ANTIBIOTIC DOS & DON’TS
Antibiotics have been called the miracle drug, but overuse is making them less effective, says sister Burgie Ireland
WITHOUT ANTIBIOTICS, bacterial infections could make your child very sick, with the risk of serious complications – even death. Antibiotics work quickly, prevent complications and are relatively inexpensive. But are antibiotics always necessary, and are they the only choice to cure an infection? Doctors and clinics have been warned that over-prescribing antibiotics has led to the development of so-called “superbugs” or strains of bacteria that are resistant to even stronger antibiotics. This also means that antibiotics are becoming ineffective. Some studies have even found that the overuse of antibiotics can weaken the body’s natural immunity.
Parents play an important role in their children’s health – and recovery. It’s important that you understand and follow the doctor’s and pharmacist’s instructions when antibiotics are prescribed. Parents are also instrumental in helping to prevent infections, minimising the need for antibiotics and maximising their effectiveness when they’re unavoidable.
WHAT ARE ANTIBIOTICS?
Antibiotics are medicines used to fight disease-causing bacteria. Since penicillin was first discovered in the 1930s, hundreds of new antibiotics have been developed.
Antibiotics are a scheduled drug, which means they must be prescribed and dispensed by a pharmacist. They’re powerful medicines and must be used carefully – especially in babies and children younger than three. When incorrectly prescribed, antibiotics can build up in the body and become toxic (poisonous).
They can also destroy good bacteria in the bowel that keep the gut healthy. If antibiotics are stopped before the full course has been completed (usually because the child looks and feels better), a few surviving bacteria can multiply and start another infection. Within a few weeks, the child will be back in the doctor’s rooms, and now these stronger bacteria will be resistant to the original antibiotic, and a stronger antibiotic will have to be prescribed.
WHY DO SOME CHILDREN GET SICK MORE OFTEN?
From the time a baby leaves the sterile safety of his mother’s womb, he is at risk of infections from microbes and bacteria that are everywhere. His mother’s health during the pregnancy, labour, birth and his Apgar score all contribute to a baby’s health – possibly for life. It’s one of the reasons why antenatal care is so important.
Premature babies have many hurdles to clear. Not quite ready to survive on their own, premmies often have breathing problems. These can weaken their immature resistance to infections. That’s why nurseries today encourage skin-to-skin kangaroo care, strapping even the tiniest babies between their mother’s breasts. Here contact with the mother’s skin’s natural organisms will help her baby to develop antibodies and some tolerance to microbes.
Bottle-fed babies miss out on essential colostrum – nature’s first source of antibodies. The longer a baby is breastfed, the longer he will benefit from
mom’s antibodies. These will help to strengthen his immune system.
Special-needs and syndrome babies, “failure-to-thrive” babies, anaemic babies and those with heart conditions may get sick more often as do babies born with a blood disorder or HIV.
Children going to crèche for the first time are soon exposed to a host of germs.
HOW DO ANTIBIOTICS WORK?
Antibiotics destroy the enzymes (essential proteins found in all living cells) in bacteria. Some antibiotics prevent the development of a protective wall around the outside or the inside of the cell, while others interfere with the formation of proteins inside the cell of the bacteria, and this stops them from multiplying.
WHEN TO GIVE ANTIBIOTICS
Antibiotics should only be given for bacterial infections. These are mostly upper respiratory tract (ear infections, tonsillitis and pharyngitis) and lower respiratory tract infections (pneumonia). Urinary tract infections are also common in small children.
It’s important that antibiotics are only taken when absolutely necessary. Doctors often say that parents complain if they are not given a script. When antibiotics are prescribed for infections caused by a virus, fungus or parasite, they’re ineffective.
HOW SHOULD THEY BE GIVEN?
Parents are often told to give their child their first dose of antibiotics as soon as they get home – this is called a “stat” dose. The pharmacist will tell parents how often (four-hourly or three times a day) the medicine must be given, and for how long.
A broad-spectrum antibiotic is most commonly prescribed because these cover a multitude of bacteria. Tests can be done to identify the bug responsible for the infection if the infection does not respond to the antibiotic of choice.
It’s important to remember that children are not mini-adults. The way that medicines are absorbed, distributed and eliminated is different to that of adults – especially in premature babies and those younger than six months. The dose needs to be carefully calculated according to the baby’s age and weight. For example, penicillin in the newborn is not well excreted. If the wrong dose is prescribed, it can become toxic.
WHEN NOT TO GIVE ANTIBIOTICS
Antibiotics should not be given for an infection that is not bacterial. If parents are allergic to penicillin, the child should be tested before giving antibiotics.
SHOULD WE GO TO THE DOCTOR?
0 – 6 months: Newborns and premature babies can get seriously ill very quickly. Upper respiratory tract infections can spread to the ear and even the brain causing meningitis or encephalitis. Lower respiratory tract infections can quickly become bronchitis or pneumonia.
WHEN TO WORRY:
✓ Temperature 38°C and above ✓ Refusing feeds ✓ Wetting fewer nappies ✓ Baby whimpers (rather than cries) and is lethargic (floppy) ✓ Coughing or wheezing or rubbing ears ✓ Has a rash 6 – 12 months: By the time babies are six months and older, their immune system is getting stronger and they may be able to overcome mild infections, but do take your baby to the doctor if symptoms deteriorate or persist for more than a day. 1 – 3 years: Toddlers are likely to pick up nursery-school illnesses. In a way, these help small children to build up their own antibodies every time they overcome an infection. Some toddlers are sicklier than others and may need to see the doctor more often. If your child has the above symptoms and has been coughing for more than two days, it’s best to see the doctor. Sometimes when you see the doctor on the second or third day, your child’s immune cells may already be responding to the bacterial infection. When this happens, the doctor may write a script with the advice that if your child has improved in the next 12 hours, the antibiotic is unnecessary.