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“Hey doc — how about prescribing an antibiotic? Even if, as you say, this is probably just a virus, how much could it hurt to prescribe one?”
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The answer — and every pediatrician can tell you a harrowing story (horrible rashes, intense and dehydrating diarrhea, painful and bloody colitis) — is “plenty.”
Antibiotics are the most prescribed medications in pediatrics. Prescribing antibiotics only when necessary, with specificity regarding the target and prudence regarding the patient, is the modern pediatrician’s mantra. Even when great care is taken to prescribe the correct type of antibiotic at the correct dose, a new study reminds parents and doctors that things can still go wrong, seriously and unexpectedly, with these drugs. Published last month in the Journal of the Pediatric Infectious Diseases Society, the study by researchers from the Centers of Disease Control and Prevention (CDC) found that adverse side effects in children taking antibiotics accounted for nearly 70,000 emergency department visits each year between 2011 and 2015. Fortunately, only 3% of ED visits resulted in admission to the hospital, Roxanne Nelson says:
Most ED visits were for allergic reactions, which varied in severity from a rash to anaphylaxis, and these events disproportionately affected young children.
“For parents and other caregivers of children, these findings are a reminder that while antibiotics save lives when used appropriately, antibiotics also can harm children and should only be used when needed,” said lead author Maribeth C. Lovegrove, MPH, from the Division of Healthcare Quality Promotion at the Centers for Disease Control and Prevention, in a statement. “For health care providers, these findings are a reminder that adverse effects from antibiotics are common and can be clinically significant and consequential for pediatric patients.”
Younger children tend to have higher rates of adverse reactions from antibiotics compared to older kids. Amoxicillin — the antibiotic prescribed most by pediatric primary care providers — accounted for the highest rate of reactions and ED visits in children 9 years old and under. For children ages 10-19, trimethoprim-sulfamethoxazole (Bactrim) was the most common culprit.
Rashes that break out while children are taking antibiotics are often not allergic reactions, though it can be very difficult to discern other causes while a child is sitting in a pediatrician’s office or in an emergency room. Unless the rash resembles classic hives or welts, pediatricians will more likely than not hedge their bets and not declare a child allergic to that antibiotic.
One very serious and potentially life-threatening side effect that can occur during and after a course of antibiotics is infection with Clostridium difficile. In this event, a “bad” bacteria (C. diff) can overwhelm the intestine’s normal population of “good” bacteria and cause inflammation of the large intestine. This condition is called antibiotic-associated pseudomembranous colitis and was not included in the CDC study.
Remember that all the reactions and side effects discussed above can occur in anyone taking antibiotics for the right reasons or the wrong reasons. Limiting their use and prescribing them only when necessary will reduce a lot of unnecessary inconvenience, illness, and pain.
(Image: CDC.gov/antibiotic-use)