Growing up
Most children are well most of the time, and when illness happens, often all that’s needed is a little bit of time for your child to get over whatever problem he or she has. Colds, diarrhea and rashes are all common problems that almost always resolve on their own.
If your child is well, you should come in once a year for a check-up so we can mark his or her progress, catch potential problems early, and explore any questions that you -- or he or she -- may have. Questions especially will get better attention at a check-up than in the shorter time allotted for a sick visit.
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There are two kinds of infections that account for nearly all of pediatric infectious disease: infections by viruses and infections with bacteria.
Most infections are caused by viruses. Although there are some exceptions, infections caused by viruses are not treatable with antibiotics. Antibiotics work by killing bacteria. They have no effect on viruses.
Drug-resistant strains of bacteria
Being “resistant” to antibiotics is a characteristic of the bacteria in question -- not of the patient. There’s no such thing as a child for whom amoxicillin “doesn’t work,” although there certainly are children who have infections which amoxicillin does not treat in any way.
For instance, many of the bacteria which cause ear infections have become resistant to amoxicillin, mainly because of inappropriate use of amoxicillin throughout the community. Even if your child has never taken amoxicillin, the bacteria which are part of our environment are more frequently resistant to amoxicillin than was the case 20 years ago, because of amoxicillin which has been used by others.
Another way of saying it is that the bacteria have evolved; the ones that could be killed by amoxicillin are no longer the ones that are circulating.
On the other hand, strep throat is an example of a relatively common problem where antibiotic resistance is not something we have to worry about. There’s no such thing as Group A streptococcus which is resistant to penicillin or amoxicillin – at least not yet.
Antibiotics
The term “antibiotic” generally refers to a type of medicine which is effective against bacteria. Examples of antibiotics are penicillin, amoxicillin and erythromycin. These medicines are among the great discoveries of modern science and have reduced childhood mortality almost to zero where they are available.
Still, we need to be careful about how we use them. Antibiotics always carry risks of side-effects or allergic reactions, which are particularly upsetting if there wasn’t a good reason to be taking them in the first place.
Also, as you may know, the overuse of antibiotics is creating a lot of other problems for patients, including difficulties treating certain infections when antibiotics really are needed. That happens when illness-causing bacteria mutate and proliferate in drug-resistant strains. In other words, antibiotics are terrific when needed but should be avoided when not needed. That’s the purpose of coming in and being seen – so that decision can be made on a more informed basis.
If I do order a prescription for your child, please read the instructions on the prescription and follow them. Generally speaking, if there was a good reason to start the antibiotic, there’s a good reason to finish it as prescribed.
If your child is sick
If your child is sick and you think he or she needs prescription medication, then you should come in to the office to be seen. Making a decision about what medicine might be helpful for your child’s problem is a big part of what my job is all about, and to do that well I need to examine the patient.
Many times, all that’s needed is a little bit of time for your child to get over the problem. Colds, diarrhea and rashes are all common problems that almost always resolve on their own. Many illnesses – probably the majority of infections that children get, including most longer-term illnesses like the flu – are caused by viruses. If that’s what your child has, antibiotics will have no effect at all. There are a few “anti-viral” medications which we use, but generally viral infections are not treatable with specific medications. The best we can do is treat the symptoms and wait for the illness itself to run its course -- that is, for the body’s own immune system to fight it it off.
Fortunately, most of the viral infections that we have to cope with in pediatrics in Los Angeles are relatively mild and not really dangerous, although they certainly can be a big nuisance, with fever, rash, discomfort, and so on while you’re waiting for it to go away. And unfortunately, it’s not so unusual for there to be some degree of diagnostic uncertainty about whether a particular person has an infection caused by a virus or caused by a bacteria.
Usuallly though, colds, coughs, vomiting and diarrhea are likely to be viral, ear infections are usually bacterial, pneumonia can be either or both, urinary tract infections are usually bacterial, and most rashes come from viruses. Eye infections can go either way.
