Use of antibiotics in childhood

Use of Antibiotics in Childhood

Antibiotics are often the first line of defense against illnesses in children. But is it always necessary to use them, and are there negative effects? Find out in this article.

When Do Antibiotics Help?

“I have children aged 3 and 5. Both of them took different antibiotics twice within four weeks—once for tonsillitis and once for a middle ear infection. Now they are still sick, and I think they need another, stronger antibiotic to finally get better…”

This is what one mother says, whose children are constantly exposed to new infections and frequently take antibiotics. However, she is not alone. Many parents are reluctant to give antibiotics to their children; some even refuse to give them, even when necessary. Other parents believe antibiotics are miracle drugs that can effectively stop any illness in a short time.

The main question is: do children need antibiotics, and if so, when? In the treatment of some illnesses, antibiotics are essential and can only help in those situations. However, in other illnesses, they can be harmful. Let us clarify some common questions regarding antibiotic use.

What Is an Antibiotic?

Antibiotics are based on natural substances produced with the help of bacteria, fungi, or mold. They can also be artificially manufactured in laboratories. There are different classes of antibiotics. Some target specific groups of microorganisms, while others act on multiple groups of bacteria.

How Do Antibiotics Work?

Antibiotics destroy or disable the disease-causing microorganisms, making it easier for the body’s immune system to eliminate them.

When Should Children Take Antibiotics?

Some illnesses can lead to life-threatening complications or even death if a child does not receive timely antibiotics. These include:

• Various septic conditions

• Bacterial pneumonia

• Infections of the brain and meninges

• Certain skin diseases

• Other bacterial infections

For example, in the treatment of scarlet fever or whooping cough, most pediatricians prescribe antibiotics. However, there is some disagreement on this issue.

Dr. Helmut Kendel, a pediatrician from Munich, prescribes antibiotics for suspected whooping cough, especially in children who are not fully vaccinated or have been in close contact with an infected person. During the first two weeks, whooping cough symptoms resemble a common cold: children cough and have a runny nose, and parents often do not take them to the doctor. If antibiotics are not administered in time, after 2–3 weeks it may be too late, and the child will develop a dry, persistent, sometimes choking cough. At that point, beyond symptomatic therapy, little can be done to improve the cough itself.

Almost all doctors today treat scarlet fever with antibiotics. The challenge is establishing a certain diagnosis. Many children carry the causative bacteria (Group A Streptococcus), but only when it multiplies to a certain concentration do symptoms appear (sore throat, difficulty swallowing, high fever). Even then, it may not yet be clear if it is scarlet fever or another upper respiratory infection. Typical symptoms of scarlet fever include:

• Characteristic skin rash

• White area around the lips

• Raspberry-red tongue

However, these typical symptoms may sometimes be completely absent. When scarlet fever is diagnosed, antibiotics should be administered long enough and at a sufficiently high dose to prevent late complications such as:

• Kidney damage with hypertension

• Heart muscle damage

• Rheumatic diseases

Do Antibiotics Weaken the Immune System?

Antibiotic treatment helps the body’s immune system fight the disease. Antibiotics support the immune system but do not do all the work alone. Therefore, prescribing antibiotics should be done with great caution, especially in children.

A child’s immune system in the first years of life is not fully mature. To become fully functional, it needs exposure to various pathogens. Contact with pathogens allows the child’s immune system to produce antibodies. The stronger the response against pathogens, the more antibodies are produced. These natural defenses help the child develop lifelong immunity to certain diseases.

Thus, in some situations, it may be better to wait a day or two rather than immediately giving antibiotics.

Possible Undesirable Effects of Antibiotics

Antibiotics contain substances that may cause:

• Allergic reactions

• Nervous system damage

• Gastrointestinal disturbances (most often diarrhea)

For mild allergic reactions, it is usually sufficient to stop the antibiotic and switch to another class. For severe reactions, treatment for the allergic manifestations may be required, including short-term corticosteroids.

Diarrhea in children often occurs with broad-spectrum antibiotics, which kill most bacteria, including beneficial gut bacteria needed for proper digestion.

When Are Antibiotics Unnecessary?

Antibiotics do not help treat viral infections, only bacterial infections. At least 90% of all respiratory infections are viral.

Viral and bacterial infections can have similar symptoms, which is why viral infections are often mistaken for bacterial ones. A simple rule:

• Viral infections: nasal or throat secretions are clear, thin, watery

• Bacterial infections: secretions are thick, sticky, foul-smelling, whitish, yellowish, or greenish

Parents should know that the presence of such secretions does not automatically require antibiotics. The child should be observed. Only if the child’s condition worsens and a bacterial infection is suspected, accompanied by fever, should antibiotics be given—with consultation regarding type, dose, and duration.

Children taking antibiotics should ideally stay home from daycare or school to allow the body time to recover.

How Long Does Treatment Last?

Antibiotic therapy usually lasts 5–10 days, depending on the drug and severity. If successful, the child should be fever-free within three days and show general improvement.

If the child does not improve after three days, the antibiotic may need to be replaced with a more effective one.

Why Do Antibiotics Have a Bad Reputation?

One of the biggest problems with antibiotics is the development of resistant strains, which no longer respond to treatment. Bacteria can “learn” resistance mechanisms. When bacteria survive exposure to antibiotics, they multiply and may harm the body.

“Bacteria and antibiotics ‘become friends,’” explains Dr. Urban Himbert, pediatrician and anesthesiologist at Heidelberg University Clinic. “They change properties so the antibiotic no longer works, and this resistance is passed to future generations, creating resistant strains.”

Many dangerous resistant bacteria exist today. Overuse, misuse, or improper application of antimicrobial drugs contributes to this problem. In the future, resistance may be limited with targeted, precise use of antimicrobials, especially in hospitals.

Why Do Most Children Get Antibiotics Immediately?

Many antibiotics exist; some target only specific microorganisms, others multiple bacteria. Only laboratory tests can confirm the exact causative bacteria, but these take time and resources.

Many pediatricians would prefer easier access to microbiology labs to provide more effective therapy. Since this is often not possible, antibiotics are prescribed immediately, sometimes unnecessarily or incorrectly. Parents may support “quick” prescriptions, believing it will speed recovery and reduce complications.

However, for common colds, antibiotics are not needed. A saying goes:

“With medicine, a cold lasts seven days; without it, also seven days.”