[Dr. Dina News] When we use antibiotics and when we try to avoid them

Hello friends!

I hope you had a wonderful Father’s Day weekend!

We have seen record levels of viral illness, fever, cough, and flu-like symptoms these last few months.

Many parents are concerned their children have a bacterial infection and request antibiotics.

I want to take some time to review common illnesses with you and help shed light on when we use antibiotics and when to try to avoid them.

The following is summarized from an excellent resource called Choosing Wisely Canada. Choosing Wisely looks at all the available research, identifies tests and treatments commonly used, and identifies which are supported by evidence and which are not recommended by evidence and could actually lead to potential harm.

In short, health care providers rely in part on Choosing Wisely’s extensive work to make evidence-based decisions about appropriate testing and treatment for common illnesses.

Ear Infections

Ear infections are common in childhood. Viruses or bacteria can cause ear infections.

Parents often worry about a bacterial ear infection when a child has ear pain and request antibiotics. However, most ear infections are caused by viruses that don’t respond to antibiotics. Therefore, in most cases, antibiotics are not needed to treat an ear infection.

Here is why:
• Viruses cause most ear infections, and antibiotics don’t help viral infections
• Antibiotics do not relieve the pain from an ear infection in the first 24 hours and rarely relieve pain after that.
• Most ear infections will resolve on their own in 2-3 days if you watch and wait.

What should you do if your child has an earache?

• Get in touch with your health care provider and review your child’s symptoms with them.
• Give over-the-counter fever/pain medication such as Acetaminophen or Ibuprofen. That is usually all that is needed.
• Most children will no longer have ear pain after 2-3 days, even without antibiotics.
• If your child still has ear pain after three days, consult your healthcare provider if you have not already done so.

What is the downside to giving antibiotics?

• Many children will develop diarrhea, vomiting or abdominal pain from using antibiotics.
• Some children develop allergic reactions.
• Antibiotics kill off healthy bacteria and other microbes that are helpful for our body.
• Antibiotic use can lead to the growth of drug-resistant bacteria, which can be harder to kill.

Who should receive antibiotics for ear pain?

Ear pain that is persistent for three days or more is more likely a result of a bacterial infection.

Some children require antibiotic treatment sooner, such as those six months or younger, with immunodeficiencies or cochlear implants.

On examination, if your healthcare provider sees a perforation, pus, a bulging of the eardrum signifying pus behind the drum, if a child is moderately or severely ill, or if symptoms last longer than 48 hours, they may prescribe antibiotics.

If your health care provider gives your child antibiotics, please be sure to give them as directed and for the number of days prescribed. Stopping antibiotics too soon can increase the risk of reinfection and/or antibiotic resistance.

Sore throats

Choosing Wisely recommends against the routine practice of prescribing antibiotics for sore throats unless a throat swab culture confirms strep throat AND there are MORE THAN 2 of the following on the Center Score.

• fever >38.5°C
• swollen, tender cervical lymph nodes
• tonsillar exudate (white pus on the tonsils)
• NO cough

(The Center score is an algorithm to assess the likelihood that a sore throat is caused by Strep bacteria.)

Most sore throats are a result of… you guessed it, viruses. These do not require antibiotics.

We do not perform strep tests on patients with a Center Score of ≤ 1, OR if there are other symptoms of a viral illness, such as runny nose, cough, or oral ulcers.

Pneumonia/Chest infections

Viral illnesses cause the vast majority of kids’ coughs. Kids do not require antibiotics for a cough unless there is objective evidence with a chest XRAY.

Per Choosing Wisely, physical examination alone is insufficient to diagnose pneumonia, and antibiotics should not be given unless there is this objective evidence. If a child has normal vital signs (respiratory rate, heart rate, oxygen saturation) and a normal chest exam, they likely DO NOT need a chest XRAY, and it is likely not pneumonia. Your doctor can decide if an in-person exam and XRAY are required before determining if antibiotics are needed.

What is the plan with the Pfizer and Moderna vaccines for kids?

The US FDA gave emergency use authorization last week for Pfizer and Moderna vaccines to be provided for kids aged six months – to 5 years. In addition, the CDC voted unanimously in support of giving babies and kids as young as six months the COVID-19 vaccine.

Both vaccines are safe and effective. Preliminary results show that the three-dose Pfizer vaccine is more effective at preventing symptomatic infection, and both induce strong antibody levels, which will protect against severe disease.

Currently, the Moderna vaccine is undergoing review by Health Canada. However, Pfizer’s vaccine has not yet been submitted for Health Canada review.

Have a wonderful week, everyone.