In my practice as a pediatrician, I see many children suffering from colds. When their concerned parents bring them in for me to examine and provide treatment, they often think that an antibiotic may be needed. But that's usually not the case. Instead of writing a prescription, I take the opportunity to educate parents on an important health issue with potentially grave consequences: antibiotic resistance.

When used appropriately, antibiotics are one of our most vital weapons for fighting off harmful bacterial infections. Unfortunately, however, studies have shown that almost 30 percent of antibiotics prescribed to children are unnecessary.

Why is this a problem? Because every time we take an antibiotic, resistant bacteria may be left to grow and multiply. The repeated use of antibiotics can increase the number of drug-resistant bacteria. Then, the next time we do need an antibiotic, these drugs are less likely to help.

Antibiotic resistance is a real and growing public health concern. According to the Centers for Disease Control and Prevention, more than 2 million people each year get sick with an antibiotic-resistant infection, and about 23,000 die. After decades of over-prescribing antibiotics, we're now seeing the development of "superbugs" that just don't respond to any of the antibiotics in our arsenal.

And resistance isn't the only problem. Antibiotics are not benign; they do have side effects. As they are doing their job of killing "bad" bacteria, they are also killing "good" bacteria. These good bacteria are an important component of our normal body flora. We need them to aid in proper digestion and even to help our brains grow. When antibiotics knock out healthy bacteria, more harmful bacteria grow in their place.

You might also be surprised to learn that it's not uncommon for children to have adverse reactions to antibiotics - serious enough to send them to the hospital. In fact, according to the CDC, antibiotics are the most common cause of emergency department visits for adverse drug events in children under 18 years of age.

As pediatricians, we take seriously our need to be good stewards when it comes to antibiotic usage. As parents, you can help us in this important mission. When a doctor does prescribe an antibiotic for your child, be sure to complete the entire course of treatment, even if your little one seems fully recovered after a few days. And never hold some medication back and start treatment on your own the next time your child (or her sibling) develops a similar illness.

Twenty years ago, many parents who came into my office felt like they weren't getting their "money's worth" if they didn't leave with a prescription for an antibiotic. Now that we're experiencing the fallout, it's important for today's parents to be savvier. Don't insist on an antibiotic from your pediatrician if he or she advises against one: Some studies have shown that doctors will succumb to such pressure, even when an antibiotic isn't warranted.

While it's natural to want to relieve your child's suffering, remember that the vast majority of all infections are viral in nature, and antibiotics are never effective for viral infections.

Here are some common viral infections in kids that often don't need an antibiotic:

  • Earaches: While the pain of an earache can make children miserable, for those over 2 years of age and without a fever, antibiotics are not recommended right away to treat many ear infections. Instead, trust your pediatrician to determine whether your child needs an antibiotic to improve or whether watchful waiting is a better option.

  • The common cold: Cold symptoms - sneezing, stuffy nose, sore throat, coughing, post-nasal drip, watery eyes, mild body aches - typically peak within two to three days, though they can last up to two weeks. Generally, rest and over-the-counter medicines to help with symptoms like fever and coughing will get your child through the cold. Antibiotics are never needed.

  • Bronchitis: The hacking cough caused by swelling airways and mucus can linger for weeks, as can accompanying soreness in the chest, mild headaches, fatigue, a sore throat and body aches. Acute bronchitis is almost never caused by bacteria and almost always gets better on its own. (If your pediatrician thinks your child is suffering from asthmatic bronchitis, then follow his or her recommendations for treatment.)

  • Sinusitis: Sinus infections occur when fluid gets blocked or trapped in the sinuses, allowing germs to grow. In children, between 50 to 70 percent of sinus infections are caused by viruses, not bacteria. So the odds are good that your child will not need an antibiotic to effectively treat sinusitis. Your pediatrician can make the call.

  • Sore Throat: Most sore throats with an associated cold are caused by viruses and will go away on their own without any antibiotic treatment. The exception is strep throat - caused by bacteria such as group A Streptococcus. If your child has a sore throat and a fever but no cold symptoms, a strep test is often called for. Your pediatrician can perform this test by doing a quick swab of the throat and then culturing it for bacteria. If strep is diagnosed, an antibiotic will be prescribed to prevent rheumatic fever.

I certainly don't want to underplay the value that antibiotics hold in treating illness. Before the antibiotic age, people routinely succumbed to pneumonia and rheumatic fever. A cut or scratch could lead to blood poisoning - and death.

As a pediatrician, I am ever grateful to have penicillin and other antibiotics to use in healing my young patients. But to ensure that antibiotics work when we need them, we must take steps now to stop the improper and excessive use of these important drugs.

To find out more about bacteria, viruses and the proper use of antibiotics, visit the CDC's website: cdc.gov.


Dr. Joseph Vander-Walde is chief of pediatrics for MAPMG's District of Columbia and Suburban Maryland Service Area. He sees patients at the Kaiser Permanente Mid- Atlantic States Camp Springs Medical Center in Temple Hills, Maryland.