Antibiotics in Children

Antibiotics are the number one prescribed class of medication for children in the U.S., and they have transformed healthcare since their inception. They have saved countless lives, but their use has led to a threat to public health. There are global concerns regarding antibiotic resistance, and the unintended side effects are being carefully studied and finally understood. What do we need to know before we give our child, or prescribe someone else's child an antibiotic?

Why Are They Prescribed?

Physicians state that they prescribe antibiotics to children most often when 1 of 3 criteria is met:

1. Clear clinical indication
2. If they feel pressured by parents to prescribe antibiotics
3. They are uncertain of the clinical outcome they may provide them "just in case.”

Many parents are aware of the dangers of overusing antibiotics; however, they sometimes feel pressured by their child's daycare or from their employer, or just want their child to feel relief from their symptoms. Communication is paramount when it comes to healthcare. Studies show that when physicians take the time to discuss the rationale behind prescribing or not prescribing certain medications, they have greater outcomes. Parents are more accepting and have a higher level of trust in the providers' decision, therefore are more compliant with the treatment regimen.

What Are the Dangers of Antibiotics?

1- Antimicrobial resistance

This is the greatest public health challenge of our time.

Antimicrobial resistance happens when bacteria or fungi no longer respond to the drugs designed to kill them. When no medications control their growth, they can become hard or impossible to treat. Infections with resistant germs often lead to extended hospital stays, additional doctor visits, and increased mortality. The CDC reports that there are 2.8 million antimicrobial-resistant infections annually in the U.S., with 35,000 deaths as a direct result. Many more die from complications.

2- Dysbiosis

Dysbiosis is an imbalance in the gut that results from a change in microbiota. The microbiota plays a role in regulating the immune system, hormone secretion, and metabolism. A shift in microbiota due to antibiotic use can alter the immune response and increase susceptibility to allergies. Both short- and long-term effects of antibiotic use are seen on infant and child's microbiota. Some antibiotics cause more dramatic changes than others, and the effects can last anywhere from a few weeks up to two years. Some effects of altered microbiota are:

• Increased risk for recurrent and prolonged wheeze
• Asthma and environmental allergies
• Food allergies and weight gain
• Autoimmune diseases such as inflammatory bowel disease (IBD) 

3- Neurodevelopment

Strong evidence supports the influence of gut microbiota on CNS development, brain function, and mood development. These are all affected when the gut microbiota is altered. More research is needed to determine the exact cause and effect, but the correlation is demonstrated with dysbiosis and neurodevelopment to include increased prevalence of:

• ADHD
• Depressive symptoms
• Behavioral difficulties
• Anxiety
• Impaired social behaviors

4- Asthma

Changes in gut bacteria, or dysbiosis, can affect Th2 phenotype responses in the body, which raise susceptibility to allergies, inflammation, and tissue damage. There has been a direct correlation between infant exposure to antibiotics and an increased risk for recurrent and prolonged wheezing. Studies suggest that an increase in antibiotic use in infancy correlates with an increase in asthma diagnosis by age 5.

Prevalence

The CDC estimates that 47 million antibiotic courses are prescribed needlessly each year for infections that don't require them. That is about 28% of all antibiotic prescriptions written in Emergency care settings and doctor's offices in the United States. Additionally, adverse reactions to antibiotic use were the number one reason for medication-related emergency room visits in children ages 0-5, and over 65,000 visits per year in children under 19.

When is an Antibiotic Used?

Antibiotics should only be used for certain infections caused by bacteria.

• Urinary tract infection (UTI)
• Strep throat
• Whooping cough
• Sepsis

When is it NOT Used?

Antibiotics are not effective against colds and viruses. Symptoms can usually be managed with over-the-counter medications.

• Colds, runny noses. (EVEN if the mucus is thick, yellow, or green)
• Most sore throats (except strep)
• Flu
• Most chest colds (bronchitis)

Infancy and the first few years of life is an especially sensitive time in a child's development, and antibiotics may have long-lasting effects. Careful consideration should be taken to ensure that children are not taking antibiotics unnecessarily, so never try to persuade a healthcare provider to give antibiotics when they feel it is unnecessary. This class of medication can be an essential part of health care, and the benefits usually outweigh the dangers.  Be certain to discuss the risks and benefits to determine the best course of action, and always take antibiotics only as prescribed.

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References/Resources

Antibiotics in early life: dysbiosis and the damage done

Antibiotic resistance

Antibiotic Stewardship in Pediatrics

Antibiotic Use Questions and Answers

Decreasing antibiotic use, the gut microbiota, and asthma incidence in children: evidence from population-based and prospective cohort studies

A systematic review of parent and clinician views and perceptions that influence prescribing decisions in relation to acute childhood infections in primary care