Understanding antibiotics for kids

Antibiotics have saved millions of lives, but using antibiotics too often or when you don’t need them can make them less effective at killing bacteria. While they still are important weapons in fighting disease, it's important to understand if, and when, antibiotics are safe for children.

How do antibiotics work?

Antibiotics work by killing infection-causing bacteria. Bacteria are living, one-celled organisms. Most bacteria are harmless and some are even beneficial to your health. However, some types of bacteria can cause infections and make you sick, including:

• E. coli, which can cause diarrhea and stomach problems
• Staphylococcus, which can cause infections in the skin and other parts of the body called staph infections
• Streptococcus, which causes strep throat

Viruses are different from bacteria: They are tiny particles that can make you sick by entering your body and making copies of themselves. Unlike bacteria, viruses are not technically living things.

Antibiotics can kill bacteria, but not viruses. This means antibiotics won’t help if your child has a virus. If your child has a virus, they may get better with rest, home remedies or antiviral medicines, which are not antibiotics.

When are antibiotics useful?

Antibiotics are useful when your child has a bacterial infection. For example, pneumonia, whooping cough, urinary tract infections, strep throat and some sinus infections can be treated with antibiotics. Antibiotics are not useful in treating viral infections like the flu.

Some children have conditions that make it harder to heal, in which case antibiotics may be prescribed. Those conditions include cleft palate, Down syndrome and immune disorders and having a cochlear implant.

Antibiotics and children

Doctors are very careful about prescribing antibiotics in children. If an illness is mild, your doctor may recommend observation or non-antibiotic treatment.

Doctors are especially careful about using antibiotics in children under 3. There are times when antibiotics are the right treatment for infants, including if they have a high fever, moderate to severe ear pain or symptoms of pneumonia.

Types of antibiotics

Different antibiotics work on different types of bacteria. Here's a list of antibiotics that may be prescribed for children:

• Penicillins (amoxicillin and penicillin G). These are typically the first medicines prescribed for ear infections and bacterial sinus infections, given twice a day, usually for 10 days.
• Beta-lactamase inhibitors (amoxicillin-clavulanic acid or Augmentin). These are usually prescribed for more complicated ear infections, for children with a history of ear infections that come back after treatment (recurrent), for more complicated sinus infections and for some forms of pneumonia. They're given twice a day, usually for 10 days.
• Cephalosporins (cefdinir, ceftibuten, etc.). These are also prescribed for complicated ear infections, pneumonia and for children with a history of recurrent ear infection and for bacterial sinus infections.
• Macrolides (azithromycin and erythromycin). These are usually prescribed for whooping cough and milder forms of pneumonia, and can be given for shorter courses, such as three or five days. A one-time dose is sometimes prescribed.
• Sulfa drugs (trimethoprim-sulfamethoxazole). These are typically prescribed to treat resistant staph infections and urinary tract infections.

Disadvantages and side effects of antibiotics

Antibiotics may not always be the right treatment for children. If you use them too much or when you don’t need them, bacteria can build up resistance to antibiotics, requiring higher doses to treat an infection. Antibiotics can also kill good bacteria in the body, which can cause diarrhea. In some cases, antibiotics cause bad bacteria, like Clostridium difficile (or C. diff), to grow and spread and cause infections that are hard to control. Antibiotics can also cause allergic reactions, like rash and nausea in children.

How to use antibiotics

If your child’s doctor prescribes antibiotics, follow their instructions closely. Make sure to give your child the full prescription. This means every dose of the antibiotic for the full amount of time it was prescribed, for example twice per day for five days. Antibiotics take time to work, and your child may not show improvement for a few days.

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Children's Health Primary Care offers comprehensive health care for children from birth through young adulthood. Our pediatricians combine quality care with evidence-based practice to meet your child’s medical needs. Learn more and find a pediatrician.