Does My Child Need An Antibiotic? Understanding the Difference Between Viral vs. Bacterial Infections

Antibiotics have been one of the most amazing advances in medicine, preventing countless deaths and relieving suffering for conditions that historically had no treatment.

While antibiotics are critically necessary in particular infections, doctors must evaluate their necessity on a case by case basis. Bacterial infections often require antibiotics, but some infections (such as ear infections) that were once thought to require them, may be able to resolve on their own. Viral infections do not respond to antibiotics and thus should not be treated with them.

Two studies released in the past few months suggest that the use of antibiotics in infancy likely increases the risk of allergic disease in childhood. The research found the use of a particular type of antibiotic during the first trimester of pregnancy  (macrolides such as azithromycin), increases the risk of congenital anomalies.

Each year, thousands of kids flood the Cook Children's Emergency Department with bronchiolitis. Bronchiolitis is one of the most common illnesses pediatricians see. Lots of viruses can cause bronchiolitis, but the most well known is RSV.  In the past, doctors have tried breathing treatments like albuterol, steroid medicine, cough and cold medicine, and even sometimes antibiotics. We now know that these things don’t help and can make things worse.

"Antibiotics treat bacterial infections, not viruses like bronchiolitis. Giving your child antibiotics when they aren’t needed may cause diarrhea, and over time can cause bacteria to become resistant to antibiotics," Stacey VanVliet, M.D., wrote in her about post about this topic.

Even with more and more information warning against overuse of antibiotics, I hear from parents all the time wondering why I didn't prescribe them to their child.

So when should you give your child an antibiotic? Let's take a look.

What common bacterial conditions require antibiotics? The list is surprisingly short:

• Strep throat
• Whooping cough
• Urinary tract infection

The conditions require antibiotics, either for treating the infection or treating potential complications that can arise when they are not treated (or both). If you suspect your child has one of these conditions, it is important to have them evaluated.

Some common conditions for which antibiotics are often prescribed but could resolve on their own:

• Ear infections
• Sinus infections
• Bronchitis

For certain ear infections, antibiotics can be avoided. It is essential to talk with your doctor about your desire for this if you are interested. Many children with ear infections will get better without antibiotic treatment. Similarly, sinus infections can be both viral and bacterial. Talk with your doctor about whether treatment with antibiotics is necessary.

Bronchitis in kids is almost always a viral infection. It can be treated by treating the symptoms and allowing the passage of time.

There are some standard conditions for which treatment with antibiotics is not indicated. These infections are caused by viruses such as:

• Common cold
• Viral sore throat

Being cautious with antibiotic use is important for preventing unnecessary complications and side effects for you and your children. If you’re not sure, ask your doctor. The CDC provides a helpul guide on when antibiotics are necessary. Here's a quick version for you:

If you want to learn more about these or any other conditions, Cook Children's offers a great service "Ask a Librarian." Click here to learn more, but a Cook Children's librarian can send you information that is up to date and most importantly from reliable sources.

We've also written a ton on this topic for the newsroom:

• Does My Child Really Need An Antibiotic?
• What Is Cook Children's Doing About the 'Antibiotic Crisis'?
• Too many antibiotics not helpful, could cause harm
• 3 Myths About Antibiotic Use Every Parent Should Know
• Probiotics for Tummy Bugs: Do they Help Your Child?
• Is It Strep Throat or the Flu?
• Is It Croup or Whoop?
• Let's Learn About Whooping Cough?
• When It Comes to Your Kid's It's Never Just a Virus