From about October through May I get, literally, two to three emails a week from my boys’ schools warning me that strep throat has been identified in one of their classrooms. I’m not entirely sure how other parents respond to this dire tidbit of information. Personally, I shake my head, yawn and continue perusing the plethora of junk mail in my overflowing inbox. Why do I take such a laid-back position on something that obviously freaks out most responsible parents? Several reasons. First, many people have the strep bacteria living on their throats all the time. In fact, as many as 30% of well kids will test positive for strep at any given moment. So just because your child tests positive for strep in the doctor’s office does not mean he or she needs to be on an antibiotic.
According to Michael Pichichero, M.D. and professor of microbiology and pediatric immunology at University of Rochester Medical Group, a sore throat is the chief complaint of the majority of patients all the way from late fall through early spring. He estimates that less than 30% of children (and only 10% of teens) who present with a sore throat actually have a strep infec- tion. What that means on a percentage basis is that physicians routinely over-diagnose strep throat in 90% of teenagers and 70% of children. That is a lot of kids!
Here’s the big thing nobody seems willing to tell the public. If your kid has any cold symptoms, like a runny nose, a cough, hoarseness or even pink eye, accompanying a sore throat, he does not have strep throat; likewise, if your child has diarrhea, he does not have strep throat – even if he tests positive on a rapid strep test in the doctor’s office. The cold symptoms above indicate that your child has a viral infection that will not respond to antibiotics. Antibiotics treat bacterial infections. It is difficult for parents to know when an infection is viral or bacterial. A sore throat without cold symp- toms may indicate strep throat. A positive strep test, in this instance, can detect a strep infection that should be treated with a course of antibiotics. If an in-office strep test is negative, that has a 95% accuracy rate, and your child should not take antibiotics.
We treat strep with antibiotics for one main reason: to prevent rheumatic fever. In America, however, rheumatic fever is extremely rare. We also know that kids under 3 years of age (and those 30% of kids who naturally carry strep all the time) are not at risk for developing rheumatic fever. This indicates clearly that the risk of overtreatment with unnecessary antibiotics is greater than the risk of undertreatment. Here’s how the cycle generally unfolds. Doctors are often consulted after a child has had cold symptoms for a week or longer and has developed a sore throat. While most doctors should know that your child doesn’t have a strep infection if she presents with other cold symptoms, doctors are often pleasers who want to make parents happy. When parental pressure is applied to test for strep and provide antibiotics “just in case,” many doctors simply abandon what is right in favor of what is easy and what will make parents happy. So they run a rapid strep test in the office. It comes out positive (because remember, at least 30% of kids walk around with strep bacteria on their throats all the time), and boom, you walk out with a prescrip- tion for Amoxicillin and you pat yourself on the back for having taken admirable care of your child. Since most colds tend to last a week to 10 days on the average, your child begins to feel better almost instantly because they have already had the cold a week. But you attribute her wellness to the miraculous antibiotic rather than the fact the cold has run its course.
Antibiotic overuse in this country is a serious issue. Side effects of antibiotics – like diarrhea, yeast infections and allergies – are unpleasant at best and life-threatening at worst. We also see more and more drug-resistant bacteria and harder-to-cure diseases due to overprescribing and overuse of antibiotics. Many doctors will tell you that parents simply don’t feel they’ve gotten their “co-pay’s worth” if they leave the doctor’s office without a prescription. Parents put a lot of pressure on doctors to prescribe antibiotics. But you are not doing your child or society a favor by insisting on antibiotic treatment.
In fact, certain diseases may be linked to early antibiotic use in children. Inflammatory bowel disease (IBD), which we’ve seen double over the last 10 years, has recently been associated with early antibiotic use. Likewise, the rise in Crohn’s disease and ulcerative colitis seem to correspond to early antibiotic exposure. Approximately 49 million antibiotic prescrip- tions are written for children each year in the United States. An October study published in the journal Pediatrics estimated that 1,700 IBD cases were directly attributable to antibiotic overuse. In a study of over 1 million children, researchers discovered that those treated with antibiotics during their first year of life were actually five times more likely to develop IBD than children who had never taken antibiotics. Antibiotics are amazing drugs that kill bad bacteria in the body. Using them when necessary is prudent. But they also kill good bacteria, which is needed in the course of digestion, hence the link between IBD and antibiotics. A link has also been suggested between antibiotic use in children under 6 months old and later childhood obesity. Early studies suggest that antibiotic use in babies can disrupt the flora in the intestines, and may influence how children absorb calories throughout their lives.
The other worrisome issue related to antibiotic overuse is the continuing growth of resistant bacteria that are immune to many baseline antibiotics. The staph infection MRSA (methicillin- resistant Staphylococcus aureus) has been linked to 60% of skin infections detected in hospital emergency rooms. If the MRSA bacteria invade broken skin, they can create life-threatening lung, bone, blood and nervous system infections. Likewise, Clostridium difficile, or C. diff., is a drug-resistant intestinal bac- terium that causes severe diarrhea and may lead to colitis. Both MRSA and C. diff. are resistant to first-responder antibiotics. The concerns about superbug resistant bacteria are not theo- retical. They are real. Insisting that your child be given antibi- otics for any number of viral respiratory ailments is just bad parenting. So stop. Tell a trusted pediatrician that you do not want an unnecessary antibiotic. Recognize that sometimes it really is better to do nothing and let illness run its course.
Debra Rich Gettleman is a mother and blogger based in the Phoenix area. For more of her work, visit unmotherlyinsights.com.
