When should a child take antibiotics and when is it not necessary?

BarcelonaAntimicrobial drugs, including antibiotics, marked a turning point in modern medicine. However, this great advance is threatened because, every year, more microorganisms are found. learn To defend themselves against treatments, bacteria become stronger and more resistant, rendering medications ineffective. Eneritz Velasco, attending physician in the infectious diseases department at Sant Joan de Déu Hospital and coordinator of the hospital's antimicrobial stewardship program, points out that among the uses that most compromise their effectiveness is "using them when they are not necessary," since antibiotics are effective against viral infections such as the flu, the common cold, or COVID-19. Velasco emphasizes that "they are also not analgesics," so they do not relieve pain "nor do they treat coughs or reduce fever."

What should we consider when administering antibiotics to children?

Antibiotics should never be taken without a prescription. "Nor should leftover antibiotics from another treatment be used," Velasco emphasizes. Not adhering to the prescribed dosage and duration can also reduce effectiveness, as bacteria are being exposed to doses that are too low, which encourages them to develop resistance more quickly. The attending physician in the infectious diseases department at San Juan de Dios Hospital mentions one final factor: "Using an antibiotic with too broad a spectrum, which therefore also affects bacteria that we shouldn't be treating at that moment."

What dangers are involved in taking antibiotics, for example, in the case of colds or flu?

Velasco points out that "they can not only fail to do good, but they can actually do harm." Firstly, in the case of a cold or flu, the goal should be to promote healing, which, she notes, "doesn't happen when we administer antibiotics." Furthermore, the doctor warns of the dangers of adverse drug effects, which can be immediate, such as diarrhea, vomiting, or stomach pain. "These alert us to more immediate toxicity," she points out. But there are also long-term effects, "such as the possibility of promoting the development of resistant bacteria that reduce the effectiveness of antibiotics in future treatments." Finally, she adds, we can also disrupt the natural balance of bacteria in our bodies, known as the microbiota, which is essential for good health.

What other infections can lead to confusion?

"Bronchitis is usually viral. Even pneumonia is," Velasco points out. In childhood, she emphasizes, viruses predominate, by a wide margin, compared to bacteria. "There are specific cases in which a healthy person with no immune problems develops bacterial infections that don't require antibiotics," the doctor explains. Even ear infections can be treated initially with anti-inflammatories, without antibiotics, and "most clear up." The message, therefore, is that many bacterial infections benefit from antibiotics, but not all. In any case, she insists, it's essential to consult a medical professional.

Are families aware of the importance of giving the dose prescribed by the pediatrician?

Dr. Velasco points out that families are increasingly aware of the impact that the inappropriate use of antibiotics can have on their children. She emphasizes that with proper daily monitoring, "relapses are not the norm." It is also important that both hospital and community settings monitor bacterial sensitivity profiles identified through urine or blood cultures, allowing doctors to "observe how sensitivity to certain antibiotics decreases and anticipate how to adjust treatments."

Should there be more outreach about the proper use of antibiotics?

In recent years, pediatric hospitals and laboratories have been working along these lines in accordance with the national plan to combat antimicrobial resistance and WHO guidelines. "In primary care centers, we have programs to promote the appropriate use of antibiotics among professionals, and pediatricians, family doctors, microbiologists, pharmacists, and specialists work together," explains Velasco, who also emphasizes the need for coordinated work between hospitals and primary care. The doctor also considers the integration of families, schools, and the community at large to be "essential" in this objective, since, she insists, the problem of resistance is very complex and affects not only human health, but also animal health, livestock, and the environment.

Are there any cases that justify the preventive administration of antibiotics?

The doctor clarifies that it should only be done in specific cases, such as before surgery in cases of primary immunodeficiency, before a dental procedure in cases of heart problems, or in infections like meningitis. Otherwise, it wouldn't be necessary, not even to prevent infections during early childhood, when children typically experience four to five respiratory infections a year. "This," Velasco explains, "doesn't mean their health is at risk, unless hospitalization is required."

So how can we somehow prevent these recurring infections?

They emphasized measures such as hand hygiene, teaching children from a young age to wash their hands after using the toilet and coming in from outside, or before eating, and to cover their mouth and nose with their elbow when coughing or sneezing. All of this, Velasco points out, "in addition to keeping vaccinations up to date and avoiding contact with at-risk individuals when sick."