Antibiotics are necessary and can even save lives, but they are also overprescribed and misused. When antibiotics are prescribed to children for viral (rather than bacterial) illnesses, they are ineffective and can cause lifelong changes to gut bacteria, metabolism, and the immune system. Read on to find out when antibiotics are appropriate, and learn strategies to reduce the need for antibiotics and to protect your children’s microbiome and future health.
Antibiotics are among the most frequently prescribed medications for children. One out of every five pediatric acute-care visits resulted in an antibiotic prescription (1). By age 20, the average American child has received 17 courses of antibiotics (2).
Unfortunately, overuse of antibiotics starts even earlier. In the U.S., about 40 percent of women get antibiotics during delivery, just as their babies are acquiring their crucial microbes. To top that off, most American-born babies are given an antibiotic immediately following birth. This was a historical practice designed to protect a newborn from eye infections if the mother had gonorrhea, but it is now regular practice, regardless of the mother’s STD status (3).
The worldwide rise in antibiotic resistance has alarmed the medical community. Pathogenic bacteria are becoming resistant to antibiotics. (4) Potentially dangerous bacteria that are immune to antibiotics could become “super bugs” that have no cure.
Fortunately, some doctors have cut back on their use of antibiotics and now prescribe them only when strictly necessary. However, as a parent, you still need to be watchful when antibiotics are prescribed to your children.
Many childhood illnesses do not benefit from antibiotics: colds, ear infections, and sore throats
Antibiotics kill bacteria, not viruses. Nonetheless, many doctors prescribe antibiotics for childhood illnesses that are viral, meaning that antibiotics are unlikely to have any effect. The two most common reasons for pediatric antibiotic prescriptions are upper respiratory infections and ear infections, of which 60 to 73 percent are estimated to be viral (5). Most childhood sore throats are caused by viruses too. Let’s take a look at each of these separately.
Upper respiratory infections (URIs) such as the common cold or the flu are mainly caused by viruses. As many as 80 percent of URIs are viral in nature and can be traced to microbes such as rhinovirus, parainfluenza, and metaphenumovirus (6). Antibiotics target bacteria only and have no effect on the outcome of viral infections. One study showed that antibiotics were prescribed about 57 percent of the time for acute respiratory tract infections despite the fact that only 27 percent were bacterial. Extrapolation of this data leads to an estimate that there are up to 11.4 million unnecessary prescriptions for antibiotics every year! (5)
Ear “infections” don’t necessarily benefit from antibiotics either. A recent systematic review found that 24 hours after the start of treatment, 60 percent of children had recovered from their ear infections, whether or not they received an antibiotic. Children in the antibiotic group were also more likely to experience adverse events such as rash, vomiting, or diarrhea (7).
When are antibiotics appropriate for children?
When researchers compared immediate antibiotic treatment to a “wait and see” approach, there was no improvement in pain associated with ear infection at follow-up visits and no difference in ear abnormalities or symptom recurrence. This makes you question whether antibiotics help at all in these cases. Antibiotics were most useful in children under age 2 with bilateral ear infections and discharge. In most other cases, a wait-and-see approach was best (7).
In fact, the medical term for “ear infection” is otitis media, which literally means “middle ear inflammation.” It does not necessarily indicate an infection. Some cases may actually be caused by food allergies or food sensitivities, most commonly to dairy products (8). Ironically, treating these cases with antibiotics may alter gut bacteria and further increase food sensitivities.
Sore throats shouldn’t typically be treated with antibiotics, either. In children under 5 years old, 95 percent of sore throats are viral. In older children (ages 5 to 16), 70 percent of sore throats are viral. (9) In fact, only 20 percent of sore throats are thought to be caused by bacterial infection. (10) The bacteria that most commonly leads to sore throat is group A B-hemolytic streptococcus, but up to 30 percent of healthy people carry this bacteria without any problems. Most sore throats will clear up on their own and do not pose serious after effects. (9) Martin Blaser’s book, Missing Microbes, summarizes more of this research. (2)
Why we shouldn’t take antibiotics so lightly
Overusing and misusing antibiotics has long-term consequences for children’s health. When you take an antibiotic by mouth, it is absorbed in your gut and enters the bloodstream. Once in circulation, it travels to all of your organs and tissues, destroying bacteria wherever it finds them. Broad-spectrum antibiotics are especially adept killers, targeting a wide variety of bacteria, including many beneficial microbes. As you can see, oral antibiotics are not a very precise treatment. Regardless of where the infection might be, they affect the entire body and they take out a lot of innocent bystanders.
Four long-term risks of childhood antibiotics
#1. Changes to the gut microbiota
Every day we are learning new things about the human microbiome, which outnumbers the cells in our bodies ten to one. Seventy percent of the immune system resides in the gut (11) and the microbiota collaborate with the immune system to protect and defend us.
Gut bacteria influence:
- Immune function
- Weight gain
A recent study (2016) showed that one single treatment with antibiotics leads to serious and long-term changes to the gut microbiota. In Finnish children, a single course of macrolide antibiotics caused major changes in the gut microbiota, and these changes were not reversed until nearly two years after the antibiotic course was completed. (12) Macrolide antibiotics include erythromycin, azithromycin, and clarithromycin.
The study showed that children who took antibiotics had:
- Lower Actinobacteria, including Bifidobacterium, which is a beneficial gut bacteria commonly used in probiotics. (13)
- Higher gram-negative phyla Bacteroidetes and Proteobacteria, which are thought to be opportunistic pathogens.
- Lower bile-salt hydrolase (BSH), an enzyme that mediates host-microbe communication and has been shown to play a role in cholesterol metabolism and weight gain in mice. (14)
Higher macrolide antibiotic resistance, meaning these antibiotics may not work later in life.
Not only that, but the diversity of the microbial communities didn’t return to normal until approximately two years after the antibiotic course. This means that most children’s gut flora do not have time to recover because two years is longer than the average time between courses of antibiotics (1.5 to 1.8 doses per year). (12)
For more on this topic, see my article on how antibiotics affect our gut flora.
The impact of antibiotics on gut bacteria might be directly or indirectly related to the higher rates of inflammatory bowel disease, asthma, allergies, and impaired metabolism that we see in children who are given higher levels of antibiotics.
#2. Gut inflammation
A study in Denmark showed that children who develop inflammatory bowel disease (IBD) are 84 percent more likely to have received antibiotics in their lifetime. Children who had taken antibiotics were more than three times as likely to develop Crohn’s disease (CD) than those who had never taken antibiotics, and each individual course of antibiotics was associated with an 18 percent increased risk of CD. (15)
#3. Asthma, eczema, and allergies
Asthma was almost twice as likely to develop in children who had received antibiotics in the first year of life than those who had not. The risk was highest in children receiving more than four courses of antibiotics, and especially those receiving broad-spectrum antibiotics like cephalosporin. (16) Antibiotic use in the first year of life is also associated with rhinoconjunctivitis and eczema in children. (17)
Both antibiotic use during pregnancy and early-life antibiotic use have been associated with increased risk of food allergies. The risk of food allergy increases with the increasing number of antibiotic courses. (18, 19).
#4. Metabolism and weight
Antibiotics also have an impact on metabolic health and body weight. Early life antibiotic use increases a person’s risk of being overweight in later life. (12) Fecal microbiota composition in infancy can predict whether a child will be overweight or normal weight at age seven. (20) In animals, even a short-term disruption to the microbiota from antibiotics changed gene expression in the small intestine and led to lifelong changes in body composition. (21)
Thanks to the gut flora, early life appears to be an especially critical period of development for the metabolism and the immune system, during which time even short-term disruptions can have lasting effects. (22, 23)
Lower your child’s antibiotic prescriptions with these five simple steps
The most important step you can take toward reducing antibiotic use in your children is preventing the need for them in the first place. Here are five key steps you can take to do that:
- Feed them a nutrient-dense, whole foods diet to reduce the likelihood, frequency, and severity of childhood infections.
- Have your children wash their hands frequently to reduce their exposure to infectious germs. A good habit to get into is washing hands just after they get home from school or other outings, in addition to the typical times (before meals, after using the bathroom, etc.).
- Give them supplemental nutrients that can prevent or shorten the duration of infections
- Encourage their consumption of fermented foods and fermentable fiber to support gut health, and consider supplemental probiotics and prebiotics.
- Consider botanical remedies that can shorten the duration of viral infections, improve immunity, and provide symptom relief.
If your doctor does prescribe antibiotics, ask if he or she is certain that the condition is bacterial in origin and whether the condition requires antibiotics or may safely resolve on its own without them. “Watching and waiting” is a valid strategy that is often preferable to treating with antibiotics prophylactically.
That said, there are times when antibiotics are necessary. If you and your doctor determine there is a good reason for your child to take them, there are things you can do to reduce the long-term effects. These include taking probiotics and prebiotics, consuming bone broth, and supporting healthy liver detoxification.
I hope this article has made it clear that antibiotics should be given only after careful consideration, especially if the condition your child has is likely to be viral. Antibiotics have a time and a place, but since they can have wide-ranging effects on the gut flora, metabolism, allergy, and inflammation, they should be used with discretion.
Now I’d like to hear from you. Did you know that many childhood illnesses that doctors prescribe antibiotics for are caused by viruses rather than bacteria? Were you already aware of the significant risks of antibiotic overuse in children? What steps have you taken to protect your children’s health? What alternatives to antibiotics have you found to be most helpful? Let us know in the comments section.