Antibiotics: When Do We Really Need Them?

On Call for All Kids - When Do We Really Need Antibiotics?

Antibiotics are a major tool in treating illnesses caused by bacteria, but like any tool, they should be used appropriately. If they are not, the tool may not work when we really need it. The Centers for Disease Control and Prevention reports that at least one-third of pediatric antibiotic prescriptions are unnecessary.

On this week’s On Call for All Kids, David Berman, D.O., FAAP, FPIDS, a pediatric infectious disease specialist at Johns Hopkins All Children’s, and Katie Namtu, Pharm.D., pharmacy clinical coordinator, explain when we do, and do not, need antibiotics, just in time for U.S. Antibiotic Awareness Week, Nov. 18-24.

When do we need antibiotics?

Antibiotics are for bacterial infections only. This includes infections such as bloodstream infections, skin abscess/impetigo, bacterial pneumonia, urinary tract infections, streptococcal pharyngitis and some middle ear infections. Certain antibiotics should be used very infrequently in children, such as azithromycin, commonly known as the “Z-Pak,” so it’s important to ask your child’s doctor what is truly necessary for their bacterial infection.

When should we NOT use antibiotics?

Colds, sore throats, upper respiratory infections and influenza — “the flu” — are caused by viruses, which antibiotics won’t kill, prevent or stop from spreading. The only treatment for a cold is rest and time. While your child may not feel his or her best, it’s important to remember that within 10-14 days, symptoms will likely improve and there’s no need to take an antibiotic.

What are the possible reactions and side effects of improper antibiotics use?

Research shows that about 70,000 kids visit the Emergency Center each year due to reactions from antibiotics. When inappropriately prescribed, adverse events can occur like diarrhea, and liver and kidney injuries. Antibiotics can interact with other medications you might be taking and allergic reactions can also occur, which are sometimes life-threatening, resulting in Emergency Center visits.

Are there risks to taking antibiotics even when needed?

Even when taken appropriately, antibiotic adverse events are still possible, so parents should monitor their children closely and ask their health care provider questions like, “Does my child absolutely need this?” and “Is this the right antibiotic?”

Additionally, 90 percent of patients who report a penicillin allergy are not truly allergic and can receive penicillin or similar antibiotics safely. A rash during a childhood viral illness or gastrointestinal side effects from an antibiotic may have been called an allergy.

Unfortunately, once someone is labeled in their record as having a penicillin allergy, it is difficult to remove that label. This results in prescribing broader-spectrum, more expensive, and less safe antibiotics. Dr. Berman encourages families to talk to their child’s provider in depth about these concerns before they officially mark down a penicillin allergy.

The chart below shows examples of when your child does and does not need antibiotics. Always remember, antibiotics do not treat viruses, so never ask your doctor to prescribe you an antibiotic for a virus.


A chart depicting where different common conditions are bacterial or viral in nature and whether antibiotics may be needed
On Call for All Kids is a weekly series featuring Johns Hopkins All Children’s Hospital medical experts.

Johns Hopkins All Children's Infectious Disease Specialists

The pediatric infectious diseases specialists at Johns Hopkins All Children’s Hospital in St. Petersburg, Florida, provide expert care for children of all ages with a variety of infections. Our physicians are experienced in diagnosing and treating children with complex, hard-to-treat infections, and caring for very ill or immunocompromised children with infections, including children with cancer or heart disease, post-surgical patients and neonatal patients.

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