When you can give antibiotics to children?

Principles of antibiotic

Antibacterial drugs should be used only for infections caused by bacteria. In the hospital for severe and life-threatening infectious diseases (such as meningitis — inflammation of the meninges, of pneumonia — inflammation of the lungs, etc.) responsible for the selection of the correct medication rests entirely on a physician, which is based on the observation of the patient (clinical) and the results special studies.

For mild infections occurring in the "home" (outpatient) conditions, the situation is fundamentally different. The doctor examines the child and prescribe medication, sometimes accompanied by explanations and answers to questions, sometimes — not. Often, parents are asking doctors prescribe antibiotics. In such situations, the pediatrician sometimes psychologically easier to write a prescription than to risk their reputation and take the time to explain the purpose of this inexpedient.

In any case, the doctor must follow two main principles of antibiotic therapy:

• Fast assignment of the most effective drugs in cases where their effect is inconclusive.
• The maximum reduction in antibiotic use in all other cases.

Reliable outward signs or simple and inexpensive laboratory methods to distinguish between viral and bacterial origin of respiratory tract infections, unfortunately, no. At the same time, we know that acute rhinitis (runny nose), andsharp bronchitis (inflammation of the mucous membrane of the bronchi) are almost always caused by viruses, and tonsillitis (inflammation of the tonsils and pharynx) sharp otitis (Inflammation of the ear) and sinusitis (inflammation of the mucous membranes of the paranasal sinuses) to a large proportion of cases — bacteria.

It is natural to assume that the approaches to antibiotic therapy of individual acute upper respiratory tract infections should be slightly different.

Runny nose and bronchitis

In acute rhinitis (runny nose) and bronchitis antibiotics are not shown. In practice it occurs differently: one or two day fever, and cough in a child's parents, typically do not provide antibacterial baby. But then they start to fear that become complicated pneumonia, bronchitis, and decide to use antibiotics. It is worth noting that a possible complication, however, it is virtually independent of the preceding receiving antimicrobials. The main signs of pneumonia is worsening (further rise in body temperature, increased cough, dyspnea appearance). In such a situation it is necessary to immediately call a doctor who will decide whether or not to adjust the medication.

If the condition is not getting worse, but not significantly improved, the apparent reason for the appointment of antibacterial drugs is not. However, during this period, some parents do not stand up and start giving drugs to children "just in case".

It should be emphasized that a very popular destination criterion antibiotics for viral infections — saving an elevated temperature for 3-x days — absolutely no way justified. The natural duration of the febrile period in viral respiratory tract infections in children varies considerably, may fluctuate from 3 to 7 days, and sometimes more. Longer retention of the so-called low grade temperature (37,0-37,5⁰C) is not necessarily associated with the development of bacterial complications, and may be the result of very different reasons. In such situations, the use of antibiotics is doomed to failure.

A typical sign of a virus infection is persistent cough in the background of improving the general condition and the normalization of body temperature. Keep in mind that antibiotics are not antitussives. The parents in this situation, there is ample scope for the use of people's antitussives. Coughing is a natural protective mechanism disappears and the last of all the symptoms of the disease. However, if a child has an intense cough persists 3-4 or more weeks to look for its cause.

Otitis

In acute otitis media tactics antibiotic therapy is different, because the probability of bacterial origin of the disease reaches 40-60%. Given that, until recently, antibiotics administered to all patients.

Practice shows that for acute otitis media is characterized by intense pain in the first 24-48 h, then the majority of children the state is greatly improved and the disease resolves on its own. After 48 hours the symptoms persist only a third of young patients. There are interesting calculations showing that if the antibiotics given to all children with acute otitis media, then some relief (reduction of febrile period and duration of pain), they can provide only those patients who should not have happened independent speedy recovery. So maybe only one child out of 20.

What will happen to the rest of 19th children? When receiving penicillin group of modern drugs, such as amoxicillin or augmentin, nothing really bad will happen. In2-3 Children may develop diarrhea or skin rashes appear that quickly disappear after drug withdrawal, but the recovery is not accelerated. As with bronchitis, appointment antimicrobials for otitis does not prevent the development of septic complications. Complicated forms of otitis media with the same frequency as developed in children treated and not treated with antibiotics.

There are currently developed new tactics to use antibiotics for acute otitis. Antibacterials appropriate to prescribe to all children under the age of 6 months, even with a questionable diagnosis of acute otitis media (to find out that a young child's ear ache is not that simple).

At the age of 6 months to2-x years with a questionable diagnosis (or less severe) acute otitis media treatment with antibiotics can be postponed, limiting the supervision of the child — the so-called watchful waiting. Naturally, during the observation of the children should be given pain medication and, if necessary, antipyretics. If during the 24-48 h his condition did not improve, it is necessary to start antibiotic therapy.

Of course, in this case the parents are increased requirements. First of all, you need to discuss with your doctor when to give antibiotics, and to clarify what the signs of the disease should pay attention to. The main thing is to be able to objectively assess the dynamics of pain, its gain or reduction, and the time to notice the signs of the emergence of new diseases — cough, rash, etc. Parents should be able to contact the doctor on the phone, and be available for a prescription for an antibiotic.

In children older than 2 years of waiting and watching for 48 hours is the preferred tactic, except in cases of severe (temperature above 39⁰C, intense pain) disease.

Pneumonia

When the diagnosis of pneumonia or serious suspicions of this pathology tactics antibiotic therapy is different from the previous two cases.

For different age groups of children characterized by certain features of the prevailing pathogens. Thus, under5-6 years, according to some researchers up to 50% of case
s 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 pneumonia. However, in all age groups common cause of the disease is Streptococcus pneumoniae, which causes severe course of the disease. It is therefore Pneumonia is an absolute indication for antibiotic therapy.