Antibiotics and children
What are antibiotics?
Antibiotics are medicines used to treat bacterial infections. Since they were introduced, they have saved the lives of many children with serious infectious illnesses such as meningitis, pneumonia and septicaemia (‘blood poisoning’). Antibiotics are frequently used in Australia to treat common bacterial infections in children, including middle ear infections and skin infections such as impetigo.
Does my child need antibiotics?
Many common childhood infections, such as the common cold, are caused by viruses. Most children, especially when they first start mixing with lots of other children, will get 5 to 10 colds a year. These viral infections cannot be treated with antibiotics because antibiotics have no effect on viruses.
Even some bacterial infections, such as otitis media in children, usually get better on their own without the need for antibiotics. However, some infections do need to be treated with antibiotics to help your child get better and avoid complications.
If your doctor is not certain that your child needs antibiotics, they may write a prescription and ask you to start the antibiotics only if your child gets worse or doesn’t improve within a day or so.
How can you tell if it’s a bacterial or viral infection?
Some conditions – pneumonia, middle ear infection, bronchitis, sinusitis and conjunctivitis – can be caused by infection with either bacteria or viruses. The best way for doctors to work out what type of microbe is causing an infection is to take a sample from the infected area. For example, your doctor may recommend taking a throat swab if your child has a sore throat or a sputum (phlegm) sample if they have a cough.
The sample can be tested in a laboratory to work out whether there is a bacterial infection, whether antibiotics are needed and if so, which antibiotics would be the best choice.
Sometimes, it’s not possible or practical to take a sample and wait for the results before prescribing antibiotics. If your child is unwell, your doctor may take a sample and prescribe antibiotics before getting the test results back. Or they may prescribe antibiotics without taking a sample at all. The decision to prescribe an antibiotic in these circumstances will depend on many factors, including their symptoms, how unwell your child is and how long they have been sick.
Which antibiotic is the right one?
There is a range of different antibiotics for doctors to choose from. Some are only effective against particular bacteria, while others, known as ‘broad-spectrum antibiotics’, will kill a wide variety of different bacteria.
The aim of treatment is always to try and give an antibiotic that will as closely target the germ most likely to be causing the infection as possible.
However, often it’s not known what exact type of bacteria is causing the infection. In these cases, doctors usually recommend a broad-spectrum antibiotic at first. They may then prescribe a more specific antibiotic if test results identify the type of bacteria involved.
Can babies take antibiotics?
Sometimes even babies get bacterial infections that need to be treated with antibiotics. The baby’s age and weight are taken into account when deciding on the type of antibiotic and the dose needed.
How to take antibiotics
Antibiotics can be given by mouth, as an injection or via a drip into a vein. In young children, a liquid preparation is often given by mouth. Older children and teenagers are usually given tablets or capsules.
When your child is taking antibiotics, always follow your doctor’s instructions on:
- how often you should give your child their antibiotics;
- whether they should take the antibiotics with or without food; and
- the number of days they should take the antibiotics.
Give the antibiotics for the length of time prescribed, unless your doctor advises you to stop or change to a different antibiotic. This is sometimes referred to as ‘taking the entire course’. Taking the whole course doesn’t always mean taking all of the tablets in the packet or finishing the entire bottle of antibiotic liquid.
If your child has taken antibiotics for the recommended number of days and there are still antibiotics left, return the leftover antibiotics to the pharmacy to be safely disposed. If in doubt, check with your doctor or pharmacist.
Never give antibiotics to your child without a prescription, and don’t keep leftover antibiotics and give them to your child or another child at a later time, even if their symptoms are similar.
Side effects of antibiotics in children
No medicine can be guaranteed to be free from side effects, and antibiotics are no exception. About one in 10 children taking antibiotics will experience side effects. However, when side effects do occur, they are usually mild.
Common side effects associated with antibiotics include:
- abdominal pain;
- vomiting; and
Less common antibiotic side effects
Sometimes during or after a course of antibiotics, an infection with a bacterium called Clostridium difficile can develop in the bowel due to the antibiotics disrupting the natural balance of bacteria in the gut.
Many children carry C. difficile in their bowel with no adverse effects, but when antibiotics wipe out the normal protective flora of the bowel, the C. difficile can over-grow and release toxins.
C. difficile infection can cause watery diarrhoea and abdominal pain, and in more severe cases there may be bloody diarrhoea. This type of infection can be serious and lead to significant complications.
A candida yeast infection (thrush) can also develop after using antibiotics.
What are the signs of an allergic reaction to antibiotics?
Being allergic to antibiotics is uncommon. If an allergy does develop it is usually to a penicillin-type of antibiotic. Allergic (hypersensitivity) reactions include:
- Immediate allergic reactions, which develop within 1-2 hours after taking antibiotics, causing hives (itchy rash), swelling and wheezing. A life-threatening allergic reaction (anaphylaxis) is possible.
- Delayed hypersensitivity reactions are more common and cause a rash to develop on the skin several days after starting antibiotics. These reactions are not usually serious.
If your child has a severe, immediate allergic reaction, they should not be given that antibiotic ever again because they are likely to have another allergic reaction which could be very serious. Most severe allergic reactions happen with penicillin.
If your child has a delayed-type hypersensitivity reaction to an antibiotic, they may be able to take that antibiotic again, depending on the symptoms they experienced. Your doctor will let you know what the safest approach is.
People who have suffered severe reactions to antibiotics are strongly advised to wear a MedicAlert bracelet or necklace.
Why is it important to use antibiotics properly?
It’s very important that we all use antibiotics only as prescribed and when needed, to reduce antibiotic resistance. Antibiotic resistance is when overuse and improper use of antibiotics leads to the development of strains of bacteria that are resistant to the effects of antibiotics. These bacteria (sometimes referred to as superbugs) can be dangerous and very difficult to treat.
That’s why it’s so important that children and adults only take antibiotics that have been prescribed for them, and to take them according to their doctor’s instructions.
Last Reviewed: 14/09/2019
1. Principles of antibiotic use (published November 2014; amended February 2015). In: eTG complete. Melbourne: Therapeutic Guidelines Limited; 2019 Jan. https://tgldcdp.tg.org.au (accessed Feb 2019).
2. NPS MedicineWise. Antibiotics, explained (updated 15 Mar 2017). https://www.nps.org.au/medical-info/consumer-info/antibiotics-explained (accessed Feb 2019).
3. Centers for Disease Control and Prevention (CDC). Be antibiotics aware: smart use, best care (updated 9 Nov 2018). https://www.cdc.gov/features/antibioticuse/index.html (accessed Feb 2019).
4. Antibiotic-associated diarrhoea (published November 2014). In: eTG complete. Melbourne: Therapeutic Guidelines Limited; 2019 Jan. https://tgldcdp.tg.org.au (accessed Feb 2019).
5. World Health Organization (WHO). Antimicrobial resistance (15 Feb 2018). https://www.who.int/news-room/fact-sheets/detail/antimicrobial-resistance (accessed Feb 2019).
6. Wilson HL, Daveson K, Del Mar CB. Optimal antimicrobial duration for common bacterial infections. Aust Prescr 2019;42:5-9. DOI: 10.18773/austprescr.2019.001. https://www.nps.org.au/australian-prescriber/articles/optimal-antimicrobial-duration-for-common-bacterial-infections (accessed Feb 2019).
Otitis media in children
Otitis media (middle ear infection) is a common childhood illness causing earache and fever. It usually gets better quickly with pain relievers but sometimes antibiotics are needed.
Sore throat: what you need to know
Most of us know what a sore throat feels like - pain or irritation in your throat that’s often worse when you swallow. Treatments inclulde home remedies, pain relief and sometimes antibiotics.
Colds: commonsense not antibiotics
If you have a cold, commonsense self-care measures and over-the-counter medicines can help to relieve symptoms. Antibiotics are not helpful in treating the common cold, which is caused by a virus.
Antibiotics attack bacteria - germs responsible for certain infections. Each antibiotic attacks different types of bacteria and will be useful for treating particular infections.
Cellulitis is a bacterial infection of the skin. The infection can spread quickly and become very dangerous and so cellulitis requires treatment with antibiotics.