When do kids need antibiotics?

February 28, 2014 Elizabeth Meade, MD

Winter can seem like one long continuous “sick day” for families - kids pick up frequent infections at school or daycare and pass them around to everyone at home.  Often it feels like by the time the illness has worked its way through the household, a new one has started!  Even for physicians, it can sometimes be difficult to distinguish between viral and bacterial infections.  Since antibiotics cannot treat viruses, they are often over-prescribed - which can lead to significant side effects in children and also contributes to bacteria becoming resistant to existing medications.  In November 2013, the American Academy of Pediatrics released an updated guidance regarding antibiotic treatment, helping answer the frequently asked question about when kids need antibiotics.

Here's what you should know about antibiotics in these situations:

  • Ear infections - Signs of bacterial ear infections include pain (often one-sided), fever, drainage from the ear, or in younger infants, irritability and poor feeding.  Your doctor will use a tool called an otoscope to look inside the ear - if there is pus behind the eardrum or visible drainage, this indicates a probable bacterial infection.  Even bacterial ear infections frequently resolve without treatment!  But if your child has severe pain, pain lasting > 48 hours, fever above 102, has infections in both ears, or is less than 2 years old he or she may need antibiotics.  Otherwise, the best thing may be to watch and wait - if symptoms fade within a couple of days your child may not need treatment at all, especially if they are over 2.
  • Sinus infections - It is important to understand that viral infections (“cold” or “flu”) can last up to 10 days or even 2 weeks in children.  It can be frustrating to have a child with cough or runny nose lasting this long, but this does not necessarily indicate a bacterial infection.  However, if a child has symptoms that are not improving at all or worsening at 10 days, develops new fevers above 102, or has nasal discharge that looks cloudy or thick green/yellow for more than 3 days - they may need antibiotics to treat a sinus infection.  Your doctor can look for signs of this on exam.
  • Sore throat - Is it strep or a cold?  Sore throats are most often caused by viruses and resolve without treatment - if someone has cough or runny nose, they are unlikely to have strep throat.  It is also very rare in children under 3.  Signs of “strep throat” include sore throat WITHOUT significant cough, fevers, swollen lymph nodes in the neck, and white discharge seen on the tonsils.  If your child is over 3 and has these signs, your physician can perform rapid testing on a throat swab.  If that rapid test is positive, antibiotics should be prescribed.  If the child does not have signs of strep infection or the test is negative, things should get better on their own.

By prescribing medication only when needed, we can all help our kids avoid unnecessary side effects.   Using the tips above can help parents distinguish between viral and bacterial infections, and maybe even save a trip to the doctor!

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