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Antibiotics and Children: An Overview

by George H. McCracken, Jr., M.D.
reviewed by Laura Jana, M.D., F.A.A.P.
If your infant or young child is typical, he'll develop an average of three respiratory infections each year. Although some are viral and will resolve on their own, others (e.g., ear infections and strep throat) are bacterial and will require antibiotics. Today, bacterial infections usually can be treated easily and successfully in children with access to good medical care. This was not the case, however, during the first three decades of the twentieth century, when antibiotics were not available and common childhood bacterial infections often resulted in severe complications. For example:

  • Middle ear infections (acute otitis media) could be complicated by mastoiditis, a severe and painful inflammation of a bone behind the ear, or they could spread to the brain and cause meningitis.

  • Strep throat could lead to debilitating rheumatic fever.

  • Pneumonia could result in a bloodstream infection (bacteremia or sepsis)-and even death in some children and adults.
We are fortunate that some key medical breakthroughs have changed all that. The era of modern drug treatment for bacterial infections was launched by the discovery of sulfanilamide, a sulfa drug, in 1936, and penicillin in 1941. Life expectancy increased by 10 years over the next two decades as additional antibiotics became available. Currently, around 60 kinds of antibiotics are available for use in infants and children, and many more are being developed. It is estimated that 30 million courses of antibiotics are prescribed for children with ear infections alone in the United States each year.

Appropriate use of antibiotics
Antibiotics are only effective against infections caused by bacteria, not those caused by viruses. It is appropriate--and important--to use antibiotics for bacterial infections such as middle ear infections, strep throat, and urinary tract infections. However, it is not appropriate to use antibiotics for viral infections like colds and flu. Since most childhood infections are caused by viruses, more often than not, a child will not need an antibiotic for an infection, but each episode should be evaluated separately.

Impact of the inappropriate use of antibiotics
Unfortunately, wonder drugs like penicillin have been taken for granted. Excessive and inappropriate use of antibiotics has made many strains of bacteria resistant. Currently, for example, about one-third of each of the two main kinds of bacteria causing middle ear infections are resistant to amoxicillin, the most frequently prescribed antibiotic for this disease. Antibiotic resistance requires providers to use newer and more expensive drugs. Unless antibiotic usage is controlled, some currently treatable bacterial infections will become untreatable once again, while others will require administration of multiple drugs and/or intravenous (by vein) therapy.

Development of new antibiotics
Drug companies are actively engaged in developing new antibiotics to treat resistant bacteria. This is slow work because each drug must be evaluated thoroughly in adults before the extensive trials in infants and children can even begin. Although this process is time consuming, it serves a valuable purpose by ensuring that new drugs like antibiotics are safe and effective for use in children.

In summary
In many ways, antibiotics are miracle drugs--but only if they are used wisely.
 RELATED INFORMATION
*  Antibiotics


Created January 05, 2001
Reviewed January 07, 2001
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