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Saturday, June 24th, 2017

Viral Versus Bacterial Infections/Use of Antibiotics

The vast majority of the illnesses that your child will experience will be caused by viruses.  They are infectious organisms that multiply within various cells of the body.  Because they multiply within our own cells they are very hard to kill or inhibit while not harming the body’s cells at the same time.  Because of the ability of viruses to “hide” within the body’s cells progress toward anti-viral therapy has been slow.  There are effective therapies for some serious viral infections such as systemic Herpes Simplex infections and HIV, but there are no (with the exception of Flumadine for Influenza A and Tamiflu for Influenza A & B) safe and effective therapies for the common viral illnesses such as colds, tonsillitis, gastroenteritis (vomiting and diarrhea), etc.  These viruses are spread from person to person by close physical contact, contacts with bodily fluids such as stool, vomitus, nasal secretions and saliva as well as aerosols generated by coughing and sneezing.  The larger the number of people that your child has contact with, the greater the likelihood of acquiring such an infection.  The body’s immune system recognizes each of these unique viruses and generates an immune response which ends the infection and renders the child immune to that particular strain.  So it is very common for a young infant to experience a significant viral illness as often as every two to three weeks for the first few years as they are exposed to a larger pool of people at daycare, church nurseries, play groups, babysitters, etc.  The greater number of contacts, the more frequent the illnesses.  As the children’s list of antibodies grows, they will be increasingly immune to all the common strains and will not become ill when they are re-exposed.  As there are no specific therapies for the majority of common viral infections, we are currently limited to symptomatic treatments aimed at relieving discomfort and supporting the child with adequate fluids and calories while we await the successful ending of the infection by the child’s immune system. 

 A smaller number of your child’s infections will be due to bacteria which can be specifically treated with antibiotics.  These drugs are selectively toxic to the bacteria and minimally so to the body’s cells when used in proper dosage and duration; examples include middle ear infections (otitis media), sinusitis, certain forms of pneumonia, etc.  This distinction between a viral infection and a bacterial infection (the basis for deciding whether to treat the patient with an antibiotic or not) rests on several factors: a thorough history of symptoms and exposure; a careful physical examination and laboratory tests in selected cases (white blood cell count, urine analysis, cultures of blood, urine, tonsillar swabs, spinal fluid).

 There is a growing awareness that our society has been overusing antibiotics for several decades.  Countless rounds of antibiotics are given for viral infections for which they are totally ineffective.  Not only do these treatments do the patient no good, but they increase the likelyhood of secondary yeast infections, increase chances of the patient becoming allergic to that class of antibiotics and promote an incorrect belief that “my child always needs an antibiotic to get over a bad cold.”  In addition, there is a growing and very serious problem with the emergence of multiply-resistant organisms caused by the overuse of antibiotics.  Infections with these organisms are very dangerous, as there is a very short list of drugs that are still effective against them.  Therefore, it is more important than ever before for parents and pediatricians to do their best to reach as accurate a diagnosis as possible and use antibiotics very cautiously. 

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