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Be cautious with antibiotics for kids: committee

By Genevra Pittman

NEW YORK (Reuters Health) - Pediatricians should carefully evaluate kids with ear infections, runny noses and sore throats before giving them antibiotics, doctors said today.

Antibiotics will only help shorten kids' sickness if their symptoms are caused by bacteria and not by a virus, the American Academy of Pediatrics (AAP) Committee on Infectious Diseases noted.

Still, studies show many children and adults are given the drugs for coughs and colds caused by viruses. That increases the risk of antibiotic resistance, without doing patients any good.

"People tend to not recognize how big of a problem this is," Dr. Theoklis Zaoutis said.

He is a member of the AAP committee and an infectious diseases specialist at the Children's Hospital of Philadelphia in Pennsylvania.

According to the Centers for Disease Control and Prevention, at least 2 million Americans get infected with antibiotic-resistant bacteria each year and 23,000 die as a result. Any antibiotic use - appropriate or not - contributes to the risk of resistance.

Antibiotics can also come with side effects like diarrhea and rashes, which account for more than 150,000 doctor visits among kids each year. And they occasionally cause severe allergic reactions.

Symptoms of bacterial and viral respiratory infections can overlap, the committee said. So pediatricians should use strict criteria to decide when antibiotics are warranted.

For ear infections, toddlers who have severe pain and infections in both ears are most likely to benefit from the drugs, the AAP said. But in most cases, symptoms will go away on their own - so a wait-and-see approach is an option for older kids who are not in a lot of pain.

Antibiotics for runny noses and coughs should be used when symptoms are severe, have been around for a long time or are getting worse. When kids have a sore throat, pediatricians should test only those who have certain symptoms - such as swollen lymph nodes or tonsils and a fever - for strep throat.

When antibiotics are justified, the committee recommended doctors prescribe amoxicillin (marketed as Moxatag or DisperMox, among other names) or amoxicillin together with clavulanate (Augmentin) to kids with ear infections and sinusitis.

The combination, in particular, causes diarrhea or other stomach problems among one-quarter to half of patients, Dr. Jeffrey Linder said.

"If you're going to take something that has that high a rate of adverse event, you should be pretty darn sure it's going to help you," he told Reuters Health. Linder, from Brigham and Women's Hospital in Boston, has studied antibiotic prescribing but wasn't involved in the new research.

For strep throat, amoxicillin or penicillin is the best bet, the committee wrote Monday in Pediatrics, the journal of the AAP.

Newer, so-called broad-spectrum antibiotics are more likely to cause resistance.

"You want to use the antibiotic that has the narrowest spectrum, meaning it will kill the germs that are causing the infections but not have collateral damage on all the other bacteria within our bodies," Zaoutis told Reuters Health.

Linder said one thing doctors may need to work on is telling parents when they don't need to come to the office. For colds and other viruses - even those that last a long time - there's not much doctors can do except tell people to wait it out.

"We still have a lot, a lot of visits in healthcare for these acute respiratory infections and it's not clear to me that we as doctors are really helping patients, and we're wasting people's time and money," Linder said.

Parents can also play a role in making sure their kids don't get antibiotics unnecessarily, Zaoutis said.

"Talk to the doctor and say, ‘Do I really need that antibiotic? What are the risks and benefits of my child taking an antibiotic?'," he advised.

SOURCE: http://bit.ly/cxXOG Pediatrics, online November 18, 2013.

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