I’ve written this article for parents of older children. If you have a newborn, please make sure your baby is seen by a doctor in person if they have any symptoms of infection and/or a temperature of 100.4F or higher.
I’ve lost count of how many times parent have expressed frustration that they’ve brought their child to be seen by their pediatrician and been told their child has a virus. In many cases parents share that they feel like their doctor should have “done something more” during their child’s sick visit. If I ask what they mean by this, they often say that they had hoped for an antibiotic prescription for their child. It’s not uncommon to hear that parents feel like they wasted their time and money taking their child in to be seen, only to be told it’s a viral illness that needs to run its course.
I’m writing this because it’s important to remember that, in most cases, kids’ infections are due to viruses (which are not treated with antibiotics). There are actually just a few bacterial infections in children that pediatricians see in their offices that require antibiotic prescriptions.
When are antibiotics truly needed?
1. Strep throat. Strep is caused by a bacteria called Group A strep. The main symptoms of strep in kids are a sore throat, fever, headache, and/or abdominal pain. I cannot tell by looking inside of a child’s throat whether or not they have strep! This is because there are many viruses that also cause sore throats and have overlapping symptoms with strep. If you are concerned your child might have strep, they will need to have a strep test done to confirm the diagnosis before starting antibiotic treatment.
2. Urinary tract infections (UTIs). UTIs are diagnosed based on symptoms + having urine tests collected for urinalysis and culture. The only way to confirm a diagnosis of a UTI in a child is to have a urine culture sent to a lab that shows the presence of a significant amount of bacteria. In my practice, most children I see with painful urination have not had UTIs.
3. Some ear infections. Ear infections can only be diagnosed by having a doctor look into a child’s ear to examine the ear drum(s). This is because ear pain can be caused by many different things, including a build-up of fluid from a viral cold. All children under the age of 2 years old should be prescribed antibiotics for treatment of ear infections to prevent complications. Ear infections in older children are often caused by viruses and will go away on their own without any treatment. The decision as to whether or not to treat an uncomplicated ear infection in an older child should be made between doctor and parent.
4. Bacterial sinusitis. Most sinus infections in children are caused by cold viruses, which need to run their course. In pediatrics we do not diagnose bacterial sinus infections until children have had 10+ days of cold symptoms that have not improved at all, or a worsening of cold symptoms + new fever after a period of getting better. Most of the time when kids have fever with some combination of nasal congestion, runny nose, sore throat, and/or cough, they have a viral upper respiratory infection (cold) which will not go away with an antibiotic.
5. Bacterial pneumonia. Children with bacterial pneumonia are usually very ill with fever, persistent coughing, and shortness of breath. The only way to diagnose bacterial pneumonia is by getting a chest x-ray. I cannot determine if a child has bacterial versus viral pneumonia by looking at them and listening to their lungs. If there is any concern of pneumonia a chest x-ray has to be done.
6. Skin infections. Bacterial skin infections, such as impetigo and cellulitis, do require treatment with antibiotics. In some cases topical antibiotics are enough, while in others oral antibiotics are needed.
7. Bacterial conjunctivitis (pink eye). Children with bacterial pinkeye have a red or bloodshot appearance to the whites of their eye(s) plus a lot of yellow-green drainage that causes matting of the eyelashes. Small amounts of yellow drainage with normal appearing whites of the eye are usually due to viral conjunctivitis. Viral pinkeye does not improve with antibiotic eye drops and antibiotics do not make children with viral pinkeye less contagious.
Children with more severe bacterial infections, such as meningitis, osteomyelitis, and sepsis, are usually sick enough to have to go to the emergency room. Your pediatrician cannot diagnose any of these during a regular sick visit as they require special blood and other tests.
When are antibiotics not needed?
· Upper respiratory viral illnesses (colds)
· Bronchitis
· Persistent cough
· Influenza and other flu-like illnesses
· Croup
· RSV
· Hand, foot, and mouth virus
· Viral pharyngitis (sore throat with negative strep testing)
· Covid infection
· Roseola
· Parvovirus (Fifth Disease)
· Chicken pox
· Adenovirus
· Viral gastroenteritis (“stomach bug”)
If you’ve actually read this far, thank you! For more on this topic, please refer to the American Academy of Pediatrics’ Healthy Children website, or the Centers for Disease Control topics for parents.