Overprescription of antibiotics can be harmful
Naturally parents want to make their sick children feel better, but some easy fixes aren’t the healthiest choice in the long run
As many as half of the 25 million antibiotic prescriptions written every year in Canada are estimated to be unnecessary. Overuse of antibiotics is especially true for children with coughs, colds and sore throats.
When our kids are feeling sick, we will do just about anything to try and help them feel better. Perhaps it is not surprising that we expect to come away from a visit to the doctor with something guaranteed to do just this. An antibiotic prescription with precise instructions seems more reassuring than being told the illness will run its course, or to give lots of fluids and some acetaminophen for fever.
Truthfully, in many cases of fevers in healthy children, the antibiotic option is actually unhelpful and can sometimes even be harmful. Yes, your child may have gotten better after using antibiotics for their sore throat last time, but more than likely that was the natural course of their viral illness and would have happened even if you had substituted sugar water for that banana-flavoured amoxicillin.
Don’t get me wrong, antibiotics are one of the great inventions of the last century and have saved millions of lives. However, we run the risk of antibiotics becoming ineffective in the future due to inappropriate overuse. In healthy children, especially with the addition of vaccines over the past 20 years, most fevers, sore throats, coughs and colds, and tummy upsets are caused by viral infections. Unfortunately, antibiotics only kill bacteria; viruses smile at them and keep on trucking.
The majority of viral illnesses run their course in three to five days and are adequately dealt with by a child’s immune system. You may think the antibiotic “worked” as symptoms often improve on their own within one to three days of starting the prescribed treatment. Often as the fever breaks, a skin rash appears as part of the viral illness, and is then erroneously blamed on an allergy to the antibiotic that was (unnecessarily) started the day before. Then your child may be incorrectly labelled as “allergic” to that antibiotic.
Overuse of antibiotics commonly causes minor side effects, such as rashes or diarrhea and, very rarely, may cause severe and potentially life threatening allergic reactions or complications. At the same time, germs are pretty adaptable, and after being exposed to an antibiotic often become resistant to it. Increasingly, hospitals are encountering “super bugs” which are resistant to almost all of our current antibiotics.
There is also much concern that overuse of antibiotics, especially “broad spectrum” types that kill a wide range of good and bad germs, alter the child’s gut microbiome (the millions of normal germs living in all of our guts) in a way that may potentially increase the risk of many chronic diseases such as allergies, asthma and even obesity.
I don’t blame parents for the overuse of antibiotics. Medical professionals are, after all, the ones writing the prescriptions. This is often because situations aren’t always black and white. Viral and bacterial infections do have overlapping symptoms, including fever. Doctors may also assume that parents don’t want to be told that TLC is all that can be done for their child, but will feel much more satisfied if they are given a prescription for antibiotics.
I think both parents and doctors need to be more thoughtful and not reach for what appears to be the easy fix. Doctors should take the time to talk to parents about why their children may not need antibiotics for many cases of sore throats, coughs and colds, and fevers.
For example, antibiotics should not be prescribed for a sore throat without a positive throat swab for “strep” (strep throat and a viral pharyngitis usually look pretty much the same to the naked eye). Instead, doctors and parents could create acontingency plan to reassess the child at a certain point if they’re not recovering. Parents could also request a delayed antibiotic prescription to be filled after a few days only if symptoms don’t improve.
To get these conversations started, I encourage parents to ask these three important questions suggested by Choosing Wisely Canada, a national campaign to reduce unnecessary tests and treatments: 1. Does my child really need antibiotics? 2. What are the risks? 3. Are there simpler, safer options? Dr. Jeremy Friedman is a professor in the Faculty of Medicine’s Department of Paediatrics and the associate paediatrician-in-chief at the Hospital for Sick Children (Sick Kids). Doctors’ Notes is a weekly column by members of the University of Toronto’s Faculty of Medicine.