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Infections and Germs:

We have all been there.  Your little one was fine yesterday, and now all of a sudden they are sluggish and not acting right.  And then when you check your superstar, they are burning up with a high fever.  Fever itself isn’t dangerous, but it is a sign that some kind of infection or germ has unfortunately set up shop.  And now the question is – is that germ viral or a bacterial - and will we need to see the doctor and get antibiotics? 

There is no doubt that antibiotics were and still are overused, and there is no doubt that antibiotics, like every medicine can have side effects.  That is the easy part.  The hard part is when your child is sick, how do we know if antibiotics, in that particular moment of fever and illness, are actually the right thing.

The Art Behind the Science:

There is both an art and a science to this complex topic.  The science is actually rooted in some undeniable facts.  While viruses will cause illness, the illness is most often self-limiting, and since viruses won’t listen to antibiotics, there is no need to prescribe or use and antibiotic with a viral illness.  On the other hand, bacterial infections can be very serious and even life-threatening, so if we know for sure we have a bacterial infection, we most definitely need antibiotics.  

Each bacteria is different, and your pediatrician will have a good idea of the most common types of germs depending on the type of infection.  So the bad guys causing an ear infection are different from those causing a skin infection, like impetigo or cellulitis, and those are different from those causing a urine infection or appendicitis.  

When we speak about limiting antibiotics, or a “watch and wait” method, we are referring to avoiding that tendency to give every child with a fever an antibiotic.  Even the ear that looks slightly red with fluid may be a viral ear infection, and not a bacterial infection.  

That brings up the idea of the art of medicine, and the need to analyze the entire picture with an experienced eye.  A child who is happy and has no fever most likely doesn’t have an ear infection even if there is fluid behind the ear drum.  Even the child who has 104 fever may not have a bacteria, because viruses can cause very high fevers.   An adult doctor, or perhaps a walk-in urgent care facility, or a very young doctor may be more likely to see a red ear in a febrile child and prescribe antibiotics just in case.  But a seasoned pediatrician can really tell which ear drum is infected with a bacteria, and which are viral, and therefore don’t need antibiotics.  

Strep throat is the name of another common infection.  This is caused by the bacteria called streptococcus, (group A Beta Hemolytic streptococcus if you really want to greet him appropriately!) and this bad guy surely needs antibiotics, or it can progress to secondary complications, such as rheumatic heart disease or kidney issues or even OCD type behavior.  But that doesn’t mean each sore throat and fever needs antibiotics.  Our cultures or test results will dictate whether it is strep or not, and therefore we will decide if antibiotics are needed.  Always ask for a culture, and don’t let a doctor simply look at a red throat and prescribe what could be an unnecessary antibiotic.  

With urine symptoms we also will send off urine tests, and with some skin infections we will also send cultures.  Doctors and parents both want to limit antibiotics, and yet it is the thorough investigation – the history of the illness, the symptoms, the physical exam and possible testing that will determine when we need antibiotics or when we can wait it out.

When we do give antibiotics, we give as low a dose as possible that will still work.  We do scientific studies to establish the exact dose depending on your child’s weight and age, and we try to limit the course when possible, although 7-10 days is the most common length of treatment. 

Some bacteria can be resistant to antibiotics, so there are times when the initial choice of an antibiotic may fail, and the doctor needs to prescribe another one.  Indeed a very serious infection may need stronger antibiotics – by a shot or even intravenously in a hospital.   Common side effects are stomach upset, diarrhea, or yeast infections, but there can be allergic reactions or even bloody stools after an antibiotic is given. I always recommend using probiotics while your child is on an antibiotic to limit side effects.

An individual doesn’t become dependent or addicted to an antibiotic, but a given germ can become resistant to an antibiotic.   Doctors will read the latest research on those resistant patterns and select antibiotics accordingly.  Indeed at the beginning of my career 20 years ago we were just learning about “resistant staph” or MRSA, but nowadays it is so common that we often select an antibiotic that can treat the MRSA instead of choosing the old fashioned antibiotics that the staph may not listen to.  

There are new antibiotics coming out all the time, and each antibiotic is targeting a different type or types of germs.   The strongest ones can work quicker, but often at the expense of more side effects.  The more targeted ones will be softer on the system, but may not always work as well.  Therefore, as with most complex pediatric health care issues, the most important step may be finding an experienced and intelligent pediatrician that you trust.  And of course, wash those hands and cover those mouths!  


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