When Your Child Needs an Antibiotic: Important Information for Parents

While antibiotics can be life-saving when a child has a severe bacterial illness, they often have side effects like allergic reactions, rashes, yeast infections, stomach upset, diarrhea, disruption of the microbiome of the intestine, and the development of antibiotic-resistant bacteria. A course of antibiotics has about a 30% chance of causing a side effect. While life-threatening side effects, like anaphylaxis, (a serious allergic reaction), or C. difficile infection (a toxic bacterial overgrowth in the intestine), are uncommon, the chances of a reaction increase when antibiotics are used often or for long periods of time.

That is why the physicians at Cornerstone Pediatric and Adolescent Medicine are committed to using antibiotics only when they’re necessary to treat a serious bacterial illness or prevent your child from developing a severe complication of a bacterial illness. We are also committed to using antibiotics for the shortest period of time needed to treat your child’s infection.

Most parents are aware that antibiotics are useless in treating viral illnesses like colds and flu, but many are unaware that for most healthy children and teens, taking an antibiotic for minor bacterial infections like early or mild sinusitis, uncomplicated ear infections, and minor skin infections may not be necessary or beneficial. However, when you suspect a bacterial infection, especially if fever is present, or if your child seems very sick, a doctor’s visit is always necessary to determine if antibiotics are needed. A physical exam and sometimes laboratory testing are necessary.

Recent studies have proven the optimal length of antibiotic treatment for many bacterial illnesses is shorter than treatments used in the past, and that some bacterial infections don’t need antibiotics at all. Often, healthy children with bacterial infections, like mild sinusitis or ear infections without fever, get better just as fast without antibiotics. When your child is diagnosed with bacterial disease, a period of “watchful waiting is sometimes the most appropriate course of action because your child is likely to heal on his own in a few days without antibiotics. If an antibiotic is needed, your doctor will determine which antibiotic will be most useful and the length of course that is most appropriate based on your child’s specific condition and medical history. 

Here are some common examples of pediatric infections requiring a doctor’s visit to determine if antibiotics are needed.

Bacterial Ear infections (Otitis Media)

Bacterial ear infections are caused by bacterial overgrowth in the middle ear. They’re a common complication of respiratory allergies and viral upper respiratory infections. Ear pain is the most common symptom in older children. Babies are often fussy and sleep poorly when they have ear infections. Fever is not always present.

About 80% of ear infections get better on their own, but infants under 6 months of age and children with fever and severe pain in both ears always need treatment when they have a bacterial ear infection. Most older kids without fever will be prescribed a period of “watchful waiting” during which the ear infection is treated with ibuprofen or acetaminophen to relieve pain while the child heals on his own. If fever develops or symptoms worsen, an antibiotic may be prescribed. While ear infections were traditionally treated for 10 days in the past, recent studies have shown that 5 days of antibiotic treatment is just as effective for most ear infections in older kids, and dramatically decreases the chances of side effects from the medication. Your child’s length of treatment will be determined by his medical history, age, and severity of the infection. Feel free to discuss this with your doctor.


Strep Throat (Group A Streptococcal Pharyngitis)

The only way to know for certain if a sore throat is caused by Group A Strep is to do a rapid strep throat test or throat culture. Most sore throats are not caused by Group A strep and do not benefit from antibiotics. Typical symptoms of strep throat include fever, very sore throat, painful swallowing, headache, and sometimes stomach ache, nausea, vomiting, or rash. Strep is very rare in children under 3 years of age. That’s why your doctor does not perform a strep test on infants with symptoms unless there has been a household exposure to strep. Since most colds start with a couple of days of a sore throat before the runny nose starts, it is best to wait 2 or 3 days before testing for strep. Most viral sore throats get better after a few days. Also, if an antibiotic is started in the first 2 days of a strep infection before your body has had a chance to develop antibodies to strep, you’re more likely to get strep again in the future. Don’t worry, there is no rush to treat strep as long as antibiotics are started in the first 10 days of symptoms.

Strep throat never causes a runny nose, cough, hoarseness, or congestion. If these symptoms are present, strep testing is not recommended unless there has been a household exposure.

When strep throat is diagnosed, antibiotic treatment for the full 10 days is necessary because rare complications like Rheumatic Fever (inflammation of the heart, nervous system, and joints) or Kidney Disease (glomerulonephritis) can develop if strep is not treated. 

Uncomplicated Bacterial Pneumonia (Bacterial lung infection)

Pneumonia can be viral or bacterial. Symptoms of Bacterial Pneumonia almost always include fever, rapid breathing, rapid heart rate, fatigue or lethargy, poor appetite, and cough. The cough is not often severe. All children with fever and lethargy or trouble breathing need to be evaluated by a doctor right away. While pneumonia can often be diagnosed by a physician’s exam alone, sometimes a chest X-ray is necessary to determine if the pneumonia is bacterial or viral. Most Uncomplicated Bacterial Pneumonia is treated with 5 days of high-dose Amoxicillin. Pneumonia that develops in a hospitalized patient or that is unusually severe may require longer treatment.

Bacterial Sinus Infection (Acute Bacterial Sinusitis) 

Typical symptoms of an acute sinus infection are similar to those of a cold: nasal discharge of any color, stuffy nose, headache, sore throat, and cough during both day and night. Keep in mind that the average cold can cause a cough that lasts about 16 days, but symptoms usually start to improve after the 7th day. Even when a sinus infection is diagnosed, “watchful waiting” is often appropriate to see if the infection will clear on its own. During the waiting period, an intensified regimen of nose irrigation with saline, nasal steroids, and sometimes decongestants are prescribed. Bacterial sinus infections need antibiotic treatment if they are not improving after 10 days, are unusually severe, or cause high fever or fever for more than 3 days. If antibiotics are needed, Amoxicillin is the drug of choice for most people and a 10-day course is usually prescribed but longer courses are sometimes needed. (Symptoms should be much better in 3 days and treatment should continue until symptoms have been better for 5-7 days).

Bacterial Urinary Tract Infection (UTI)

Symptoms of UTI are pain when urinating, the urge to urinate more often, feeling an urgent need to urinate even if the bladder is not full, and sometimes fever, abdominal pain, and nausea. A urinalysis and usually a urine culture are needed to diagnose a bacterial UTI. Urine must be obtained by “clean catch” for older kids and teens, and by bladder tap or catheter specimen for infants and young children who are not potty trained or able to pee in a cup. Urine samples obtained at home or bag specimens are not reliable and can have false positives. Treatment requires 3 days of antibiotics. UTIs with fever require 7 days of treatment. A repeat culture is not needed unless symptoms return or fail to resolve. If symptoms fail to resolve after antibiotic treatment, call our office.

Boils (Skin Abscesses) and other skin infections (cellulitis and impetigo)

Small boils like pimples (pustules) and styes (a raised red bump on the eyelid) don’t usually need antibiotic treatment as long as there is no fever, significant pain, or rapid enlargement. Treat these at home with gentle cleaning and warm compresses three times a day, and avoid touching them. (Never try to pop or squeeze a pimple or boil! This can cause a deeper infection or cellulitis). If a pimple, sty, or boil becomes very painful, gets bigger even after warm compresses, fails to go away in a few days, or is associated with fever or new skin lesions, it’s time to call our office for an appointment. 

Abscesses (larger collections of pus) often require an office procedure to drain them. If the abscess drains and there are no other signs of infection, no oral antibiotic is needed. If the abscess can’t be drained or cellulitis has developed, antibiotics will need to be prescribed. (Some skin infections require more than one antibiotic because of antibiotic-resistant bacteria like MRSA).

Cellulitis (a skin infection that causes swollen, red, warm, tender area of skin) needs to be treated with oral antibiotics until the signs of infection are gone.

Skin infections like impetigo (red inflamed sores with oozing or honey-colored crust or pus) require antibiotic treatment too. We will treat the infection with topical prescription antibiotic cream if at all possible, but if the infection spreads, it will need to be treated with an oral antibiotic until the signs of infection have gone away.


How to give antibiotics:

Any time an antibiotic is given, be sure the correct dose is given at the specified interval for the specified length of time. Liquid medicines should always be measured with a syringe. The pharmacy can provide one. 

Antibiotics should never be added to a bottle or drink because this causes incorrect dosing. 

If a child refuses to take the antibiotic, most drugs, like amoxicillin can be added to a small amount of chocolate syrup or flavored by your pharmacist (ask your pharmacist). Do not add the antibiotic to hot food or large amounts of food or liquid.

Many antibiotics need to be taken with food to prevent stomach upset. Antibiotics should be given around the same time each day if possible. If your child’s medicine is dosed twice daily, you may want to give them after breakfast and after supper about 12 hours apart. 

It can take 2 to 3 days for antibiotics to take effect, but if there is no improvement after 48 hours, call our office. 

Because antibiotics can cause diarrhea, stomach upset, or disturbances in the intestinal microbiome, it’s a good idea to eat yogurt like Activia or take a probiotic like Florastor or Culturelle daily while on antibiotics and for a few weeks afterward if your child is at least 6 months old. Encourage a diet with plenty of legumes,  vegetables, and whole grains to maintain gut health.


Warning: Even if you have taken an antibiotic before, you can develop an allergic reaction. 

If your child develops a rash, stop the medicine, take a picture, and call the office. If breathing difficulty, repeated vomiting, swelling of the mouth or throat, weakness or lethargy with flushing, pallor, or hives develop following a dose of medicine, these are signs of anaphylaxis and require a 911 call and a trip to the emergency department.

Keep all medicines out of children’s reach. Medicines that require refrigeration can be kept in the back of the refrigerator on the top shelf. 

If your child ingests too large a dose of medicine, takes medicine more often than prescribed, or ingests somebody else’s medicine, call NC Poison Control 1-800-222-1222.


Click here to learn how to give medicine to a reluctant toddler