What you should know about the common cold, sore throats and ear infections.

Although we all know that winter is the season for the common cold, I would like to share with you current medical opinion about upper respiratory infections and the role of antibiotics.

In general, American children get too many unnecessary antibiotic prescriptions for upper respiratory infections. Pediatricians today encourage parents to take steps to ensure that antibiotics are used only when truly needed for both themselves and their children.

Many office visits result in an antibiotic prescription, according to the authors of a 2013 report from the American Academy of Pediatrics (AAP). About 10 million antibiotic prescriptions are written every year for upper respiratory infections that likely won't improve from antibiotic use.

In addition, physicians often prescribe broad-spectrum antibiotics. These are medications that can kill a wide variety of bacteria, rather than narrow-spectrum antibiotics that target the probable bacteria which are presumed to be responsible for the infection being treated, like Strep throat. Narrow-spectrum drugs generally are preferred so bacteria don't become resistant to broad-spectrum drugs that may be needed to battle more serious infections that could occur at a later time.

"Our primary goal is the best outcome for a child," said lead report author Dr. Mary Anne Jackson, a member of the AAP Committee on Infectious Diseases. "The best treatment for a child doesn't always include an antibiotic." Very often our treatment is simply tailored to helping the child feel better while the child’s immune system fights off the virus. Doctors still try to relieve pain and suffering.”

“Although some progress has been made in reducing the amount of unnecessary antibiotic use, it's still a problem,” said Jackson, Division Director of Infectious Disease at Children's Mercy Hospitals and Clinics, in Kansas City, Mo. “Unnecessary antibiotic use puts children at risk of side effects or a potential allergy to the medications, and increases the risk of antibiotic resistance,” Jackson said. The report of the AAP details the appropriate times to prescribe antibiotics for upper respiratory infections, which include sinus infections, ear infections, and strep throat.

"This clinical report from the AAP, done in conjunction with the U.S. Centers for Disease Control and Prevention [CDC], looks specifically at upper respiratory infections because these are a common area where antibiotics are used injudiciously," Jackson said. According to the report, however, upper respiratory infections are also an area where it can be difficult to distinguish whether the cause is viral or bacterial. Antibiotics won't be helpful if an upper respiratory infection is caused by a virus_and most are.”


"[The 2013 report recommends] using stringent clinical criteria to establish the diagnosis before prescribing antibiotics," Jackson said. For example, in the past, many children were routinely given antibiotics if they had fluid in their ear. But fluid in the ear is common, Jackson said, and on its own doesn't require antibiotics. The new report recommends looking in the ear to see if the eardrum is bulging significantly and assessing how much pain a child is having before considering antibiotics. If the eardrum shows moderate or severe bulging, or if it's mildly bulging and the child is in pain, antibiotics might be useful. Even with these physical findings, one of the accepted treatment options for a middle ear infection is the careful withholding of antibiotics in certain circumstances for a few days while offering effective pain therapy. In these situations, there is an 80% chance of full recovery without antibiotics in a comfortable child. In those 20% not better after a few days, antibiotics are started at that point for a 5-10 day course of treatment_no longer always the usual 10-day course of treatment as has always previously been done.

Strep throat is another common childhood infection that can lead to an overprescription of antibiotics. The new report recommends that doctors don't test for strep throat unless a child is showing two or more symptoms of throat infection. About 15 percent to 20 percent of children and adults are carriers of strep and will test positive for the bug even when they don't have an active
infection and are completely well. Carrier Strep does not present health risks to children or adults but does cause diagnostic confusion when discovered during a viral illness. The physician’s challenge is to use good judgment in deciding what circumstances merit a throat culture and which ones do not to avoid the confusion of identifying Carrier Strep which does not need antibiotic treatment.

Another significant concern is the use of inappropriate antibiotics for certain infections. Amoxicillin is a good first treatment for ear infections, sinus infections, and strep throat. Penicillin also is a good first-line treatment for strep throat. Broad-spectrum antibiotics aren't necessary and have the potential to cause more side effects and resistant organisms from treatment. Most pediatricians still use liquid Amoxicillin for Strep throat, over Penicillin, because liquid Penicillin tastes terrible. Once a child can swallow pills, Penicillin tablets are preferred.

Jackson said azithromycin (Zithromax) often is prescribed for ear and sinus infections, but it's not an effective antibiotic to treat the bacteria that currently cause those infections.

One pediatric expert praised the 2013 report. "While there are no absolutes in medicine, this report has a lot of ideas and concepts that, if applied, will decrease the use of unnecessary antibiotics," said Dr. Kenneth Bromberg, Chairman of Pediatrics and Director of the Vaccine Research Center at the Brooklyn Hospital Center, in New York City.

Bromberg said some patients may be more likely to adopt a physician advised wait-and-see approach to take antibiotics for an infection, such as those who have a pediatrician with whom they have an ongoing relationship. On the other hand, Bromberg said, people who rely on urgent-care facilities may be less willing to see if an infection starts to get better on its own, because of the time or cost involved in having to return for care a second time if an infection doesn't improve.

All these principles are well known to today’s pediatricians in Children’s Hospitals, Urgent Care facilities, office-based practice and concierge practice, such as Priority Pediatrics. The decision to use antibiotics or to carefully withhold antibiotics is a subtle decision of judgment and experience based on accumulated scientific research and medical opinion and is very difficult for parents to make on their own without a knowledgeable physician’s input.

So as we work together over the winter season to keep your children healthy or treat illness, please know that I will always do my best to offer you my best opinion and medical advice.