Antibiotics – Are They Necessary?

Help, my kid’s nose is running and it’s green like a Martian!

It’s that time of year again, the time of year when the leaves begin to turn, there is coolness in the air in the mornings, homework begins to pile up and the noses start to produce amazing amounts of mucus!! Fall, back to school, ragweed season, cold and flu season-they all mean the same thing: your child is likely going to be coming home with a stuffy, runny nose.  With all of these things going on, you may feel like you are constantly running to the doctor’s office, and you may become frustrated when you hear, “It’s a virus!”  Antibiotics have become increasingly overused over the past several years. And with this overuse comes increased bacterial resistance. This means that when bacteria do infect, it is more difficult to clear the infection. Therefore, judicious use of antibiotics is necessary! I hope to dispel some myths, to help you to know when you need to make an appointment for your child, and to help you know when you need to let it run its course.

Myth 1: If it is green, it needs antibiotics.

Truth-Mucus produced by the cells lining the respiratory tract can be any color at all, ranging from clear to green, and may mean nothing more than the body is fighting off an infection. As our immune system gets the message that an “enemy” has invaded, white blood cells are recruited to the sight of the infection. Their job is to kill viruses or bacteria that are foreign to our body. When that happens, mucus becomes thicker and will often turn yellow or green, especially as it sits around in the nose overnight. THIS DOES NOT MEAN IT IS TIME FOR AN ANTIBIOTIC!!

MYTH 2: If there is a fever, an antibiotic is necessary.

TRUTH: Most viruses cause at least a low grade fever during the first several days of the illness. Even colds in babies are often associated with fevers of 101-102 degrees. Many viruses are known to cause fever in the 104-105 range-with no associated bacterial infection. While we would certainly want you to call our office if your baby under 3 months has any fever or if your baby or child has a fever of 104-105, usually these are indicative of a healthy immune system doing its job to fight infection. Whenever a fever lasts more than 5 days or if your child has cold symptoms that seem to be getting better then a fever recurs, we need to see her in the office. Just having a fever at the beginning of an illness, however, does not mean an automatic need for antibiotics.

Myth 3: If the cough sounds “wet”, an antibiotic is necessary.

Truth: Most viruses produce wet sounding coughs. As the virus invades the respiratory tract, the normal lining cells are sloughed off. The normal function of these cells, the respiratory cilia, is to clear mucus and debris from our respiratory tract and thereby prevent these from entering the lungs. When these cells are infected with a virus, they do not work properly and therefore, mucus builds up. Our body’s next defense for clearing this mucus is to cough.
There are many reasons you may want to bring your child in to be seen for a cold. These may include, among others, ear pain, fever, or perceived shortness of breath. Please know that we are always happy to see your child and would want to anytime you are concerned. We will assess his symptoms and decide whether an antibiotic is necessary. Sometimes knowing that nothing more than your love and care is needed is worth your time to come in! After all, chicken soup is still the best treatment for a cold!
Michelle Lynch, MD