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Kids with routine respiratory infections do not benefit from antibiotics, study finds

The overprescribing of antibiotics contributes to the very serious problem of antibiotic resistance, the ability of bacteria to resist the effects of the drugs.

Antibiotics are not helpful in reducing the risk of complications in young children who have upper respiratory tract infections, a new review from the Cochrane Collaboration has found.

The review, which was conducted for Cochrane by a team of Brazilian researchers, analyzed data from four previously done randomized, controlled trials (the “gold standard” in research). The studies involved more than 1,300 children under the age of 5 with acute respiratory infections. Three of the studies had investigated the use of antibiotics to prevent ear infections; the other study had looked at the use of the drugs to prevent pneumonia.

The Cochrane reviewers found no evidence that giving antibiotics to children with upper respiratory infections prevents either type of complication.

This finding shouldn’t be big news. Reports about the overprescribing of antibiotics — to adults as well as children — have been in the media repeatedly in recent years.

Just last fall, a study in JAMA Internal Medicine reported that doctors prescribe antibiotics for sore throat and acute bronchitis (“chest colds”) at rates that are 5 to 7 times higher than needed.

The overprescribing of antibiotics is not just a waste of medical resources. It also contributes to the very serious problem of antibiotic resistance, the ability of bacteria to resist the effects of the drugs. In 2013, the U.S. Centers for Disease Control and Prevention issued a “threat report” on the dangers this problem poses to all of us. Each year, the report pointed out, more than 2 million Americans come down with infections from antibiotic-resistant bacteria, a factor that leads to at least 23,000 deaths annually.

And those numbers are growing.

Pressure from parents

Still, many parents — as well as many pediatricians and other primary care physicians — aren’t getting the message. As background information in the Cochrane study points out, upper respiratory infections — including those with symptoms such as sore throats, sinus infections and ear infections — are the leading reason why parents in the United States (and many other developed countries) take their children to the doctor.

Many of those parents pressure their child’s pediatrician for antibiotics, and, too often, the physicians comply. In fact, say the authors of the Cochrane review, research suggests that upper respiratory infections are responsible for 75 percent of the total amount of antibiotics prescribed to children in developed countries.

Yet, antibiotics are ineffective against most upper respiratory tract infections. These illnesses are almost always caused by viruses, not bacteria, and they typically go away without any medication, usually within two to 14 days.

Serious bacterial complications can result from upper respiratory infections, but such complications are very rare, especially in the United States and other developed countries, the Cochrane reviewers point out.

Guidelines for parents

So, when does your child need antibiotics? The American Academy of Pediatricians says antibiotics may be needed if:

  • A cough does not get better in 14 days.
  • A bacterial form of pneumonia or whooping cough (pertussis) is diagnosed.
  • Symptoms of a sinus infection do not get better in 10 days, or they get better and then worse again.
  • Your child has a yellow-green nasal discharge and a fever of at least 102° F for several days in a row.
  • Your child has strep throat, based on a rapid strep test or a throat culture. Antibiotics should not be prescribed unless one of the tests shows strep. Strep cannot be diagnosed just by looking at the throat.

For all other children with upper respiratory infections, the AAP recommends rest, fluids — and parental patience.

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Comments (3)

  1. Submitted by Lance Groth on 02/20/2014 - 11:48 am.

    Old news?

    I guess I thought this was already well established.

    But, one thing people should get onto with respect to sinus infections is silver hydrosol nasal spray. It works better than antibiotics, usually knocking the sinus infection out in just a few days.

    I used to get 4-5 sinus infections a year. I’d go to a doctor, get an antibiotic prescription (usually amoxicillin, which is so weak and so widely resisted by bacteria that I think it ought to be retired for 50 years or so), and it would knock the infection back for a couple of months or so. Then it would return. I don’t think it ever really went away, it was probably the same chronic infection. Then I tried silver hydrosol nasal spray. It knocked the infection out, so thoroughly that I could go a year without another infection. I haven’t had to see a doctor about a sinus infection for 3 or 4 years now. It’s available over the counter, fairly cheap (about $15 for one bottle), and just works.

    It also has the virtue that bacteria cannot develop resistance to silver. Silver works by being absorbed into the bacterial cells and binding to the cellular machinery needed to process oxygen – so the bacteria just suffocate. It’s been used for thousands of years to keep water and milk fresh longer (Alexander the Great put silver in water barrels on his ships for this reason, and our pioneer ancestors put silver coins in water and milk containers for the same reason).

  2. Submitted by Matt Haas on 02/20/2014 - 03:22 pm.

    Yes we COULD try snake oil

    Or just learn basic biology. AntiBIOTICS don’t kill viruses. But then that might require folks to actually think and we couldn’t have that. No wonder “Miracle” cures that “Doctors don’t want you to know about” find such traction in our increasingly scientifically ignorant and ever gullible society.

    • Submitted by Lance Groth on 02/20/2014 - 08:19 pm.

      Biology, indeed

      I’ll assume this was intended as a reply to my post, because it makes no sense as a general post about the article, and will deal with the facts accordingly, ignoring the snark (except to note that emotional load is almost always the hallmark of “arguments” that are short on facts).

      First, a clarification. I should have specified “bacterial sinus infections”. Sinus infections can be either bacterial or viral in nature. I happen to know a lot about sinus infections, having suffered through so many of them. Chronic infections are by definition bacterial, as viral infections burn themselves out within a couple of weeks. There is no help for viral infections in any case, other than time. When you’ve had an infection going 8-10 weeks, as I have at times, it is bacterial.

      It is true that antibiotics do not kill viruses. The article is clear about that. Silver ions are not an antibiotic, although they are anti-bacterial, for reasons I already described. Silver will not kill viruses either. Silver works specifically against bacteria by interfering with their ability to process oxygen.

      That silver kills bacteria, and how it does so, is not in dispute by anyone. Indeed, NASA astronauts wear clothing containing silver threads, and/or silver coated fabric. Why? Because it kills the bacteria which produce body odor (which can be quite a problem in the confines of a spacecraft). It works so well that they only need to change their shirts and undies every 7 or 8 days. Copper oxide and compounds of ammonium also work, and there has been some experimentation with those.

      So, with bacterial sinus infections, you have three choices. Do nothing, in which case it will not get better, and may develop into something more serious. Or, use an antibiotic, which will help, but is not completely effective. Why? Because the antibiotic kills the infection inside the tissue, but is not very effective at killing the bacteria living on the surface of the tissues. That’s why an infection will get knocked back for a while, but then reappear – the surface bacteria continually reinfect the tissues. Meanwhile the repeated application of antibiotics contributes to the problem of antibiotic resistance. Or, third choice, spray the tissues with silver ion solution. This kills the surface bacteria, and some will also be absorbed. My experience is that it reliably knocks out infections in 3-4 days, and they do not recur for many months or a year or more (meaning that when it does, it is a new infection, not re-appearance of a chronic infection). It is nontoxic and does not contribute to antibiotic resistance.

      Research beats snark every time. Google is your friend.

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