Risks Higher For Young Children
The researchers came up with their estimate of using data from an ADE surveillance project based on a nationally representative sample of hospitals, and from national estimates of oral antibiotic prescriptions dispensed from retail pharmacies. The cases included ED visits that the treating clinician attributed to the use of a systemic antibiotic.
More than 95% of the ED visits for antibiotic ADEs involved a patient on a single antibiotic, mainly oral antibiotics. Amoxicillin, which is commonly prescribed in children for conditions such as acute ear infections, was the most frequently implicated antibiotic in children aged 9 and younger, while sulfamethoxazole/trimethoprim was the most common cause of adverse events in children 10 to 19 years old.
After accounting for prescribing frequency, the researchers calculated that, for all antibiotics except sulfamethoxazole/trimethoprim, the risk of an ED visit for an antibiotic ADE was higher for young children than for older children. The rate of ED visits for adverse reactions to amoxicillin, for example, was four times higher for children 2 years and younger than for 10- to 19-year-olds. Fleming-Dutra said there are a number of reasons for this, including the fact that younger children get more antibiotics than older children and are more susceptible to allergic reactions to antibiotics. But she also suggested that parents are more likely to react to an adverse event in a young child.
Risks Involved In The Overuse Of Antibiotics
Antibiotic overuse is a major problem because many worried parents often demand them as a safety precaution to simple conditions such as common colds and flu. Its much easier for a doctor to prescribe an antibiotic rather than take time and explain to the parents as to why it shouldnt be overused.
Antibiotics are also available over the counter, and often, people self-medicate improperly. Some parents also give antibiotics to their babies when they are sick. This practice should be avoided completely to prevent further medical complications.
Agriculture and animal farming also use antibiotics extensively to fight diseases and improve their yield. The overuse of antibiotics is beefing up the bacteria while our immune systems are not strong enough to keep up with them naturally, which increases the risk of outbreaks of dangerous diseases.
When you and the paediatrician are 100% sure that your baby needs antibiotics, you need to ensure you keep a few things in mind to help your baby heal faster with no or fewer side-effects. Heres how you can use antibiotics wisely.
Other Points To Consider
For children with chronic complex conditions, the clinical profile and causative medications of spontaneous ADR are different i.e., medicines that are more frequently prescribed for a more extended time result in higher incidence of adverse reactions. A high frequency of off-label prescriptions to younger subjects is prone to cause adverse reactions . Polypharmacy is a constant risk factor of ADR . Female sex is a risk factor of ADR in adults but not in children . Although biologics are increasingly prescribed these days, there is no specific report to date on the prevalence of risk factors of ADRs to these drugs in children.
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Antibiotics For Ear Infections
Antibiotic misuse is most likely to occur in children with ear infections , the number one reason a child is brought to a doctor. Antibiotic therapy is the most common treatment of ear infections, with amoxicillin being the first choice by doctors. The side effects of amoxicillin include upset stomach, diarrhea, allergic reactions, and diaper rashes. These side effects may seem minor, but are these antibiotics actually necessary for otitis media?
The purpose of antibiotics is to kill harmful bacteria. Otitis media means middle ear inflammation not necessarily bacterial infection. Many cases are caused by allergies, particularly to milk and dairy products. In a significant number of cases of otitis media, the middle ear contains no harmful bacteria. In a Dutch study of 2,975 children, it was found that 88% of children with acute otitis media did not need antibiotics. Other studies in the U.S. and Scandinavia came to similar conclusions.
Another cause of ear infection may be an obstruction to the eustachian tube, due to misalignment of the bones of the jaw, skull or neck. Craniosacral work, chiropractic care or osteopathy would be especially helpful to release the blockage to allow drainage of the fluid.
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We should be careful in stressing this is an association and not a cause and effect relationship, said Dr. Purvi Parikh, an allergist and immunologist at NYU Langone Health in New York and a spokesperson for the Allergy and Asthma Network, who was not involved in the new research.
One reason why there might be an association is because, our microbiomes, specifically in our gut, play a large role in our immune systems. Antibiotics are known to not only kill the bacteria that are causing an infection but also good bacteria our immune system needs to protect us from developing allergic or autoimmune diseases, Parikh said.
She added that the research is helpful in the sense that it further affirms what we know about antibiotic use being associated with microbiome changes, which may lead to various immune diseases such as allergic conditions.
Overall, parents should know this study shows an association but not necessarily cause and effect. So, if a child truly needs an antibiotic for a bacterial infection, they should not withhold it due to fear of allergic disease, she said. However, on that same note, one should not over use antibiotics if not needed for a virus or a cold as there may be long-term consequences from over use.
When Do Babies Need Antibiotics
Babies need antibiotics only if they are suffering from these common childhood ailments:
High Fever from a Bacterial Infection.“A fever indicates that the body’s immune system is fighting off germs,” says Dr. Munjal. This is a good thing, but temperatures that spike too high may signal a more serious bacterial infection. If this is the case, antibiotics such as ampicillin or cefotaxime, or both, may be required.
Pneumonia. It’s difficult to determine whether the cause of this lung infection is viral or bacterial. Symptoms of pneumonia usually start with fever, coughing, shortness of breath, and/or vomiting. Because infants have a higher risk of complications from pneumonia, including death, pediatricians often prescribe antibiotics such as amoxicillin, ampicillin, and penicillin, even if they aren’t positive that it’s a bacterial infection.
Pertussis . Antibiotics are most effective when started within the first week or two of this respiratory disease, when early symptoms include a mild cough or fever, before the signature whooping cough begins. Azithromycin is typically the first choice for treating pertussis other options include clarithromycin and erythromycin. The best way to prevent whooping cough is to ensure your baby is caught up on recommended vaccinations, and to encourage any caregivers for your baby to get vaccinated as well.
What The Study Found
Using national data on emergency room visits between 2011 and 2015, CDC researchers estimated that 69,464 annual visits were made by children younger than 19 who were experiencing antibiotic-related adverse events.
The vast majority of these events86.1 percentinvolved some kind of allergic reaction. Fleming-Dutra notes that there was a broad spectrum of what could constitute an allergic reaction, from anaphylaxisthe severe, life-threatening condition often seen with peanut or bee-sting allergiesto mild rashes and gastrointestinal issues. Seventy-seven percent of all the problems counted in the study were considered mild allergic events.
The antibiotic side effects that were not allergic reactions were most commonly things like diarrhea and diaper rash in younger children and gastrointestinal issues, such as nausea, vomiting, diarrhea, and abdominal pain, in older children. Headaches and yeast infections were less common reactions, and certain antibiotics produced rare side effects like light sensitivity.
The researchers observed the most adverse events among children younger than 2fully 1 in 400 children two or younger visits the ER each year with a reaction to antibiotics. The older the child, the less likely they were to have a negative reaction to antibiotics.
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What Parents Should Know
Sawyer says discussion of the pros and cons of antibiotics has increased in recent years, and that fewer physicians are prescribing them needlessly for, say, viral infections.
And the growing body of research on the risk of antibiotic side effects and the harms of overusethe CDC published a similar study on adverse reactions in 2016can help shift the conversation between parents and doctors.
I think nervous parents can sometimes push and push pediatricians for antibiotics, because theyre seen as a quick-fix for all kinds of sickness, he says. Studies like this can help people understand they arent always the answer.
The next time you bring your child to the pediatrician, either with an ailment that may require antibiotics, or with symptoms of an adverse reaction to the drugs, here are some things you should know.
Coughs and runny noses typically do not require antibiotics. These drugs cant do anything to fight colds and other viruses. If your childs symptoms are severe, you can certainly bring them to the doctorjust know that antibiotics probably wont be the answer.
Sore throats are not treatable with antibiotics, unless your child has strep. Parents sometimes assume a childs sore throat is caused by the bacteria streptococci , and is therefore treatable with antibiotics. In roughly 80 percent of cases, however, sore throats are viral in origin. Your pediatrician should test for strep before prescribing antibiotics.
How To Safely Take Antibiotics In Pregnancy
The best way to take your antibiotics is to follow your doctors instructions. Because antibiotics have been used too much in the past, your doctor might be careful about what they give you.
Your doctor will choose the best type for you. They might think about other factors before giving you antibiotics. These might include:
- Avoiding antibiotics in the first trimester
- Testing to confirm the type of infection
- Giving the smallest dose possible
- Giving antibiotics for the shortest time possible
- Using only one type of antibiotic
- Only giving antibiotics when necessary
Antibiotics can interact with other medications or over-the-counter drugs. Your doctor might tell you not to take antibiotics with any other medicine.
Take as directed. Sometimes when you take antibiotics you start to feel better right away. Its important to take your medicine until its finished and the way your doctor says. This might help stop the bacteria from becoming resistant to the medicine.
Use other safe remedies. If you have a common cold or other minor conditions, your doctor likely wont give you antibiotics. Instead, ask about other over-the-counter medicine that is safe for you to take when you’re pregnant. Other self-care practices for the common cold might be helpful, including:
- Hot shower
- Saline nasal spray
- Warm salt water gargle
If you dont get better or you have new symptoms, make sure to talk to your doctor to rule out more serious conditions.
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Symptoms Of A Penicillin Allergy
A penicillin allergy can cause life-threatening allergic reactions, but fortunately, most kids with a penicillin allergy have more mild reactions, leading to simple skin rashes such as hives.
Children with more severe symptoms will experience hives as well as wheezing, difficulty breathing or swallowing, or swelling in their mouth or throat, as well as anaphylaxisa serious allergic reaction.
If your child just has hives , you will likely notice red or pink raised areas on your child’s skin that are itchy, varied in size, and come and go over several hours. They often don’t go away completely, though. Instead, older hives go away in one part of your child’s body, while new ones continue to appear somewhere else. Any individual hive shouldn’t last more than 24 hours. If it does, then your child may have a similar skin rash, such as erythema multiforme, and not simple hives.
Erythema multiforme is an uncommon type of immune system reaction that can also be caused by a penicillin allergy or things like other drugs, bacterial infections, or viral infections. Unlike hives, which come and go, the rash from erythema multiforme usually continues to spread and may last for one to two weeks. Other symptoms of erythema multiforme can include fever, joint aches, mouth sores, and red eyes.
What Antibiotics Are Safe For Kids
1. Propolis is Beneficial and Indispensable for Children. Propolis is one of the best natural antibiotics for kids. It is often called Natures premier preventive, while in Russia it has even been nicknamed Russian penicillin, due to its extensive use in this country.
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Antibiotic Choice For Children With Penicillin Allergy
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It is not uncommon for caregivers or older pediatric patients to inform their pediatric health care provider of an allergy to penicillin. The lay public often loosely uses the word allergy with regard to medications, but hearing penicillin allergy by a health care provider is likely to raise a red flag. Eliminating the use of penicillin, amoxicillin and other beta-lactam antibiotics because of an allergy presents significant implications for antibiotic choice and infectious disease treatment.
Types of reaction
As readers of this column are aware, perhaps the most useful question to ask a caregiver or patient about a penicillin allergy is the type of reaction the patient experienced. A history of nausea, vomiting, loose stools or diarrhea when the antibiotic was taken may have been distressing to the caregiver or patient, but these effects are certainly not indicative of a type I allergic reaction the allergic reaction that is most concerning to health care providers.
Edward A. Bell
Cephalosporins as an alternative
Likely not a true allergy
Campagna JD. J Emerg Med. 2012 42:612-620.
For more information:
Disclosure: Bell reports no relevant financial disclosures.
What Are The Signs And Symptoms Of An Allergic Reaction To An Antibiotic
- Mild symptoms include red, itchy, flaky, or swollen skin. You may have a flat, red area on your skin that is covered with small bumps. You may also have hives.
- Severe symptoms include skin that blisters or peels, vision problems, and severe swelling or itching. Severe reactions include conditions such as toxic epidermal necrolysis . Ask your healthcare provider for more information on TEN and other serious conditions.
- Anaphylaxis symptoms include throat tightness, trouble breathing, tingling, dizziness, and wheezing. Anaphylaxis is a sudden, life-threatening reaction that needs immediate treatment. Anaphylaxis may occur if you exercise after exposure to a trigger, such as after you take an antibiotic.
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Is The Amoxicillin Rash Dangerous
An amoxicillin rash by itself is not dangerous. But if the rash is being caused by an allergy, the allergy could be dangerous to your child. Allergic reactions tend to get worse the more the allergen is exposed.
Your child could develop an anaphylactic reaction and stop breathing if you continue to give them the medication.
Allergic Reaction To Amoxicillin Symptoms
One of the most common infections that almost every child suffers in his/her lifetime is a painful ear infection, and it kills the childs parents to see the child in such pain and agony. This condition can be treated with amoxicillin, but there are chances that an allergic reaction may take place and manifest itself in red blisters which resemble chickenpox and can be very itchy.
An allergic reaction to amoxicillin in children can also result in hives and the worst case scenario can be anaphylaxis . About 6% of kids who take amoxicillin suffer from an allergic reaction and this allergic reaction can result into frequent itching and unexplained swelling of the body, especially of the face, throat, lips and tongue. Difficulty in breathing is also an allergic reaction to amoxicillin, if immediate treatment is not taken kids may become unconscious and suffer from anaphylaxis which could be life-threatening.
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Help My Kid Is Having An Allergic Reaction To Antibiotics
As a parent, its important to know the signs of an allergic reaction to antibiotics and what to do should the situation arise. Heres the 411 on what to do if your child is having an allergic reaction to an antibiotic.
What does an allergic reaction to an antibiotic look like?
The most common allergy trigger for individuals with drug allergies is penicillin. However even though penicillin is a very common antibiotic, The American College of Allergy, Asthma, and Immunology estimates approximately 10% of patients report being allergic.
The most common sign of an allergic reaction to medication is a rash or hives spread all over the body. Depending on the reaction, the reaction could be flat or bumpy and raised.
Other signs of a reaction include:
- Abdominal pain and vomiting
What do you do if your child is having an allergic reaction to an antibiotic?
If you suspect your child is having an allergic reaction to an antibiotic, heres what you should do:
- Dont give your child another dose of the medication without talking to your doctor. Remember even if you stop giving your child the medicine, it will need time to work its way out of your childs system.
What should I do after an allergic reaction?
Once your child has had an allergic reaction, constant vigilance is key to preventing another allergic reaction. Heres a few precautions to take:
- Update your childs medical history forms on file at school with the new allergy.