Preventing Antibiotic Overuse
Working with Your Child’s Provider

By Eric Goodman, ARNP

“It’s just a virus. Fortunately no antibiotics are needed and he should be feeling better in a few days…”

While these words should be comforting, often they lack the reassurance many parents want. As both parent and provider, I’ve experienced both sides of the issue. I’ve spoken the above statement countless times to concerned parents and heard it myself, when bringing my own son to see one of my colleagues.

As parents we naturally want to help our children recover from illness as quickly as possible. Unfortunately, many people have equated the use of an antibiotic with recovery from infections. The reality, however, is that the majority of childhood ailments—colds, sore throats, stomach bugs, and even ear infections—will resolve themselves on their own.

Identifying the Infection

To better comprehend which infections can be treated effectively with antibiotics, one needs to understand that there are two major types of germs that make people—especially children—sick. Of the two, viruses, microscopic organisms that cannot live without invading a person’s or animal’s cells, cause the greatest number of infections. We come into contact, through our noses, mouths, and skin, with hundreds of viruses a day. We generally do not become ill from them as our immune systems are able to fight those organisms off. Occasionally one of these viruses will get by our immune system’s first line of defense, and we will become sick.

Most respiratory viruses, such as colds and bronchitis, can cause a runny nose, sometimes with thick, green mucus, cough, sore throat, and fever. Additionally, a virus can attack our gastrointestinal system, the stomach and intestines, and lead to vomiting and diarrhea. In almost all cases, a person’s immune system will eventually rise up and fight off the infection. Usually a cold will last about five to ten days and a stomach virus, or gastroenteritis, will last from one to five days. Antibiotics have absolutely no effect on viruses and will not prevent or shorten the course of the infection.

Bacteria will respond to antibiotics. These germs are much larger than viruses and can live on their own. Most bacteria are enclosed by a protective wall that antibiotics are designed to harm. While antibiotics are usually prescribed for such infections, they can sometimes resolve on their own, as our immune system learns to fight them off. Your child’s provider may want to wait a few days before considering an antibiotic to see if they recover spontaneously from a bacterial infection, such as an ear infection.

Often, it is not easy to identify the source of an infection, as both viruses and bacteria can cause similar symptoms. A good rule of thumb is that viruses generally will cause more symptoms than bacterial infections.

Parents often come in to see me because their child has multiple simultaneous complaints–respiratory and stomach. Most of the time this means the infection is viral. Bacteria infections have more isolated symptoms. For instance Strep throat—one of the more common bacterial illnesses—is known for a sore throat without runny nose or cough. A viral sore throat will generally include those other symptoms.

Sometimes the only way to distinguish between a viral and bacterial infection is to wait and see if it resolves on its own. Infectious disease experts have asked providers to wait about ten days before diagnosing a bacterial sinus infection, for example. Before that period of time, a cold, which can also include fever, thick green nose mucus, and sinus pressure, cannot really be distinguished from sinusitis.

Antibiotic Overuse

The reasons for antibiotic overuse are twofold. As providers we are at fault because we have become too comfortable prescribing these medicines, “just in case.” Studies have shown that up to 60% of children with colds are treated with antibiotics. If you consider that on average, infants and toddlers will have up to ten colds a year, a tremendous number of antibiotics are prescribed unnecessarily.

The advent of antibiotics in the 1940s has saved hundreds of thousands of lives and could be considered the greatest medical invention ever. However, like many new advances, we did not realize the risks until recently. Now we understand that bacteria are smart and will evolve in order to stay resistant to these medicines. We have not and will not be able to develop new antibiotics quickly enough to keep up. Using antibiotics too frequently for these illnesses not only puts today’s children at risk, but will have significant repercussions for the youth of tomorrow.

The Role of Parents

Blame also rests with us as parents. Do you expect antibiotics every time you bring your child into the doctor’s office? According to a study published in the February issue of Pediatrics, the medical journal of the American Academy of Pediatrics (AAP), 50% of pediatricians stated that parental pressure was the leading reason why they chose to prescribe antibiotics when it was not indicated. Additionally, 96% of the pediatricians said parents had requested antibiotics during the previous month even when they were not needed.

I often tell parents that it would be easier for me to prescribe an antibiotic than to take the additional time to counsel parents about comfort measures for their child. With a waiting room packed full of sick children and their concerned parents, why would I take the additional time—instead of just prescribing an antibiotic—if it were not in the child’s best interest?

My best advice for parents is to have an open mind when visiting the office. Make it clear at the start of the visit that you do not expect an antibiotic prescribed, unless it is necessary. Ask about comfort measures and alternatives to medications. Additionally, discuss the safety and risks of over-the-counter products.

The good news is, while there is still a lot of pressure to prescribe antibiotics unnecessarily, I have sensed a turn in the tide. An increasing number of parents are aware of the risks associated with the inappropriate use of these medications. Together parents and providers can work to overcome the overuse of antibiotics and the development of resistant infections.

Eric Goodman, ARNP received his Masters and Nurse Practitioner Certification from University of North Carolina at Chapel Hill in 1996. He has been with Dartmouth Hitchcock-Keene Pediatrics since August, 2000.