Other than well child exams, the main reason children come to see me is because they are sick. Often they have some type of infection. This simply means that some type of germ is growing inside them somewhere and the child is fighting back. This battle between germ and child is what produces the symptoms such as fever, cough, runny nose, vomiting, diarrhea etc.
There are two basic types of germs which infect human beings; viruses and bacteria. The distinction is important since antibiotics are mainly effective against bacteria and not viruses. So when I am evaluating a sick child and considering antibiotic treatment, I am usually trying to decide if the child has a bacterial infection. The majority of the illnesses I see are caused by viruses and therefore do not respond to antibiotic treatment. Here are a few examples: most colds and coughs, most sore throats, most illnesses which produce vomiting and diarrhea, most fevers, chicken pox, roseola and many other common childhood illnesses---these are viral infections. By and large a child will fight off most of these illnesses with their own immune system. We can provide supportive treatment like Tylenol or Motrin, Pedialyte (balanced mineral beverage), humidifier, cough and cold medicines. These treatments do not alter the course of these illnesses but provide comfort and relief from symptoms.
A significant minority of illnesses I see are caused or complicated by bacterial infection. Otitis media (ear infection), strep throat, sinusitis, some case of bronchitis, most pneumonias--these illnesses will likely respond to antibiotic treatment and the patients will recover more quickly and safely. Sometimes the need for an antibiotic is very obvious, sometimes it is a borderline indication. That decision is made based upon my knowledge and experience. When the indication for antibiotics is borderline, then you parents and I need to make that decision together based upon what is best for you child and what works best for you. For example, some parents feel very strongly that they want their children to fight off anything they can on their own without any medicine. As long as it is not dangerous I am generally OK with that approach. Other parents are eager to have their children recover quickly, perhaps even just so they don’t miss school. Those parents might like me to consider antibiotics sooner in an illness. Both approaches are reasonable. The key to treating children is to be flexible and keep all your options open.
Antibiotics are certainly the single biggest reason why people live so much longer now than a century ago. So we benefit greatly from their availability. On the other hand, we probably take too many antibiotics so we all would do well to try not to overprescribe them.