We Just Need an Antibiotic
A large part of practicing Pediatric medicine is providing education to patients and parents. It is not enough to simply diagnose disease and deliver treatment; educating about the diagnosis and treatment can help families understand WHY the decisions are being made. This philosophy extends to all areas of Pediatrics – for example, a newly diagnosed diabetic needs to understand why checking blood sugars is so important, and the parent of an obese child needs to understand how nutrition impacts long-term health.
Today, we consider this impact in the area of antibiotic use.
Understanding infectious disease
In order to understand when an antibiotic is necessary, some basic understanding of this area of science is required. Infectious diseases are caused by different categories of organisms and affect the body in different ways.
Virus: a small, simple organism that can only replicate inside of a living cell (human, animal, plant). Viruses are not affected by antibiotics. There have been some antiviral medications developed, but they only affect the specific virus they were developed for.
Bacteria: single-celled organism that live everywhere, including in the environment, in the bodies of animals, plants, and humans. Not all bacteria cause disease in the body. Antibiotics have been developed to treat bacterial infections. These work in a variety of ways, so not all antibiotics work for all bacterial infections. Understanding how a bacteria causes disease is key to choosing the correct treatment.
Fungus: these can be single celled or complex organisms, and include yeast and mold. Fungal infections must be treated with antifungal medications.
Parasite: an organism that only survives by living in a host – amoeba and tapeworms are probably the most well-known. These must be treated by specific anti-parasitic medications that have been developed specifically to treat particular diseases.
Managing parent expectations
“We just need an antibiotic” is a phrase I hear frequently during visits. While this is sometimes true, antibiotics are not the magical cure to all illness. As noted above, antibiotics only work for bacterial infections. Unfortunately, many (if not most) of the common illnesses we see in pediatric patients are caused by viruses. There is a long list of viruses that cause cold symptoms, fever, and intestinal issues. Giving an antibiotic to a child with these infections will not treat the underlying disease and can even make the symptoms worse.
In my clinic visits “we just need an antibiotic” is met with a thorough discussion of symptoms and physical examination to determine the proper course of treatment…and education.
Lots of education.
Antibiotic stewardship
Another important piece of the puzzle when discussing antibiotics is a concept called “antibiotic stewardship.” This is an effort to improve prescribing practices and avoid overuse of antibiotics. If we prescribe antibiotics when they are not necessary, we risk encouraging the development of resistant bacteria – meaning that over time and repeated exposures to improper antibiotic use, bacteria can evolve defenses against these antibiotics and the medications we depend on will no longer work. We are already seeing this with some bacteria, which have become very difficult to treat.
Final thoughts
Antibiotics can be given in a variety of ways – oral, topical, intravenous (in the bloodstream), and intra-muscular. But just because we have a variety of them does not mean they are always appropriate treatments for infection. Antibiotics do absolutely nothing for common cold symptoms, and overuse can be harmful. Sometimes “we just need an antibiotic” is true, and sometimes it is not. It is your Pediatrician’s job to determine what is the correct treatment for your child at the time.
No parent wants their child to be sick, and we are all looking for ways to help them feel better, faster. The stark truth is that sometimes the best medicine is time, rest, and allowing the body’s immune system to function and do what it does best. Without an antibiotic.
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