How Providers Choose the Appropriate Antibiotic

August 28, 2008

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How Providers Choose the Appropriate Antibiotic

by George H. McCracken, Jr., M.D.
reviewed by Laura Jana, M.D., F.A.A.P.

Nowadays, when your child develops a bacterial infection, his healthcare provider can select appropriate treatment from a broad array of approved antibiotics. There are more than a dozen classes or types of antibiotics, including approximately 60 drugs that can be used safely and effectively in infants and children. Many other antibiotics are available, but they are not ordinarily recommended for use in pediatric patients. This is because at the time they were approved by the Food and Drug Administration (FDA), there was no information on their safety and effectiveness in children. These drugs are used occasionally in children, however, when no other suitable antibiotic exists (e.g., against highly resistant bacteria).

Your healthcare provider takes many factors into consideration before selecting an antibiotic for your child's infection. Some of these factors include:

Safety and effectiveness. First and foremost, the drug must be safe and effective. As mentioned above, in the United States, the antibiotic prescribed for your child has been carefully evaluated for safety and efficacy, and approved by the Food and Drug Administration (FDA). Your provider also will take into account your child's medical history, such as any drug allergies, so be sure she has all of his records and is aware of his allergies.

The likelihood that your child will take it. "Compliance-enhancing" features of a drug are the characteristics that make it more convenient for you to administer it. If you have ever tried to give medicine to your child, you know how important these features are! These include:

Consistency and taste of the drug. This is especially important for antibiotics in suspension or liquid form. Drug manufacturers have added artificial flavors that appeal to children to many antibiotics, but some antibiotics are more palatable than others. If you know that your child has strong preferences, be sure to discuss them with your healthcare provider.

The number of times the drug must be given daily. Drugs that need to be taken once or twice a day are much more convenient to administer than those that need to be given three or four times a day. This factor is particularly important for ensuring that children in daycare or school receive all of their doses.

The number of days the drug must be given. Therapy for 5 or 7 days is usually more convenient than 10-, 14-, or 21-day courses. The duration of therapy depends not only on the drug, but also on the kind of infection, and the age of the child.

Whether or not the drug needs to be refrigerated. This can be an important factor for children in daycare or school, or if your child gets sick while you are on vacation--anywhere refrigerators may not be readily available.

Cost. There are big differences between the costs of newer versus older antibiotics. The reason some newer antibiotics are so expensive is that it is very costly for a drug company to discover, thoroughly investigate, and bring a new antibiotic to market. This process can take10 years and cost $350 million or more. The company tries to recoup these expenses during the period that the drug is protected by its patent, which is 17 years from the time of discovery. After that period, other companies can make and sell the antibiotic (now considered a generic drug) so the price drops, often drastically, because of the competition.

Do not hesitate to discuss drug costs with your healthcare provider if you are concerned that you may not be able to afford an antibiotic--or any other medicine--your child needs.

How well it works for a particular type of infection. The final factor in selecting a drug is your provider's experience using the antibiotic for a specific bacterial infection--including the feedback she has gotten from other parents.


RELATED INFORMATION

			Antibiotics

Created January 10, 2001
Reviewed January 12, 2001

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