitis were prescribed an antibiotic, according to a study in the SA Medical Journal in 2017.
1. Know the risks
Whenever an antibiotic is prescribed, there’s a risk of a reaction:
- Short term risks are immediate side-effects, such as vomiting, diarrhoea, rash, and anaphylaxis (severe allergic reaction). A recent study supported by the Centers for Disease Control and Prevention found that from 2011 to 2015, reactions and other side-effects from antibiotics led to around 70 000 emergency room visits each year in the US. Children aged 2 and younger had the highest risk.
- Medium-term risks include developing resistant bacteria, which are harder to treat and may lead to hospitalisation; and an increase in MRSA, a type of staph bacteria that causes skin infection and more serious bone and bloodstream infections.
- Long-term risks arise because children can carry resistant bacteria for a long time and they can be spread within the family. Also, antibiotics affect the child’s microbiome (gut organisms) by killing not just the bad bacteria targeted, but the good. And good gut bacteria are important, aiding digestion, the absorption of calcium and iron, and the synthesis of certain vitamins and even neurotransmitters such as serotonin, the feel-good hormone. They help control toxic substances and keep the lining of the intestinal tract healthy, boosting the immune system. Another long-term concern is that antibiotics may be associated with inflammatory bowel disease (IBD): in a study of a million patient records in the UK, infants given antibiotics had the highest increase in IBD risk.
2. Know the limits
Antibiotics are effective, but only against bacteria, and when truly needed. Among the serious bacterial infections that require antibiotics are pneumonia, meningitis, blood infection and urinary infection.
“It’s extremely important to know the bacteria you are treating, as different antibiotics work on different organisms,” says Dr Naidu.
“Knowing the organism you are treating also ensures that you use targeted narrow spectrum therapy instead of a broad spectrum antibiotic. This will lessen the chance of allowing other bacteria to develop resistance mechanisms to the antibiotic you have used. This is why performing cultures (blood cultures, sputum, urine) is so important.”
Viruses, not bacteria, almost always cause upper respiratory infections. Acute bronchitis, too, is seldom caused by bacteria. But it can be hard to differentiate viral from bacterial infections in young babies, especially those under three months of age, and identify if they are at risk of serious bacterial infection, so they are often started on antibiotics, then taken off if no bacterial infection is detected.
- For ear infections: Antibiotics can benefit toddlers with infections in both ears and severe pain, notes the American Academy of Paediatrics. Symptoms often disappear in a few days, though, and for older children not in too much pain, a “wait-and-see” approach may be better.
- For coughs and runny noses: Antibiotics should be considered only when symptoms are severe, persistent or are getting worse.
- For a sore throat: Children who have swollen tonsils and lymph nodes and a fever should be tested for strep throat, and only if the results are positive should they be prescribed antibiotics.
3. Ask these 3 questions
- Does my child really need this antibiotic? What are the benefits and the risks of taking it?
- Can you prescribe a narrow spectrum antibiotic that targets just the bacteria causing this infection, rather than broad-spectrum, which kills good bacteria too?
- Can my child take probiotics (capsules or sachets of “good bacteria”) along with the antibiotics?
Research suggests that over-prescription of antibiotics is largely a result of parents and caregivers requesting antibiotics, and busy health professionals trying to ease their concerns. Don’t be one of those parents.
“The pressure practitioners are under from the public to prescribe an antibiotic is extreme,” says Dr Naidu. “The flu season often sees a large spike in antibiotic use even though most infections are viral. People often think they or their child will recover after taking an antibiotic, as the natural course of a viral illness will ease off around the same time as the antibiotic course is completed.
This creates the perception that the antibiotic has worked and the next time the patient or child has a viral illness they will ask for an antibiotic again. Should the practitioner not prescribe one, he or she is perceived in a negative light.“We need to change this ‘prescribing pressure’ syndrome. Practitioners and patients need to work together to ensure appropriate antibiotic prescription or we will all pay the price down the line,” says Dr Naidu.
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