Battling bacteria: The pros and cons of giving antibiotics to children

Antibiotics will not speed up recovery from a viral infection and can make the child feel worse, says Dr Phil Kieran

COMMON COLDS: Pre-school children will get between eight to 12 viral infections per year which is about every three weeks over the winter months.
COMMON COLDS: Pre-school children will get between eight to 12 viral infections per year which is about every three weeks over the winter months.

Antibiotics have been around for nearly 90 years and in this time we have seen life expectancy increase phenomenally and serious long-term illnesses like rheumatic fever nearly eradicated.

The days of young people routinely dying from pneumonia or limbs being amputated to treat skin infections like cellulitis are thankfully long gone. This is largely thanks to the discovery and use of antibiotics.

Antibiotics are great and still probably one of the most important tools we as doctors have to use in our attempts to keep people alive, healthy and fitter in older age.

So why is it whenever you hear people talking on the radio about antibiotics, they are saying not to take them? Why does your GP seem so reluctant to give out antibiotics? And what’s the harm?

Fighting bacteria

First, let’s look at how antibiotics work. There are multiple different families of antibiotic and all of them target a specific aspect of how bacteria live and work to help your immune system clear infection. This is the first important point that your immune system is essential to clearing infections not just antibiotics.

Antibiotics work by only targeting substances which bacteria contain and are not found in human cells. This means that they can damage or kill bacterial cells without causing the same damage to the person taking them.

An example I like to use is penicillin. What it does is stop bacteria building a wall around its cells. It does this by destroying a substance they use to stick the wall together. It is like removing all the cement between the bricks in a wall. Now the wall is much easier to knock down. Human cells don’t use this cement or make cell walls so the antibiotics have no effect on them.

So, antibiotics work by targeting specific weaknesses in different types of bacteria this means that the don’t affect viruses in any way at all. A virus doesn’t multiply by itself and doesn’t have a cell wall.

This means that it has very few exposed parts that are different in structure to human cells. We rely on the immune system to generate specifically targeted antibodies to each virus to help clear it.

Multiple viral infections

Most children in the early school or pre-school age will get between eight to 12 viral infections per year which is about every three weeks over the winter months.

These are most commonly chest, throat, nose, eyes and ear infections and most will get worse over the first three days and then start to settle around day five (although a cough can go on and on and on even after the infection has cleared).

These infections will clear by themselves and all we as doctors can do is to see what supportive care we can advise on.

This mainly consists of making sure they get enough fluids as children dehydrate very easily and advising on the warning signs that indicate the child may need to go to hospital.

In this setting, I’m often asked for an antibiotic and invariably I am told that they didn’t get better the last time until they had the antibiotic.

While I don’t doubt this, it is likely that the reason they got better with the antibiotic was that they were prescribed it three days after the infection started and took it for a week at which time they were on the mend.

Explaining this is something I try to do every day, in a bid to encourage people to wait a little longer. Often, I will issue a ‘just in case’ prescription and say not to get it for 48-72 hours and only then if there is no improvement.

Antibiotics will not help clear a viral infection quicker and can in fact make the child worse.

Recovery time

Antibiotics can’t discriminate between good and bad bacteria in your body — they just kill bacteria. So, when you take an antibiotic you will commonly develop bowel upset either with diarrhoea, nausea or particularly for women thrush problems.

Research shows that the gut can take up to six weeks to recover from a single course of antibiotics and a year to recover from multiple courses. This can have knock-on effects on sleep quality, mood and concentration.

Antibiotics also can cause some longer-term risks with a number of studies showing that childhood exposure to antibiotics increases the risk of developing obesity in later life significantly.

Overall, if you need an antibiotic and your doctor recommends you take it then you should, they can and are lifesaving medications.

But I also think you should be trying to avoid them as much as possible. If your doctor says your child doesn’t need an antibiotic, they are not telling you that they aren’t sick they are saying that an antibiotic won’t help.

This is good because you don’t have to expose them to the potential risks of antibiotics.

My older son has had 3 courses of antibiotics in his 5 years and my youngest is 3 and has never had any. I hope to keep it at this level as long as possible for their sake.

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