I recently read a fictional novel, “A Fall of Marigolds” by Susan Meissner.   It was a great book telling the parallel stories of two women overcoming loss in New York City, separated by 100 years.  These women were brave survivors of the triangle shirtwaist fire and 9/11. This book was beautifully written, highlighting the strength of the human spirit, and the power of friendship and love.  

What the author probably did not expect to do was to renew my admiration for antibiotics! One of the main characters worked as a nurse on Ellis Island. She cared for many immigrants suffering from scarlet fever. Many immigrants died from this, both en route to America and after their arrival. Scarlet fever is caused by the same bacteria that causes Strep throat! Huge hospital wards were filled with immigrants suffering from a disease we now treat with a routine course of antibiotics. Today, thankfully, we no longer lose loved ones to scarlet fever because of antibiotics.

However, even though antibiotics save lives everyday, they cannot cure all illness. This is because antibiotics only treat bacterial infections. In short, germs cause us to get sick. Germs can refer to viruses, bacteria or even fungus. Here’s a brief summary of each of these bugs:

Bacteria

Some bacterial illnesses include Strep throat, pneumonia, sinus infections, bronchitis, ear infections (both inner ear and swimmer’s ear), pink eye, meningitis and skin infections.  These illnesses typically require an antibiotic to clear the bacteria and assist your body in healing the infection. Antibiotics are medications that kill bacteria only.  

Viruses

The common cold, the flu, coxsackie hand/foot/mouth disease, the “stomach bug”, chicken pox and cold sores are caused by viruses.  Viruses can also cause ear infections, pink eye, pneumonia, bronchiolitis (a severe respiratory illness seen in babies) and meningitis.  We do have some medications that can help our body fight viruses (Tamiflu, for example) but they don’t typically work quite like antibiotics do.  Hence, Tamiflu can shorten the duration of the flu symptoms; but you won’t feel better in 24 hours like you do with Strep and amoxicillin!

Fungi

Fungi cause athlete’s foot, yeast infections, thrush in newborns and some diaper rashes.  We have another class of medications that cure these infections.

Antibiotic Resistance

It’s not appropriate for a doctor to prescribe an antibiotic for any and every illness.  We try to save antibiotics for only the specific bacterial infections that they can cure.  Antibiotics have side effects. Patients can develop an allergy to an antibiotic at any time in life.  Most importantly, bacteria become resistant to antibiotics. Therefore, if we use antibiotics when they are not needed, we are increasing the bacteria’s chances of becoming a “super-bug”, whose super-power is the ability to withstand antibiotics.  Once we create these “super-bugs” we will have to use stronger and stronger antibiotics. These super strong antibiotics often need to be administered directly into the veins (through an IV) and tend to have stronger side effects.

Appropriate Antibiotic Use

When your child does have a bacterial infection, the antibiotic is absolutely necessary!  Strep throat, pink eye, bacterial pneumonia, swimmer’s ear, ear infections, impetigo, cellulitis and urinary tract infections to name just a few!  In these cases, it’s very important that the antibiotic prescribed be taken exactly as directed. Antibiotics should be taken according to schedule and for the exact number of days prescribed.  Even though the child may feel better after 24-48 hours on antibiotics, the bacteria causing the illness is not fully eradicated until the full course is completed.  

Viral or Bacterial?

It’s important to remember that most childhood illnesses are caused by viruses.  In these cases, an antibiotic will not help. Certain illnesses can be caused by either a virus or bacteria, such as ear infections, pink eye, meningitis and pneumonia.  This is why it’s important to bring your child to the doctor when he or she is sick for more than just a few days, has severe symptoms, or is very young. In these cases the doctor first has to determine whether it is a virus or bacteria causing the infection and then he or she can treat with the correct medication.  

So unfortunately, when your child spikes a 103 fever the night before you leave for vacation, then you go to your doctor’s office looking for a “quick fix” and your doctor doesn’t prescribe an antibiotic; go easy on him or her.  It’s not that we want to ruin your vacation. We’re just terribly afraid of “super-bugs”.