Sometimes the Best Medicine Is None At All

When I’m working in pediatric urgent care parents often bring their children in for acute illnesses hoping that I can “do something”. Worried, weary of illness, and sleep-deprived, they just want it all to be over. Sometimes, they relate a past episode during which the first doctor they saw “did nothing”, and, frustrated, they sought a second opinion where they were given antibiotics. See, they say, my child really was sick.

As a parent, I understand the misery of a sick child and the desire to do something. Even a common cold can be the cause of a pretty unpleasant week. As a pediatrician, I certainly don’t want my patients walking away from a visit feeling that their time was wasted. But, as I often explain to parents, it may be that the first doctor above was actually providing better care for their child.

Why?

  • The vast majority of illnesses that I see as a pediatrician are caused by viruses. Ah, the nebulous virus, you may say. Sometimes when I tell a parent their child has a virus I see the thought bubble above their head, “right, a virus. . . that’s just what doctors say when they don’t know what is going on.” But, really, it’s true. From a runny nose and cough to vomiting and diarrhea, various viruses are usually the culprits. And, sadly, for the vast majority, we have no curative treatment. Antibiotics do not work to fight viruses. They fight bacterial illnesses. Now, this is not to say that when I tell you your child has a virus that I’m saying they have nothing. Some viruses, influenza notable among them, can be down-right nasty. Here, prevention is the best treatment. Make sure you and your family are up to date on immunizations. Teach your kids about hand washing early on in order to protect them from catching an illness in the first place. For the myriad viruses for which we don’t have vaccines, time and a lot of TLC are usually the best medicine. If symptoms become severe, or your child has signs of dehydration, ask your health care providers about treatments to provide symptomatic relief (medicines that might make you feel better, but will not “cure” the illness).

So, now you might be thinking. Well, okay, I accept that the majority of illnesses are viruses. But, what about the off chance that my child has a bacterial illness. . . or that they may develop one. Why can’t my doctor just give my child antibiotics “just in case”? As I often describe to parents, it is true that viral illnesses can develop into a bacterial illness (a common cold that is followed by an acute ear infection is a good example in kids). But, it is definitely not a good idea to give prophylactic antibiotics for a number of reasons.

  • Antibiotics, like all medications, have adverse effects and potential for allergic reaction. About 25% of children prescribed antibiotics suffer medication-induced diarrhea. Approximately 142,000 emergency department visits occur each year due to adverse effects attributable to antibiotics. Only if your child has a bacterial infection and absolutely needs an antibiotic, do the benefits of treating the infection likely outweigh the risk making antibiotic treatment appropriate.
  • The more we use antibiotics, the higher the risk that they will not work as well for infections when we really need them. This phenomenon is called “antibiotic resistance“. Basically, the little bugs get smart- the more they “see” an antibiotic, the more they are able to develop ways to resist being affected by it. So called “super-bugs” develop which are resistant to the majority of antibiotics we have available. Scientists developing new antibiotics are already having trouble keeping up with the bugs. This is why the CDC and others have begun antibiotic stewardship campaigns encouraging health care providers to use antibiotics wisely and judiciously so they are there and effective when we really need them.

Finally, I want to emphasize that when I tell you that your child doesn’t need antibiotics or other medicines, it is not because I don’t believe that they are sick. Believe me, I’ve been there. But, take heart and realize two things:

  • If your child does not have a bacterial infection requiring antibiotics, this is a good thing. It means they do not have a potentially severe illness and will likely be back to themselves in a few short days.
  • There are a lot of things you can do at home to make your child feel better. For a few suggestions on treating the common cold, check out Dr. Arca’s great post. If you are facing vomiting and diarrhea, Dr. Swanson’s got you covered.

For much more about antibiotic stewardship and appropriate use of medications, see the CDC’s Get Smart campaign.

One thought on “Sometimes the Best Medicine Is None At All

  1. That is what I have been telling my grandma for years! Every time I sneeze, I have some silly ‘CILLIN’ come to my rescue: amoxicillin, is her all time favorite. I absolutely agree with the side effects of abics (antibiotics). Definitely refrain as much as possible from prophylactic abics. My experience as a microbiologist has taught me that a bacterial infection post viral invasion is actually helpful and a normal body process required for complete healing. Not all bacteria are dangerous. Some are friendly too, like the ones in our gut, don’t kill them! That’s why we get diarrhea sometimes. My family friend had an abnormal weight gain due to prolonged abic treatment, and she’s been shrugging it off as ‘puppy fat’ for 20 years now! I hope parents actually take note of this article. And for infants? best prophylactic antibiotic is mother’s milk.
    Again, great post doc 🙂

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