How Doctors Prescribe Antibiotics to Kids

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Antibiotic prescriptions for child infections depended on type of infection and symptoms

November 17, 2013 / Author:  / Reviewed by: Robert Carlson, M.D Beth Bolt, RPh

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(dailyRx News) In the past, it wasn't uncommon for kids to be prescribed antibiotics for almost any respiratory infection. Now doctors are more careful about prescribing them only when necessary.

The American Academy of Pediatrics has just released a clinical report that provides guidelines to doctors on how to be more certain of specific diagnoses and when to use antibiotics.

It can also be helpful for parents to understand when antibiotics are helpful and when they may not provide any benefit.

Antibiotics can be effective in treating conditions that are caused by bacterial infections, but infections caused by viruses cannot be treated by antibiotics.

Therefore it's helpful for parents to understand which conditions are more likely caused by bacteria and which ones are more likely caused by viruses.

"Ask your pediatrician to explain your child's treatment options."

The clinical report was authored by Adam L. Hersh, MD, PhD, and his colleagues along with the AAP Committee on Infectious Diseases.

The conditions the committee addressed included bacterial upper respiratory tract infections, such as acute otitis media (ear infections), acute bacterial sinusitis and streptococcal pharyngitis (strep throat).

It is important for doctors to know when they should and should not prescribe antibiotics, because prescribing antibiotics unnecessarily can contribute to antibiotic-resistant bacteria.

The first thing doctors are likely to do when a parent brings their child in for an infection is to try to determine whether the infection is caused by bacteria or a virus.

Doctors already have guidelines regarding symptoms that help them determine whether an ear infection or sinusitis is more likely to be caused by bacteria or by a virus.

For ear infections, the doctors will check if a child's eardrum is bulging and what kinds of symptoms, including pain and/or inflammation, exist.

For sinusitis, the doctors will determine whether the symptoms are getting worse, are already severe or are simply not going away.

These symptoms can include a fever, cough and nasal discharge. A fever of at least 102.2 degrees Fahrenheit is considered a severe symptom.

To diagnose acute pharyngitis, doctors must do a lab test after determining if a child has at least two of the following symptoms: fever, swollen tonsils and/or swollen throat nodes without a cough.

After determining the diagnosis, the doctor will weigh the possible benefits and harms of prescribing antibiotics. Parents can ask the doctor questions about these.

For example, a benefit of antibiotics for bacterial sinusitis is that they can improve overall symptoms, but there is not evidence that they can prevent complications such as a brain abscess.

Finally, doctors will determine whether it is best to prescribe antibiotics at that time, to wait first to see if the infection clears on its own or to wait and then later prescribe antibiotics if the child's condition does not improve.

If parents have any questions about the process of diagnosing their child's infection and determining whether antibiotics should be prescribed or not, they should ask the doctor questions.

Doctors should be able to explain to parents what kind of infection the child appears to have and what the possible benefits and harms of prescribing antibiotics might be.

The clinical report was published November 18 in the journal Pediatrics. No external funding was used in creating the report. No disclosures from authors or committee members were reported.