Sick Kids Might Do Best Without Drugs
Antibiotics have been called wonder drugs, and that they are—sometimes. Increasingly, however, researchers focused on children's health are identifying conditions in which the drugs seem to be useless, or worse. One recent study, for example, suggests that preventive use of antibiotics doesn't help kids who've previously had urinary tract infections. Another indicates that use of antibiotics for any purpose may increase kids' risk of developing asthma.
Only a small percentage of children develop UTIs. But about a third of those who do have a condition in which urine flows backward into the bladder, which puts them at high risk of getting reinfected. For those kids, doctors often prescribe daily antibiotic therapy in hopes of preventing a recurrence.
This daily preventive treatment isn't effective, according to a study published Wednesday in JAMA, the Journal of the American Medical Association. Moreover, children who developed a recurrent UTI during the study were more than seven times as likely, if they had received daily antibiotics, to have a drug-resistant infection rather than one that could be treated with common antibiotics.
"The more antibiotics a child is exposed to, the more likely [he or she is] to develop a resistant infection," says Patrick Conway, a pediatrician now at Cincinnati Children's Hospital and leader of the study. He and other doctors say that an increase in resistant bacteria is leading to more serious infections and hospitalizations from what used to be easily treated ailments, especially in children.
It's hard to keep the big picture in mind when a child is sick, concedes Conway. However, he says, parents and doctors should carefully weigh the risks and benefits of antibiotic treatment before administering the drugs. In children, antibiotics can cause side effects like diarrhea and skin rashes.
In a separate study, Anita Kozyrskyj of the University of Manitoba in Canada and her colleagues found that children who had received multiple courses of antibiotics in the first year of life faced an increased risk of developing asthma later on. Kids who got four or more courses of antibiotics increased their risk by 1 1/2 times, the researchers reported in the June issue of the journal Chest.
One explanation for this finding, according to Kozyrskyj, is that exposure early in life to a variety of germs helps the immune system develop normally. Indiscriminate antibiotic treatment could interfere with that development. "This hypothesis basically says that the world has become too clean," says Kozyrskyj. "If you're exposed to germs in early life, you're less likely to develop allergic diseases such as asthma." (The idea is supported by another of the study's findings: Infants exposed to dogs, which presumably bring babies into contact with a host of unfamiliar germs, have low rates of asthma.)
Pediatricians don't suggest abandoning antibiotic treatment entirely, but many now recommend a period of "watchful waiting" before treating illnesses like ear infections with antibiotics. Conway points out that a large proportion of childhood illnesses are caused by viruses, which are immune to antibiotics and, in any case, usually clear up on their own within a few days.