My kid feels awful! Why won’t his doctor prescribe antibiotics?
By Kristy Bleizeffer Nov 16, 2016
When your child is sick, you want him or her to feel better as quickly as possible. You bundle him up, drive to the doctor’s office and expect an antibiotic. But his doctor won’t prescribe one. Why not?
In this interview, family physician Adam Linck, M.D., explains when antibiotics are and are not appropriate.
What are antibiotics?
Antibiotics are special medications that we have at our disposal to treat bacterial infections. Each class works in different ways in order to kill the bacteria that are in our bodies. Unfortunately, they don’t work at all against viral illnesses.
What are some common bacterial ailments treated by antibiotics?
Most bacterial illness that we see commonly in our office are bladder and kidney infections, pneumonia, ear infections in children or strep throat.
What are some common viral infections for which antibiotics would be ineffective?
Some of the common viral illnesses are the common colds, flu, sinus infections, sore throats (with the exception of strep throat) and bronchitis. Antibiotics won’t work in the setting of a viral illness because they have no action against them.
When might you prescribe antibiotics for a sore throat?
When we see someone with a sore throat, there are specific questions we would ask: Do they have excudates in the back of their throat, which are the white bumps on their tonsils? Do they have a fever? Do they have a cough, and are their lymph nodes tender?
If they have those symptoms, they are more likely to have strep throat. In that setting, the doctor would probably run a rapid strep test, and if that came back positive or if the doctor had a high enough suspicion of strep throat, they would probably be prescribed antibiotics.
Unfortunately, the majority of the time, a sore throat (or pharyngitis) is more often caused by a viral illness and it will get better on its own. One other thing I might tell patients: If your voice is affected by a sore throat, what we call laryngitis, that almost exclusively occurs in viral illnesses and you most likely won’t need antibiotics in that setting.
When wouldn’t you prescribe antibiotics?
Most of the other viral illnesses -- the cold, the flu, sinus infections -- they have a self-limiting course. They last 7 to 10 days. They peak around day 5, and that’s when people feel the worse. It’s also when most people get tired of their cold and that’s why they come to the doctor around then.
In most instances, after that fifth day through seventh day, they are going to start feeling better on their own. Patients come and they say, “My doctor before prescribed antibiotics and I got better.” That’s true, you got better, but that’s because you were going to get better whether or not you took antibiotics in the first place. Your body fought off the illness, it’s not because antibiotics were working against that illness.
What are the dangers of prescribing antibiotics when they aren’t necessary?
When we talk about prescribing medications, we take that seriously. Every medication has side effects, and a lot of people have allergies. The majority of these are mild – you get nauseated, you have some diarrhea, but it clears up. But some allergic reactions can be severe, and they can be life threatening. We really take the decision to give you antibiotics seriously.
When we prescribe antibiotics in wrong instances, we give bacteria a chance to mutate or evolve and become resistant to our treatments and to those antibiotics. Then we don’t have those antibiotics available to us further down the line -- years or even months down the line -- to treat those illnesses that really need bacteria-fighting agents of the antibiotics. In that case, if antibiotics don’t work, we have nothing with which to help our patients.
If antibiotics have no effect, what can patients with a viral illness do to feel better?
For viral illnesses, we want patients to stay well hydrated, we want them to take Tylenol and ibuprofen. Adults can take over-the-counter medications. These will help improve the symptoms while the body is fighting off the illness.
We don’t really recommend cold and cough medications in children which can often be difficult to dose correctly. I would recommended talking to your doctor first before giving your children these medications because they have some bad side effects.
Dr. Linck is a board-certified family practice physician at Sage Primary Care. He grew up in Riverton and became interested in medicine at age 6 when his grandfather was treated at Wyoming Medical Center for a heart attack. He is accepting patients of all ages.