The toddler has a terrible runny nose again and, in addition, has a fever … Concerned mother calls the pediatrician as soon as possible. Meanwhile, there is no reason to panic – contrary to appearances, viral infections, which mainly affect children, are beneficial for them. Not only do they go away on their own, but they also exercise the immune system. Professor Piotr Albrecht emphasizes that administering antibiotics to children causes more harm than good dictated by over-zealousness or fear.
- Prof. dr hab. Piotr Albrecht: in children under 2 years of age, severe bacterial infections are rare
- Scientific research shows that unnecessary administration of antibiotics to children increases the risk of inflammatory bowel disease, allergic diseases and lifestyle diseases.
- Prof. Albrecht believes that we should avoid antibiotic therapy, because when there are no antibiotics in our environment, no strains resistant to them arise.
- You can find more such stories on the TvoiLokony home page
Monika Zieleniewska, MedTvoiLokony: We still have a fashion for giving children antibiotics just in case. What do you think about her?
Prof. dr hab. n.med. Peter Albrecht: This fashion is absolutely unjustified and, what is more, old. At the moment, it is nowhere treated in this way, if only because 95 percent. infections, especially of the upper respiratory tract, are caused by viruses. And against viruses, antibiotics work. It is therefore a bad fashion, leading to the emergence of antibiotic-resistant strains and the complete ineffectiveness of antibiotics in the near future.
Up to the age of 2 years, severe bacterial infections, apart from sepsis caused by pneumococcus, meningococcus and Haemophilus influenza, which can be vaccinated are rare. Most young children suffer from viral infections such as RSV, parainfluenza, rhinovirus, adenovirus, influenza, etc. They are all the same, ie runny nose, cough, fever for 3 days and then slowly disappear on their own. We don’t have to do anything, although we like it. Especially mothers would like to get a panacea that will eliminate all symptoms by magic, and the child will return to kindergarten or school the next day. Unfortunately, there are still no such miracles in medicine.
When, then, should my baby be given an antibiotic?
In everyday practice, an antibiotic is needed for streptococcal angina. Sometimes in otitis media because it becomes superinfected, often pneumococcal, and pneumococcal infection does not heal by itself. In contrast, sinusitis does not require antibiotic therapy in ninety percent of cases. In very young children, pneumonia is often caused by viruses, and the antibiotic is given out of fear and usually unnecessarily.
- See also: Six Myths About Antibiotics
Can this antibiotic given just in case be replaced with something?
Of course, symptomatic medications. Overall, symptomatic treatment of viral infection is nearly 95 percent successful. If used long enough, it is also sufficient. Speaking of symptomatic treatment, I mean antipyretic drugs, analgesics or drugs that reduce mucus secretions in the nose. On the other hand, a possible bacterial superinfection may be evidenced by a fever that persists for a long time, or despite the decrease in fever, the child behaves atypically, is drowsy, lethargic, and refuses to eat.
- Some herbs support immunity. Try Pukka Original Chai – a warming tea available at Medonet Market.
Are there antibiotics specifically for children or are they dedicated to diseases?
Antibiotics are dedicated to specific diseases or specific pathogens that we will either detect which is more difficult or which are most common in specific diseases. In streptococcal angina, as the name suggests, it is a group A beta-hemolytic streptococcus that is sensitive to everything, including the old penicillin invented in 1940.
When it comes to the ear, we have to think mainly of pneumococci. If we have true pneumonia, we think of pneumococci, sometimes atypical infections like mycoplasma, but mycoplasma heals itself without antibiotics. In contrast, pneumococcal definitely requires antibiotic therapy. For otitis, we usually give amoxicillin, and for pharyngitis, we give regular penicillin. For pneumonia or sinusitis, although bacterial superinfection occurs very rarely in the sinuses, again amoxicillin. Amoxicillin with clavulanic acid is commonly and completely unnecessarily used. The task of clavulanic acid is to inhibit enzymes produced by bacteria, and pneumococcus, for example, does not produce any beta-lactamase, i.e. an enzyme that breaks down penicillins. Therefore, adding clavulanate to the therapy is completely useless, at most it increases the frequency of side effects and breeds resistant strains. Beta-hemolytic streptococcus, which causes pharyngitis, does not produce any beta-lactamases, so adding clavulanate does nothing.
And the child’s microbiota suffers?
Many scientific data and prospective studies, i.e. observations from birth to some time, indicate that unnecessary use of antibiotics, especially in the first two years of a child’s life, increases the risk of a number of diseases, including inflammatory bowel diseases, allergic diseases and diseases of civilization. Due to their devastating effect on our intestinal microbiota.
I read that frequent administration of antibiotics in early childhood results in obesity in adulthood. Is it true?
Today it cannot be said for sure, but if we look at the scientific research on the transplantation of the microbiota from one human to another, after transplanting an obese microbiota to a lean, lean one can become obese. Therefore, if we disturb the composition of the microbiota, we may be promoting obesity. Probably more than leanness, because microbiota disorders caused by antibiotics tend to favor obesity and metabolic diseases, especially diabetes.
What else do we need to have on the back of our heads?
Most childhood illnesses heal themselves without any negative consequences. My children and grandchildren have hardly ever seen an antibiotic in their lives and survived all possible age-specific infections. Many of my patients have never had an antibiotic either and are functioning quite well despite having a fever, runny nose, cough and many other common illnesses.
It is also worth noting that antibiotics can cause allergic reactions. In the event of unusual symptoms, it is worth performing an antibiotic allergy diagnosis – it is available on Medonet Market at an attractive price.
So you can?
That’s why we have the immune system, to exercise it. European statistics show that preschool children suffer an average of 8 to 10 infections per year, the so-called catarrhal. Of course, running with fever, cough, runny nose, etc. They go away on their own, because they are viral infections. And they are not harmful at all, on the contrary useful, as they exercise the immune system. This can, of course, cause problems for parents, because a child cannot be sent to kindergarten or school. Although I think that it is completely wrong, because every child in a certain period, ugly speaking, is a jerk. He has a runny nose constantly except during the holidays. This is normal and should not cause drama or induce antibiotic treatment.
Do we exercise the immune system throughout our lives?
Yes, although we know that in the first year of attending kindergarten, on average, these 8-10 infections appear, in the next, let’s say 5-6, in the next one much less, and finally one a year, because the immune system has already been trained.
Practice makes perfect?
In my experience, when completely unhealthy children get sick, it’s terrible. I prefer those who have 10 Cathars a year than those who do not. The fever, on the other hand, proves that the immune system has responded. Research shows that cancer is more common in those who do not have a fever in childhood. So I love a fever, even a fairly high one. It is not dangerous in itself, although it can cause febrile seizures, they leave no consequences other than the mother’s fear.
How is antibiotic resistance created?
Bacteria divide extremely quickly, mutate, i.e. change their genetic material, also extremely quickly, and it may happen that in the environment of a specific antibiotic, a bacterial strain is formed to that antibiotic resistant. If he is resistant, he multiplies in this environment. Being already resistant to certain antibiotics, it infects other people. Thus, the contact of bacteria with the antibiotic promotes its transformation into bacteria resistant to that particular drug. There are cross-resistance, to a whole group of antibiotics, and even more than a group of antibiotics.
Can we somehow counteract it?
We can change the antibiotic, apply some of the so-called higher shelf. But bacteria want to live too, and they adapt very quickly. And what to do in this situation? Avoid antibiotic therapy, because if there are no antibiotics in the environment, resistant strains do not arise. Anyway, we know that when it comes to the so-called macrolides – roxithromycin, azithromycin and clarithromycin – in countries where they are used extensively, resistance is very high. However, the abandonment of use for 5-10 years causes the strains susceptible to these antibiotics to reappear.
On the other hand, if we introduce massive amounts of antibiotics, bacteria once again cease to be sensitive. Yet antibiotics are used in veterinary medicine, animal husbandry, and many other areas that we don’t even know about. There are also antibiotics that do not break down and find their way into water, sewage, and soil, where they breed resistant strains, which we later drink or eat. If these strains are not pathogenic at the moment, they may still become pathogenic in 5-10 years.
In many cases, we have the opportunity to investigate which bacteria caused the infection. Is it always worth doing?
When it comes to streptococcal angina, we can either culture or swab the streptococcal antigen. In pneumonia, finding a specific factor is very, very difficult. In otitis, if we prick the eardrum, we can take a culture. This is not done on a daily basis, because there are a lot of middle ear infections, and they can also be viral. With sinusitis, we know that even if we perform a puncture, we detect bacteria only in 0,5 – 2 percent. cases, everything else is viruses. The rest of catarrhal infections are also 95 percent. virus. And then you can’t even examine it, because if we take a swab, we’ll find Haemophilus, staphylococcus, pneumococcus, and sometimes even meningococcus.
Should we be afraid of this?
No, because each of us has such things in the nose temporarily, and some permanently. Nothing but fear follows from the seeds. When we find bacteria, they all demand treatment right away. We are able to get rid of them, of course, but in a week or two they will reappear because we are in the environment that carries them. In these circumstances, your own meningococcus or your own pneumococcus is best, because it doesn’t hurt you. However, re-acquiring it from outside can be dangerous. Therefore, erasing the throat and nose, apart from streptococcal pharyngitis, that is, in addition to strep throat, is completely pointless. You can carry these bacteria from birth to death and never get sick. Unless there are specific circumstances, such as a decrease in immunity, dramatic fatigue, etc. Then the bacteria’s own can hurt a person.
We also hear that children are allergic to antibiotics. What this is about?
Antibiotic allergy is rare. Rashes are most often associated with a viral infection, and we attribute them to the use of an often unnecessary antibiotic. Of course, there are intolerances. It is a question of additives, as all antibiotics for children come in the form of syrups with all kinds of flavors. It is an allergy, irritates the digestive tract and may cause diarrhea. Meanwhile, it all comes down to allergies. When I work for 45 years, I can count real allergic shocks after antibiotics or really serious allergic reactions on the fingers of two hands.
Professor, then should we give children antibiotics or avoid them?
To avoid.
Prof. dr hab. of medical sciences Piotr Albrecht is a specialist in the field of pediatrics, gastroenterology and pediatric gastroenterology. He works at the Department of Gastroenterology and Children’s Nutrition at the Medical University of Warsaw.
The editorial board recommends:
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