Picture this: Your two-year-old is screaming in pain and clutching her earlobe as her cheeks become more flushed by the minute. Nothing seems to soothe her. She isn’t teething. She isn’t hungry – in fact, she won’t eat. Her diaper is freshly changed. It’s probably another ear infection, which will be the third one this year. You pack your writhing wee one into the car seat and head to the nearest clinic in the hopes of getting a prescription for something – anything – to relieve her pain.
If this scenario sounds familiar, you’re not alone. According to a recent ParentsCanada survey, eight percent of parents have pressured their doctor to write a prescription, with that figure rising to 12 percent among parents of children over 10. Are parents hooked on antibiotics?
According to a 2006 Centers for Disease Control study, parents pressure doctors for antibiotics, and doctors often cave in. Results showed that doctors prescribe antibiotics 65 percent of the time if they sense that parents expect them to do so and only 12 percent of the time if they don’t.
“Parents need to understand that giving antibiotics to a child for a viral infection won’t prevent a bacterial infection,” says Dr. Elizabeth Shaw, a physician in private practice and a professor in the department of family medicine at McMaster University in Hamilton, Ont. “If a child does take antibiotics for a virus, the medication might not work when it’s really needed.”
That’s because the bacteria can become resistant to the antibiotic. According to a 2006 survey by Léger Marketing for the National Information Program on Antibiotics, there are a lot of misconceptions about antibiotic usage in Canada. While the majority of those surveyed – 85 percent – knew that antibiotics are useful for treating bacterial infections, 53 percent said they also help treat viral infections. Almost half said that antibiotics will help treat a global fl u pandemic. Most frighteningly, 63 percent of Canadians believed they can avoid getting antibiotic-resistant infections by using antibiotics sparingly, suggesting a lack of understanding that it’s the bacteria – not people – that become resistant to antibiotics.
There are other risks to taking antibiotics unnecessarily. Short-term unpleasantness includes diarrhea and an allergic-reaction type of rash; in the long run, antibiotic resistance could develop. Antibiotics are needed to treat most bacterial infections (see “Common childhood illnesses,” below) and are typically prescribed to kids for five to 10 days. If you aren’t sure whether your child has a viral or bacterial infection, it’s best to have an examination, especially if you’re dealing with an infant who has a fever. “If you have a child who is less than six months old with a fever of 38.5ºC that lasts more than 24 hours, go to a doctor,” says Dr. Shaw. “There’s no fever with a standard cold.”
If your child develops a full-body rash or hives while taking antibiotics, both of which can be itchy, he or she might be having an allergic reaction (the most common type of antibiotic to cause an allergic reaction is a form of penicillin called Amoxicillin). “If a rash appears, keep administering the antibiotics but consult a doctor right away to have the child assessed,” says Dr. Shaw. “If hives appear, stop the antibiotics but still see a doctor.”
In the family medicine classes she teaches at McMaster, Dr. Shaw cautions her students against overprescribing. “As a result of this type of education, new doctors are becoming aware of the issues related to antibiotic resistance,” she says. “And compared to a few decades ago, we now recognize that the vast majority of upper-respiratory infections like bronchitis don’t require antibiotics – they usually clear up on their own in up to 10 days.”
However, physicians don’t want the pendulum to swing too far in the opposite direction either.
“We don’t want parents to be so laissez-faire that they don’t take their sick child to the doctor to be assessed,” says Dr. Shaw. The younger the child is, the more important it is to have him or her looked at; even a day-old baby can need antibiotics.
And it’s important that parents ensure that their kids finish the full prescription, even if they start feeling better before the pills are gone. “If the bacteria wasn’t completely eradicated at the time the antibiotics were stopped, it can begin to thrive again,” says Dr. Scott Halperin, head of pediatric infectious diseases at the IWK Health Centre in Halifax. “It can also acquire resistance, particularly if low or intermittent doses of the antibiotic are taken prior to stopping completely. So it’s important to take the full prescription.”
Dr. Halperin also offers this advice: If the doctor suspects strep throat based on an examination of symptoms, ask that a throat swab be taken to confi rm the diagnosis. The results will be ready either that same day or the next day. “If the results are negative, the child doesn’t need antibiotics,” says Dr. Halperin. Although strep throat typically will go away on its own if left untreated, antibiotics are usually prescribed in children because it can lead to more serious complications such as rheumatic fever.
Not all parents pressure their doctors for an antibiotic fi x. Robert and Terri Zinck of Halifax are a case in point. They’re grateful that their daughters, Sarah, 13, and Katie, 10, have been healthy throughout their young lives except for some minor infections requiring antibiotics: when Sarah was little she had a bacterial skin infection called impetigo, and Katie has had a few ear infections. The Zincks know they can count on their family’s physician not to prescribe antibiotics unless the girls really need them.
“We trust our doctor’s opinion,” says Robert, a firefighter. “He’s cautious about prescribing antibiotics right away and prefers to take a wait-and-see approach. When he does write a prescription, he starts with an older basic antibiotic to see if it’ll work first.”
Thanks to Terri’s job as a pharmacist, the Zincks have more than the average parental knowledge about what can happen if antibiotics are taken too often when they aren’t necessary (see “Antibiotic Resistance” above). If Sarah and Katie need antibiotics in the future, their parents aren’t worried about any potential long-term consequences.
“Because the antibiotics don’t get overused, we’re not worried about antibiotic resistance,” says Robert.
The message about proper antibiotic use appears to be spreading. “I’m seeing more and more parents in my practice who want to get their sick child checked but who are accepting if I tell them that antibiotics aren’t necessary,” says Dr. Shaw. That means more of them, like the Zincks, are becoming educated on the topic.
“Anytime your child is sick it’s hard, because you don’t want to see them uncomfortable,” says Robert. “But we trust our family doctor, and if he tells us to just give our girls acetaminophen and for them to rest, then that’s what we do.”
Common Childhood Illnesses that DO Require Antibiotics
Sinusitis: An inflammation of the tissue lining the sinuses. Normally sinuses are filled with air, but when they become blocked and filled with fluid, germs (bacteria, viruses and fungi) can grow, causing an infection. Acute sinusitis is the sudden onset of cold-like symptoms that don’t go away in 10 to 14 days. Common environmental factors include allergies and illness from other children at day care or school. If antibiotics are prescribed, they’re usually for 10 to 14 days.
Bacterial pneumonia: An infection of the lungs with coughing, fever, shortness of breath and chest pain. Bacterial pneumonia can be serious because it interferes with the body’s ability to exchange carbon dioxide and oxygen. The most common way to catch it is to breathe infected air droplets from someone who has it. While most healthy children can fight the infection with their natural defences, those with compromised immune systems are at higher risk. A child’s immune system may be weakened by undernourishment, especially in babies who aren’t exclusively breastfed. Pre-existing illnesses such as measles also increase risk, as does parental smoking.
Tonsillitis: An infection of the tonsils (balls of lymphatic tissue on both sides of the throat, above and behind the tongue). The main symptom is a persistent sore throat. While tonsillitis is usually viral and often goes away on its own after four to 10 days, sometimes it’s caused by the same bacteria that cause strep throat. If that’s the case, antibiotics are often prescribed to prevent the infection from spreading.
Otitis media: A middle ear infection that usually occurs along with an upper-respiratory infection such as a cold. Fluid builds up in the middle ear, creating a breeding ground for bacteria or viruses to grow into an ear infection. Pus develops as the body tries to fight the infection, and more fluid pushes against the eardrum, causing pain and sometimes hearing problems. While antibiotics may shorten some symptoms, most of the time the immune system can fight the infection on its own. Children under two are treated with antibiotics because they’re more likely to develop complications.
Antibiotic Resistance – What Is It?
Simply put, antibiotics are medicines that kill bacteria that cause infections such as strep throat and ear and sinus infections. There are many types of antibiotics, and each works a little differently and acts on different types of bacteria. After assessing your child’s symptoms, the doctor will decide which antibiotic will treat the infection most effectively.
Our bodies consist of thousands of different types of bacteria that help keep us healthy; for example, there is healthy bacteria in our gut. “Many people don’t realize that not all bacteria is bad,” says Dr. Scott Halperin of the IWK Health Centre in Halifax. Bacteria is a concern when it’s causing an infection, which is when antibiotics are required. Antibiotic resistance occurs when the bacteria is avoiding the antibiotic and continuing to live. “It’s important to understand that a person can’t become antibiotic resistant, but that a type of bacteria can,” says Dr. Halperin.
At the IWK, a team of researchers is doing computer modelling to figure out how to develop new antibiotics; this type of research is taking place around the world. “The goal is to develop a new class of medications that aren’t similar to the old ones that may no longer always kill certain types of bacteria,” says Dr. Halperin. It can take at least a decade to move the research from the lab to having the medications in pharmacies, so until then the older classes of antibiotics will continue to be prescribed and, for most people, will be effective.
The more parents understand the subject, the better it will be for everyone. “We can’t stress enough that antibiotics won’t help a child get over a virus any faster, and if we give kids antibiotics when they don’t need them, it could lead to antibiotic resistance,” says Dr. Halperin. “Some parents think if they don’t leave their doctors’ office with a prescription, their child hasn’t been treated properly. As physicians we have a responsibility to help them understand that most childhood infections are caused by viruses, not bacteria, and that they don’t require antibiotics.”
Jane Doucet is a Halifax writer and frequent contributor to ParentsCanada. She always takes her full course of antibiotics.
Originally published in ParentsCanada magazine, February 2014.