Antibiotics and Children

The Centers for Disease Control issued stark warnings this week about germs that have developed defenses against the best antibiotics available. 

Experts say current antibiotics are no match for carbapenem-resistant Enterobacteriaceae (CRE), a strain of bacteria that is lethal in up to half of patients with serious infections. While the CDC has warned medical professionals about CRE for a decade, the germ has now been detected in 42 states and is spreading seven times faster than before.

The problem with these bacteria is that they are capable of spreading their antibiotic resistance to other germs. In short, they continue to evolve in response to medications designed to kill them.

“This means that in the near future more bacteria will become immune to treatment and more patients’ lives could be at risk from routine bladder or wound infections,” according to the CDC. 

As hospitals, doctors, and infectious disease specialists combat the latest wave of treatment-resistant germs, parents should take a closer look at how antibiotics are used to treat routine acute conditions in their children—such as the common cold—because they may be doing more harm than good.

How Antibiotics Create Treatment Resistance in Children

Antibiotics are used to treat bacterial infections, such as some sore throats, pneumonia, and ear and sinus infections. However, they are useless against viruses, including colds, flus, fevers, diarrhea, and vomiting.

Every time bacteria encounter antibiotics, there’s a chance they will mutate and become resistant to that medication, making these new germs even tougher to treat and potentially more dangerous.

Too often, doctors prescribe antibiotics for mild infections that typically clear up on their own. 

Dr. Yvonne Maldonado, professor of pediatrics and infectious diseases at Stanford and a member of the American Academy of Pediatrics' infectious diseases committee, said it's common for children under five to have multiple respiratory infections, and thanks to a host of available evidence, doctors now know what they're up against.

In an interview Thursday with Healthline, Maldonado said that, in the past, doctors would prescribe antibiotics in the belief that killing small amounts of bacteria in places like the sinuses could help treat common cold symptoms. Now, doctors know that's not the case and that excessive antibiotic use only causes unwanted side effects, including diarrhea and vomiting.

One study from 1997 found that 21 percent of all antibiotic prescriptions written for adults were for colds, upper respiratory tract infections, and bronchitis, three conditions for which antibiotics have “little or no benefit.” That amounts to 12 million unnecessary prescriptions, and researchers say the overuse of antibiotics must be curbed.

Still, many parents visit pediatricians to ask for antibiotics for common viral infections. 

"People expect to get antibiotics to make the symptoms go away when it's not really helping," Maldonado said. "When you see your child ill and distressed, you want something to help, but in [the case of] colds and upper respiratory infections, there's not much that can be done. We'd all love to have the cure for the common cold, but we don't."

While the rate of antibiotic prescriptions written for children is declining, unnecessary use only propels drug resistance.

The American Academy of Pediatrics (AAP) says that repeated use and misuse of antibiotics are part of the reason these new “superbugs” are becoming so powerful. That's why foregoing antibiotics in certain situations is the No. 1 recommendation in their Choosing Wisely campaign to combat unnecessary medical tests and treatments.

Other Sources of Resistance

Researchers are also exploring how antibiotics given to livestock may contribute to the resistance crisis. So far, evidence suggests it’s part of the problem.

Not to mention the effect antibiotics have on a person’s microbiomethe ecosystem of bacteria, viruses, and fungi that live inside us all. Preliminary research shows that children exposed to antibiotics before six months of age are more likely to have an increased body-mass index (BMI) between 10 and 38 months.

So, antibiotics may be partially responsible for everything from "superbugs" to childhood obesity. Antibiotic use has also been shown to slightly increase a child’s risk of asthma and eczema, according to a study published in Pediatrics.

The Proper Use of Antibiotics

Though we’re still discovering the long-term effects of antibiotic over-use, parents should take extra caution when doctors are ready to prescribe them. 

The AAP offers the following recommendations for parents regarding antibiotics:

  • A sick child doesn’t necessarily mean antibiotics are required. Don’t pressure your child’s doctor to prescribe them.
  • Antibiotics are only useful for bacterial infections, not viral infections, such as sinusitis, pharyngitis, and bronchitis.
  • Antibiotics don’t cure colds and flus.
  • Treat cold and cough symptoms with home remedies.
  • Remember that a fever fights infections and produces helpful antibodies to prevent future sickness.
  • Give your child all of his or her prescribed antibiotics, even if he or she is feeling better.
  • Throw away any unused antibiotics according to the U.S. Food and Drug Administration guidelines.

Maldonado said that most over-the-counter medicines shouldn't be given to children under the age of four, and should only be given to children younger than six when a doctor recommends them. Most of the time, simple home remedies are the best thing for a child with a cold or upper respiratory infection.

"The world is a little unpredictable, so sometimes it's hard to know if you're doing the right thing," she said. 

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