Your Kid Probably Doesn't Need Antibiotics

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How to help everyone prevent the looming "antibiotic apocalypse"

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We're looking for a new pediatrician, and, over coffee with friends, recommendations started flying. When it came out that our 14-year-old son had never taken antibiotics, the conversation stopped on a dime.

"What about for ear infections?" one said.

"Hasn't he ever had strep?" said another.

"Never?" said the third.

We were surprised -- is this fact really so shocking? Granted, we have been very lucky. Our son has never been in a major accident, needed surgery, or contracted any major illnesses. He was born healthy, he was breastfed, and he got his vaccines. He's had his fair share of colds and a particularly scary case of flu, but never, not even once, required antibiotics.

Our friends are smart, highly educated people who know that antibiotics kill bacteria, not viruses. They know that most colds are caused by viruses. But they are also dedicated parents who would do anything for their kids, and when a child is sick, clear reasoning can get clouded by fear, desperation, and the lure of a quick fix.

Take a cold, for example, or bronchitis. Our friends know on one level that these are usually caused by viruses, but after a week or two of yuck and snot they've had it -- so they call the pediatrician for an antibiotic. The harried doctor knows it's likely viral but doesn't want to fight with yet another parent about antibiotics -- so out comes a prescription. "Just in case this thing's bacterial, let's cover our bases," the doctor says, and moves on to the next patient. The child takes the antibiotic, and around the same time the cold would run its course anyway, the child gets better. Everyone is happy, right? No harm done.

Except there's lots of harm done.

In the short term, harm is admittedly uncommon. Antibiotics can give kids rashes, nausea, and in some cases a life-threatening antibiotic-related infection called C. diff.

In the long run, though, the harm is huge, and partially hidden. As a society, we hand out antibiotics like candy, tossing one life preserver here, one there, assuming the supply is never ending. But it turns out we are, in fact, running out of antibiotics. This will in turn affect our son, who has never taken an antibiotic in his life.

Every year, more and more children with viral illnesses are given unnecessary antibiotics, and as a result, the bacteria floating around in our bodies get exposed to those antibiotics and evolve, gaining resistance to even our most powerful antibiotics. Reports of these drug resistant bacteria are increasingly alarming. Take for instance the recent reports of worldwide spread of completely drug resistant infections from E. coli and related bacteria that have afflicted patients in hospitals and nursing homes. If that's not scary enough, there are now cases of nearly-untreatable sexually transmitted infections from drug resistant gonorrhea in the United States, and their numbers are increasing. Fast forward a few years and many fear there will be no life preservers left to toss to our kids, at which point we could be back where we were 100 years ago, watching people die from what are currently nuisance illnesses easily cured with a pill.

While scientists search the ends of the earth on shoestring budgets to find new, effective antibiotics, we can all help make sure we aren't wasting them at home. Here are five facts you can use to protect everyone from what has been called the "antibiotic apocalypse:"

  • Antibiotics are unnecessary for colds or bronchitis, even when they last longer than two weeks. Colds and bronchitis often take more than two weeks to resolve, so if there are no signs of pneumonia, then antibiotics can be withheld safely.
  • Green sinus discharge and green sputum does not mean you require antibiotics. Sinus discharge, sputum, and phlegm all turn various colors as the body fights infection, and many studies have shown that green sputum is as likely to be viral as bacterial.
  • Ear and sinus infections don't always require antibiotics. Medical guidelines for sinus and (hot off the presses) ear infections suggest that patients without red flag symptoms can be observed without antibiotics; your doctor can help ensure this is safe.
  • If your child gets a prescription for antibiotics, ask your doctor to explain why.
  • The diagnosis of pneumonia -- a legitimate indication for antibiotics -- can not be made without a chest X-ray. Since the symptoms and physical examination can be the same in bronchitis (which is usually caused by a virus) and pneumonia (often bacterial), a chest X-ray is needed to determine if the diagnosis is really pneumonia, and therefore if antibiotics are needed. Don't accept a prescription for antibiotics for pneumonia without a chest x-ray.

Modern medicine has taught us so much about how to fight disease, but sometimes, less is more. The next time your kid has a cold or bronchitis, if your doctor offers an antibiotic prescription, make sure it's really necessary. There are of course many times when it is, and only your doctor can assess your individual case. But being aware and skeptical is integral to protecting the miracle of antibiotics -- and really protecting our kids.

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Jessica Lahey is a contributing writer for The Atlantic and a former English, Latin, and writing teacher. She writes about education and parenting for The New York Times and on her site, Coming of Age in the Middleand is the author of the forthcoming book The Gift of Failure: How the Best Parents Learn to Let Go So Their Children Can Succeed.

Tim Lahey, MD, is an infectious diseases specialist and associate professor of medicine at Dartmouth's Geisel School of Medicine. He writes regularly at MedMurmurs.

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