Antibacterial drugs should be used only for infections caused by bacteria. In the hospital with severe and life-threatening infectious diseases (such as meningitis — inflammation of the meninges, pneumonia — inflammation of lungs, etc.) responsible for the correctness of the choice of medication rests with the doctor, which is based on data of monitoring the patient’s condition (clinical picture) and on the results of special studies.
In mild infections occurring in the “home” (outpatient) conditions, the situation is fundamentally different. The doctor examines the child and prescribes medicines, and is sometimes accompanied by explanations and answers to questions, sometimes not. Often parents ask the doctor to prescribe an antibiotic. In such situations, the pediatrician sometimes psychologically easier to write a prescription than to risk their reputation and spend the time to explain the impracticality of such appointment.
The Doctor should follow two main principles of antibacterial therapy:
- The Fast assignment of the most effective drugs in cases where their effect is proved.
- Minimize the use of antibiotics in all other cases.
Reliable external signs or simple and inexpensive laboratory methods to distinguish between viral and bacterial nature of respiratory tract infections, unfortunately, no. At the same time, it is known that acute rhinitis (common cold) and acute bronchitis (inflammation of bronchial mucosa) is almost always caused by viruses, and tonsillitis (inflammation of tonsils and throat), acute otitis (ear inflammation) and sinusitis (inflammation of the mucous membrane of the sinuses) in a large proportion of cases is bacteria.
It is natural to assume that approaches to antibacterial therapy of separate acute infections of the upper respiratory tract should be slightly different.
Runny nose and bronchitis – antibiotic treatment
In acute rhinitis (common cold) and a bronchitis antibiotics are not indicated. In practice everything is different: one or two days high temperature and the coughing of the child’s parents, as a rule, do not give the baby antibiotics. But then they begin to fear that the bronchitis was complicated by pneumonia, and decide to use antibiotics. It is worth noting that this complication is possible, but it practically does not depend on prior acceptance of antibacterial drugs. The main signs of developing pneumonia is deteriorating (further increase in body temperature, increased cough, dyspnea). In such a situation should immediately call the doctor who will decide whether to adjust the treatment.
If the condition is not deteriorating, but not significantly improved, the apparent reason for antibiotic prescription no. However, during this period, some parents do not stand up and start giving drugs to children “just in case”.
It should be particularly noted that a very popular criterion for appointment of antibiotics for viral infections — the conservation of high temperature in the course of 3 days — absolutely no founded. The natural duration of the feverish period at virus infections of respiratory ways at children considerably varies, fluctuations are possible from 3 to 7 days, sometimes longer. A longer preservation of the so-called subfebrile temperature (37,0-37,50C) is not necessarily associated with the development of bacterial complications, and may be due to quite other causes. In such situations, the use of antibiotics is doomed to failure.
A typical symptom of a viral infection is a persistent cough with the improvement of the General condition and normalization of body temperature. It must be remembered that antibiotics are not antitussives. The parents in this situation have ample opportunity to use popular antitussives. Coughing is a natural defense mechanism, and disappears last of all symptoms. However, if the child has an intense cough persists for 3-4 weeks or more, we must look for its cause.
Otitis – antibiotic treatment
In acute otitis media tactics antibiotic therapy is different, because the probability of the bacterial nature of the disease reaches 40-60%. Given that, until recently, antibiotics were prescribed to all affected.
As practice shows, for acute otitis media is characterized by intense pain in the first 24-48 hours, then most of the children’s condition significantly improved and the disease goes away on its own. After 48 hours the symptoms persist only a third of young patients. There are interesting calculations showing that if an antibacterial drug is prescribed to all children with acute otitis, then some help (reduction of the feverish period and duration of pains) they can render only those patients that should not have happened independent speedy recovery. This can be only 1 child out of 20.
What will happen with the other 19 children? When the reception of modern preparations of penicillins, such as amoxicillin or Augmentin, nothing particularly terrible will happen. Have 2-3 children may develop diarrhea or skin rashes, which will quickly disappear after drug withdrawal, but recovery is not faster. As in the case of bronchitis, the appointment of antibacterial drugs in otitis does not prevent development of septic complications. Complicated forms of otitis media with the same frequency as developed in children treated and not treated with antibacterial drugs.
To date, developed the new tactics of antibiotic prescription in acute otitis media. Antibacterial drugs, it is advisable to assign all children under the age of 6 months even when questionable diagnosis of acute otitis media (find out what a young child hurts the ear, not so easy).
At the age of 6 months to 2 years at the doubtful diagnosis (or less severe) acute otitis media antibiotic therapy can be postponed, limiting the care of the child — the so-called expectant management. Naturally, during the observation of children should be given analgesics and, if necessary, antipyretic. If within 24-48 hours the condition does not improve, you should begin antibacterial therapy.
Of course, in this case to parents increased requirements. First of all, you need to discuss with your doctor when to give antibiotics, and clarify what signs of disease should pay attention. Most importantly, be able to objectively assess the dynamics of pain, its increase or decrease, and time to notice the appearance of new symptoms — cough, rash, etc. The parents should be able to contact the doctor by phone, and also to have the prescription for the antibiotic.
In children over 2 years of waiting and observation for 48 hours is the most preferable tactics, except for cases of severe (temperature above 390 With, intense pain) disease.
Treatment of pneumonia with antibiotics
When the diagnosis of pneumonia or serious suspicions on this pathology tactics of antibacterial therapy differs from two previous cases.
For individual age groups of children characterized by some features of the prevailing pathogens. So, at the age of 5-6 years, according to some researchers, up to 50% of cases of pneumonia can be caused by viruses. At older ages, the probability of viral pneumonia is significantly reduced and the role of bacteria (pneumococci) in the development of inflammation of the lungs. However, in all age groups frequent causative agent of this disease is Streptococcus pneumoniae, which causes a severe course of the disease. That is why pneumonia is the unconditional indication for appointment of antibacterial therapy.