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Daily Dose

Antibiotics May Boost Risk for Recurrent Ear Infection

1.15 to read

Did you know that repeated use of antibiotics to treat acute ear infections in young children increases the risk of recurrent ear infections by 20 percent? Researchers in the Netherlands found that 63 percent of children given the antibiotic amoxicillin had another ear infection within three years, compared with 43 percent of children given a placebo at the time of their initial infection. The results of the study are published online in the July edition of BMJ. Researchers looked at 168 children, aged six months to two years. In the group given amoxicillin, 47 out of 75 children had at least one recurrent ear infection, compared with 37 of 86 children in the placebo group. That equated to a 2.5 times higher risk of recurrent ear infection for the amoxicillin group. However, the study also found that 30 percent of children in the placebo group had ear, nose and throat surgery after their initial infection, compared with 21 percent in the amoxicillin group. The higher recurrence rate among children who took amoxicillin could be due to a weakening of their body's natural immune response as a result of taking an antibiotic at the initial stage of infection, the researchers said. Antibiotic use in such cases may cause an "unfavorable shift" toward the growth of resistant bacteria. Antibiotics may reduce the length and severity of the initial ear infection, but may also result in a higher number of recurrent infections and antibiotic resistance, the researchers stated. Because of this, they said, doctors need to be careful in their use of antibiotics in children with ear infections.

Your Child

Antibiotics Often Prescribed When Not Needed

2.00 to read

By now, most parents understand that antibiotics are not effective for viral infections, only for illnesses caused by bacteria.

However, that hasn’t deterred many physicians from over-prescribing antibiotics for children with ear and throat infections.

More than 11 million antibiotic prescriptions written each year for children and teens may be unnecessary, according to researchers from University of Washington and Seattle Children's Hospital. This excess antibiotic use not only fails to eradicate children's viral illnesses, researchers said, but also supports the dangerous evolution of bacteria toward antibiotic resistance.

"I think it's well-known that we prescribers overprescribe antibiotics, and our intent was to put a number on how often we're doing that," said study author Dr. Matthew Kronman, an assistant professor of infectious diseases at Seattle Children's Hospital.

"But as we found out, there's really been no change in this [situation] over the last decade," added Kronman. "And we don't have easily available tools in the real-world setting to discriminate between infections caused by bacteria or viruses."

 Doctors have limited resources when it comes to differentiating between bacterial or viral infections. Physicians can use the rapid step test to determine if the streptococcus bacteria is the cause of a child’s sore throat, but that is about it for immediate diagnostic tools.

Most colds are virus related and one of the first symptoms will be a sore or scratchy throat. It will typically go away after the first day or so and other cold symptoms will continue. Strep throat is often more severe and persistent.

A virus often causes ear infection as well. Many doctors treat ear infections as though they are bacterial to be on the safe side and avoid serious middle ear infections.

To determine antibiotic prescribing rates, Kronman and his colleagues analyzed a group of English-language studies published between 2000 and 2011 and data on children 18 and younger who were examined in outpatient clinics.

Based on the prevalence of bacteria in ear and throat infections and the introduction of a pneumococcal vaccine that prevents many bacterial infections, the researchers estimated that about 27 percent of U.S. children with infections of the ear, sinus area, throat or upper respiratory tract had illnesses caused by bacteria.

But antibiotics were prescribed for nearly 57 percent of doctors' visits for these infections, the study found.

Kronan hopes that the study’s results will encourage the development of more diagnostic tools and will spur doctors to think more critically about prescribing antibiotics unless clearly needed.

Previous research has shown that parents often pressure their doctor to prescribe an antibiotic to treat their child’s ear or sore throat symptoms. However, when parents are given other suggestions on how to alleviate the symptoms they have been much more receptive than when their doctor just flat out says he won’t prescribe antibiotics.

Many physicians and researchers are concerned that the amount of antibiotics being prescribed these days is setting us all up for future problems when dealing with bacterial infections. Bacteria are adaptable and mutate over time becoming less responsive to antibiotics. When possible, it’s much healthier in the long run to treat your child’s symptoms with simpler therapies. Ask your physican ways you can make your little one more comfortable until the symptoms pass. 

The study was published online in the journal Pediatrics.

Source: Maureen Salamon,

Daily Dose

Get Smart About Anitbiotics

1.30 to read

It is ”Get Smart About Antibiotics” week! The Center for Disease Control and Prevention and the Amercian Academy of Pediatrics collaborated on an online article to be published in the December issue of Pediatrics) which offers updated guidance on treating respiratory tract infections in children, with the goal of reducing unnecessary antibiotic prescriptions. 

This article is especially important as the entire country is entering cough, cold and flu season. All of the former are caused by viruses, not bacteria, and therefore do not respond to treatment with antibiotics. Studies have shown that as many as 10 million antibiotic prescriptions are written each year for infections that are most likely due to a virus, so no need for antibiotics.   

One of the most common reason a parent takes their child to their pediatrician is for symptoms of a common cold.  The runny nose, cough, congestion and just not feeling well.....usually lasts for about 10 days. Pediatricians need to explain and parents need to understand that the best treatment for an upper respiratory infection is simply symptomatic. That means lots of TLC (tender loving care), which I am currently doing for my own latest cold.  Warm showers at bedtime (I love eucalyptus in my shower too), a cool mist humidifier in the room, lots of fluids and chicken noodle soup and popsicles will all work to help soothe stuffy noses, cool scratchy throats and calm coughs. I am trying tea with honey for my cough tonight (good info on honey for cough on previous posts). 

Antibiotics are very important when used appropriately.  But with that being said there are at least 2 million people infected with antibiotic resistant bacteria each year. By using antibiotics when only necessary, rather than for common upper respiratory infections, doctors are hopeful that the incidence of antibiotic resistance will not continue to rise.   

We ALL want a quick fix for our colds and coughs (me included!), but taking an antibiotic is not the answer.  Just know that no matter what you really takes 7-10 days (or even 14) to get well and that a toddler will get 5-7 colds, coughs and upper respiratory infections during the winter months.  It is great if your child does not need an antibiotic; wear that badge with honor!  As a parent you should be pleased that you do not have to give your child an antibiotic, unless necessary, for bacterial illnesses like strep throat or an ear infection in a young child. Ask your doctor questions. 

What does help? Getting your child vaccinated, including flu vaccine.  Any child over the age of 6 months needs to get flu vaccine,  and don’t delay. Flu season is here! (I saw a case of Influenza B today).  

Daily Dose

Get Smart About Antibiotics

1:30 to read

When your child is sick, do you know the best uses for antibiotics? Many parents do not, so here's how to stay in the know. It really is the time of year when “everyone” is getting sick, and fortunately most of these illnesses are due to common viruses that circulate during the Fall and Winter months.

I am already seeing so many parents bringing their young children with recurrent coughs and congestion and the strains of “can’t we just have an antibiotic” are being heard throughout the office. There isn’t a parent who doesn’t want to try and make their sick child better faster but antibiotics are usually not the answer. Antibiotics only work for infections that are caused by certain bacteria.  Unfortunately, antibiotics do not treat viruses!!  Viruses cause most of the seasonal cough, cold, congestion and flu viruses that we see throughout the year. These viruses do seem to be more prevalent in the Fall and Winter months as we all gather together in close quarters for holidays and to escape the cold days outside.

Viruses are easily spread from person to person, typically via droplets that are aerosolized when a person coughs or sneezes. The other sneaky thing about viruses is that the virus may be shed by a person before they even feel sick. In other words, the person that is sitting next to you at church, or to your child at school may be innocently spreading a virus 12-24 hours before they even begin to feel badly. Knowing that, it is hard to point a finger at who “got your child sick” as we all come into contact with germs throughout the day.

Many viral infections, such as a cold, may have symptoms that last for up to 2 weeks. This is not a “quick fix” type of illness. In fact,  the best medicine for a cold , viral sore throat or the flu is the age old fluids, rest, fever reducer and “tincture of time” .  An antibiotic given inappropriately may actually do more harm than good. By taking an antibiotic when they are not needed you may increase the risk of getting an infection later that is resistant to typical antibiotic treatment. 

As you probably already have heard, antibiotic resistance is on the rise, and one reason may be the overuse of antibiotics when they are not needed. Taking an antibiotic is appropriate when needed for a bacterial sore throat, such as strep throat (which is documented by a strep test), or for ear infections in young children.  When your doctor prescribes an antibiotic you want to take it exactly as directed and always finish the entire prescription.  Even if your child is feeling better several days after starting an antibiotic finish the medication or the infection may return.

Lastly, if you have any unused antibiotic throw it away and never save it for another use. Do not give an antibiotic for one child to another child in the family, as believe it or not, it is fairly common for one child to have a strep throat while a sibling may have a viral upper respiratory infection that does not need to be treated with an antibiotic.  Go figure, not everyone in the family gets the same illness at the same time. I tell my patients it is a good thing to “brag” that your child has never been on an antibiotic, almost like getting that straight A report card.  And remember, each viral illness is actually helping to make your child stronger by building antibody for future illness. Small victories with each cold! That’s your daily dose for today. We’ll chat again tomorrow.

Send your question or comment to Dr. Sue!

Your Baby

Gut Bacteria Linked to Kid’s Asthma


Four types of gut bacteria may reduce a child’s risk of developing asthma according to a recent Canadian study.

Most Infants - but not all - typically receive these bacteria from their environment or mothers after birth. Sometimes babies are given antibiotics that not only kill bad bacteria, but eliminating the helpful gut bacteria as well.

"We now have particular markers that seem to predict asthma later in life," lead researcher Brett Finlay, a professor of microbiology and immunology at the University of British Columbia in Vancouver, said during a news conference Tuesday.

"These findings indicate that bacteria that live in and on us may have a role in asthma," he said. This seems to happen by 3 months of age in ways that still aren't clear.

Previous studies have shown that certain environmental bacteria, such as living on a farm or having pets, appear to decrease the chances of children developing asthma.

Another interesting clue to asthma is what populations seem to have the most cases. Instances of asthma have increased in western countries where hygiene standards are higher. "Ironically, it has not increased in developing countries," Finlay said.

Organizations that specifically track asthma cases around the world say that as developing countries move from poverty into low-to-middle income, cases of childhood asthma begin to increase.

The "hygiene hypothesis," says environments that are too clean may actually impede development of the immune system.

For the study, Finlay and colleagues looked for four types of bacteria in stool samples of 319 infants at 3 months of age. The bacteria are called FLVR (Faecalibacterium, Lachnospira, Veillonella and Rothia).

The researchers found that 22 children with low levels of these bacteria at age 3 months also had low levels at age 1 year.

These 22 children are at the highest risk of developing asthma, and eight have been diagnosed with the respiratory disease so far, the researchers said.

Study co-author Dr. Stuart Turvey, professor of pediatric immunology at the University of British Columbia, said at the news conference that it's "not surprising how important early life is."

In the first 100 days of life, gut makeup influences the immune response that causes or protects kids from asthma, he said.

Turvey also noted that testing infants for these bacteria might help identify children who will be at high risk for asthma. Babies without FLVR bacteria could be followed and treated earlier for better outcomes he said.

Whether giving kids probiotics -- good bacteria -- might reduce asthma risk isn't known, the researchers said. Turvey said the probiotics available in over-the-counter forms do not include the four bacteria identified in this study.

"Studies like ours are identifying specific bacteria combinations that seem to be missing in the children at the highest risk of asthma," he said. "The long-term goal is to see if we could offer these bacteria back, not the general nonspecific probiotics."

Finlay said the findings need to be replicated in larger groups and in different populations. He said the researchers also want to know if all four bacteria are protective, or just one or two.

As with most studies, the results did not prove a cause and effect only a connection, in this case between gut bacteria and asthma risk in children.

The report was published online in the journal Science Translational Medicine.

Source: Steven Reinberg,



Your Child

Antibiotics Used in Livestock Affects Children’s Health


The use of antibiotics in food-producing animals has led to a greater risk of life-threatening infections in young children and dramatically reduced medicine’s ability to treat those infections according to a new report from the American Academy of Pediatrics (AAP).

Dr. Jerome A. Paulson, FAAP, the lead author and the AAP’s immediate past chair of the executive committee of the Council on Environmental Health, wrote in the introduction: “Antimicrobial resistance is one of the most serious threats to public health globally, and threatens our ability to treat infectious diseases.”

More than 2 million people in the United States become ill with antimicrobial-resistant infections each year, resulting in more than 23,000 deaths, Paulson told Healthline.

In 2013, there were more than 19,000 infections involving young children, according to the Foodborne Diseases Active Surveillance Network, a system operated by the U.S. Centers for Disease Control and Prevention that covers 15 percent of the U.S. population. Those infections caused 4,200 hospitalizations and 80 deaths.

The highest incidence rate in this group was for children younger than 5, Paulson said.

“Life-threatening infections are extremely unusual in otherwise healthy children,” he said. “Most life-threatening infections occur in children with other medical problems. That said, healthy children can get pneumonia, from the pneumococcal bacteria, which may be life-threatening. And they can get infections with E. coli 0157, which they may get from contaminated meat, and that can be life-threatening.” 

Consumer Reports notes that approximately 80 percent of all antibiotics sold in the U.S. are used by the meat and poultry industry to make animals grow faster or to prevent disease in crowded and unsanitary conditions.

 “These non-therapeutic uses contribute to resistance and create new health dangers for people, and often render antibiotics ineffective when doctors need them to treat infections in humans,” said Paulson, who is also a professor emeritus of pediatrics and of environmental and occupational health at George Washington University’s School of Medicine.

"Children can be exposed to multiple-drug resistant bacteria, which are extremely difficult to treat if they cause an infection, through contact with animals given antibiotics and through consuming the meat of those animals," Paulson said.

"Like humans, farm animals should receive appropriate antibiotics for bacterial infections,” he added. “However, the indiscriminate use of antibiotics without a prescription or the input of a veterinarian puts the health of children at risk.”

Paulson suggests that parents purchase meat and poultry that has not been raised using antimicrobial agents.

The report authors note that many antimicrobial agents used in food animals are the same as or similar to those used in human medicine.

“Unlike in human medicine,” they wrote, “antibiotic agents in food animals may often be used without a prescription or any veterinary oversight.”

“This issue is a danger to adults and children,” Paulson said. “The American Academy of Pediatrics, of course, only has the expertise to weigh in on the situation as it relates to children. The AAP has published this technical report to bring attention to the problem.” 

Paulson also noted that physicians should be judicious in prescribing antibiotics.

“Antibiotics should never be prescribed for colds, for upper-respiratory tract infections unless they are known to be bacterial in nature, or for other ill-defined purposes. Veterinarians should control the use of antimicrobial agents in animals, and such agents should not be added to feed or water to promote growth.”

To avoid meats and poultry laced with antibiotics, parents can look for certain labels on the poultry or meats they buy. The website,, offers several lables consumers can check out.  

The United States Department of Agriculture (USDA) verifies that foods containing the certified USDA Organic label come from animals that have never been given antibiotics.

Food Alliance also verifies that their animals are not given sub-therapeutic antibiotics. Look for food products that have the FA label.

American Grassfed label also guarantees that the animal was never given antibiotics.

The report was published in the November 16, 2015 journal Pediatrics.

Sources: Patrick Keeffe,

Gretel H. Schueller,


Daily Dose

The Truth About Antibiotics

1:30 to read

Despite warmer than normal temperatures in much of the country it is certainly already cough and cold season. Our office background music is already a lot of coughing coming from children of all ages…and a few of their parents too. In fact, a few of our nurses and docs are fighting a fall cold as well.


This makes it timely to discuss (once again) the difference between a cold which is a viral infection and a bacterial infection (example strep throat).  Viruses are NOT treated with antibiotics!! In other words, antibiotics are not useful when you have the common cold. Asking your doctor to put you on an antibiotic “just in case “ it might help is not advised, and doctors should be taking the time to explain the difference between a viral infection and a bacterial infection, rather than writing an unnecessary antibiotic prescription.  


While some people (fewer and fewer young parents) still think an antibiotic is necessary, the overuse of antibiotics has been called “one of the world’s most pressing public health problems”s, by the CDC. Not only does the overuse of antibiotics promote drug resistance, it may also cause other health concerns as well. While antibiotics kill many different bacteria, they may also kill “good bacteria” which in fact help the body to stay healthy. Sometimes, taking antibiotics may cause diarrhea and may even allow “bad bacteria” like clostridium difficile to take over and cause a serious secondary infection.  


At the same time that there are too many antibiotic prescriptions being written for routine viral upper respiratory infections, a new study in JAMA also found that bacterial infections (sinusitis, strep throat, community acquired pneumonias), are not being treated with appropriate “first line” antibiotics such as penicillin or amoxicillin.  Of the 44 million patients who received an antibiotic prescription for the treatment of sinusitis, strep throat, or ear infections, only 52% were given a prescription for the appropriate first line antibiotic. When a doctor prescribes a broader spectrum, often newer antibiotic, instead of the recommended first line drug, they too are responsible for increasing antibiotic resistance.


So, you should actually be happy when your pediatrician reassures you that your child does not need an antibiotic, and that fever control with an over the counter product, extra fluids and rest will actually do the trick to get them well.  I “brag” about my patients who have never taken an antibiotic… they have never had a bacterial illness, and tell their parents how smart they are for not asking for an antibiotic “just because”.


At the same time, if your child does have a bacterial infection, ask the doctor if they are using a “first line” drug and if not why…? It could be because your child has drug allergies to penicillins, or that your child has had a recent first line drug and has not improved or has had ‘back to back” infections necessitating the use of a broader spectrum antibiotic.  Whatever the reason, always good to ask.


Keep washing those hands, teach your child about good cough hygiene and run don’t walk to get your flu vaccines….November is here and flu usually won’t be too far behind.




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