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Scott Webb (Host): As most of us parents know, our kids get sick from time to time. And when they have a bacterial infection, their pediatricians may prescribe antibiotics. And joining me today to help us to know when antibiotics are appropriate, when they may be harmful and how we could spot side effects or allergic reactions, is Dr. Timothy Snyder. He's a Pediatrician with the Franciscan Physician Network. This is the Franciscan Health Doc Pod. I'm Scott Webb. So Dr. Snyder, thanks so much for your time today. I was just mentioning that I have a couple of kids myself, and have certainly been to the pediatrician's office numerous times, you know, with my children having sore throats.

And we had our fingers crossed that it was actually strep throat so that we could get something prescribed and start the healing process. And oftentimes it wasn't, unfortunately. That's maybe a different podcast, but for today's purposes, we're going to talk about antibiotics and kids. And when they're good, when they're bad, when they could be harmful and so on, so a lot to get to. When or why do you most often prescribe antibiotics, especially for children?

Timothy Snyder, MD (Guest): First and foremost antibiotics are prescribed for what we believe is a bacterial infection, such as a middle ear infection, strep throat, as you mentioned, pneumonia, or a urinary tract infection. It's important to note that antibiotics, don't treat a viral infection, like a runny nose or a cough. And that is a common misconception that we have to help teach parents.

Host: I think you're so right. I think that is a misconception. Of course, when our kiddos are sick, we want to try to help them. And we hope that there's maybe something that can be prescribed to help them get over things faster. But you're so right. The bacterial that much, I know, not being a doctor, but certainly being a parent. And I'm sure those that are listening are nodding their heads saying, yeah, been through that. So generally speaking, what types of antibiotics do you prescribe?

Dr. Snyder: We try to tailor the antibiotic prescription to the type of infection. Such as urinary tract infections may be caused by different bacteria than normally cause a middle ear infection. So that is a consideration. There are some antibiotics that are approved for children and some that are not approved for children.

So that is something we have to take into account. Typically, they come from several classes. We have the penicillin group, which is amoxicillin, probably most parents who listen to this, their child's been at least on amoxicillin at least one time. There are what are called cephalosporins. That's like cefdinie and Ceclor, Keflex.

There are sulfa antibiotics, which are like Bactrim or Septra. Also, thermax that's a completely with different family too, Zithromax and erythromycin. So we first try to determine whether or not an infection is likely to be bacterial and then given the location, what is the most likely pathogen and then pick the most likely antibiotic that will treat that.

Host: Yeah, that makes sense. Match the antibiotic with whatever's going on, as you mentioned, bacterial obviously. But I'm assuming there are some times when antibiotic prescriptions can be potentially harmful.

Dr. Snyder: Sure for instance, you can have an allergic reaction to an antibiotic. That would be hives and that type of thing. That can be very serious. You can have a side effect, which is different from an allergy. A side effect would be something like diarrhea or upset stomach, that kind of thing. And infants and toddlers sometimes using the antibiotic may cause a yeast infection in their diaper area or thrush.

So, yeah, they're not completely innocent and benign. So, if they're not necessary for a bacterial infection, that's why we don't prescribe them. There is also kind of a general concern that overprescription of antibiotics could lead to resistance in the bacteria that we're trying to treat.

The more times they face amoxicillin at some point there's going to be a bacteria that's mutated and the antibiotic doesn't have an effect, and then it's harder to treat. So that's another thing to think about.

Host: Yeah, it definitely is. And my kids are about four and a half years apart. And I think you're so right that when my son was younger, it seemed like the antibiotics were flowing a little more freely through the peds office. Not in any bad way, but it just seemed like they were more willing to, well, let's give this a shot, see how it goes, you know, and if it doesn't work and there's no side effects, then no harm, no foul.

But my daughter being four and a half years younger, it seems over her time going through the peds office for the various things like, you know, strep throat and so on, it seems like doctors were less willing to prescribe. And I think for that very reason that you're saying that first of all, there could be allergies or side effects. And also that children seem to like adults can build up sort of a resistance or a tolerance. Right?

Dr. Snyder: Let me say it's more the human body doesn't necessarily develop a tolerance. It's the bacteria that develop a resistance. So there is a difference there. So if a person took Benadryl or something every day, after a while, maybe your body doesn't respond as much to the Benadryl or you have to increase the dose. Whereas with an antibiotic, your body, the human body doesn't become immune to that. It's the bacteria that caused the infection.

Host: I see what you mean? Yeah. The bacteria says, yeah, you're going to need something else to fight me this time. That's just not going to work on me again. I totally get what you're saying. And, you know, I think a lot of us, whether it's through social media or just word of mouth, whatever, it might be, a lot of us wonder sometimes maybe there's some home remedies that we could try instead of antibiotics, whether it's for ear infections, sore throats, whatever it might be. Maybe you have some thoughts on that.

Dr. Snyder: Well, the classic grandmother remedy for sore throat is gargling with some warm salt water. I still tell parents to use that one. I do that myself. I did that with my kids. That is a time-tested treatment that is likely to give some relief. We recommend with the sore throats also going to soft foods, obviously you wouldn't want to be eating chips or nachos or things like that. Usually increasing fluid intake, clear liquid so as to thin out the mucus and that causes less congestion and problems there. For ear pain, it's more comfort measures like Tylenol and like warm compress to the ear. Those kinds of things can be helpful.

Host: Well, it's good to know that there are some things we can do before, you know, especially if a child gets sick on the weekend, which has happened to all of us parents and our children and the peds office doesn't open again until Monday morning and it's not really an emergency, so we don't want to go to the emergency department. So good to know there's some things we can do at home. And are there some signs or symptoms that something really probably needs an antibiotic? Like if, it's a mucus, let's say, and it's green or yellow, is that a sign to us that, yeah, we're probably gonna need some actual medicine here?

Dr. Snyder: So that's a really frequent call we get about green snot. And the reality is that the color really is not a direct indicator of bacterial infection. When there is an upper respiratory infection and inflammation, there's a white blood cells present and red blood cells and other kind of viral debris. And that's also what colors the mucus. So green snot does not equal bacterial infection and does not necessarily indicate the need for an antibiotic.

Host: Yeah. I mean, it just kind of throws us off, right? When you see something like that and you go, ooh, that looks, that doesn't look good. We should probably get you to the doctor, but it doesn't necessarily rise to the level, always of needing an antibiotic. And, you've mentioned here a couple of times, the distinction between viral and bacterial infections and not being a doctor, but having you on and having your expertise; are there times when viral infections can sort of evolve into bacterial infections?

Um, ,

Dr. Snyder: Absolutely. The virus enters the body, replicates, more virus is released into the body. It causes inflammation in the areas of infection. That inflammation then is kind of a perfect environment for a bacteria to grow. And most of us have bacteria kind of floating around here and there. And when they land someplace, that is a good environment, then they will start to grow and cause a problem.

So, it's often the bacterial infection that comes on the tail end of the viral infection. Sometimes when the child, in our case, the child seems to be feeling better after runny nose for four or five days. And they wake up that night with a temperature of 102 and they're crying with their ear hurting.

Host: Yeah, I'm just sort of nodding my head. I've been there, done that. Everything you're saying is exactly what my life has been like. And I'm sure it's been for you with your kids and all the parents who are listening. Are there some tips that you have for storing or administering meds? You know, I know over time as they, my kids got older, I would say, well, you know, the Benadryl's up in the cabinet or cold medicine's up in the cabinet, you know, just OTC type stuff that I wasn't worried about them taking too much of because they never really loved it. But I'm sure that there are some better best practices if you will. And you have some tips on just where to keep things, how to keep things away from them, how to administer and so forth.

Dr. Snyder: Really, until the child is significantly older, I would say in their teens, and even then it depends on the child; medication should be administered by the parent. Those should be kept in a location that is not accessible by the child. Sometimes that's tough because they're in the refrigerator and so forth. But I think teaching also your child from an early age, that medicine is not candy, it can be harmful and help them to develop a respect for that is important.

Host: Yeah. I know that when I would take my kids, when they actually would get prescribed something and you'd go to the pharmacy and they'd ask what flavor to add in. And I always used to think to myself, like, do we want this to taste good? Do we really want them to enjoy, you know, taking this medicine? And I don't know if you have any thoughts on that, but I would discourage them from getting something that tasted too good. I feel like that was good parenting. What do you think doc?

Dr. Snyder: That's a tough call because we have some children that are really, really resistant. And I believe in those situations, that is favorable to them not taking the medicine. I think it again, has to be done in a controlled way, but we do have some children who that is the only way they will take it. In those situations, I think, again, it's better than them spitting out the medicine every time.

Host: I see what you mean. It's a fine line there between something that tastes good, but tastes maybe good enough to be tolerated by certain kids. So somewhere in the middle, there are probably. have any tips on administering antibiotics to babies and toddlers? Having had a couple of them myself, I know that that was a unique experience.

Dr. Snyder: Sometimes it works better to use a syringe. You can kind of get that in there and get the medicine farther back in the back of their throat. Trying to get them to you know, take it from a spoon and that sometimes it's hard. So we recommended syringe a lot. Also, you can take the medicine and mix it in a small volume of other fluid. It has to be an amount that the child's likely to take all at once and then they may take it through a straw and have an easier time taking it that way.

Host: Yeah, all good suggestions. And you've touched on sort of the side effects of antibiotics and allergies. Well, what should we do if a child or a baby even seems like they're not having a great reaction to antibiotics, what should we do first? And then, maybe bring them someplace of course.

Dr. Snyder: So we would assume in that situation that the child has been seen evaluated, examined. The physician has determined that there is a bacterial infection and has prescribed an antibiotic. We ask the parents to try to give some reasonable amount of time for the medicine to work. You know, two, two days up to three days, you have to remember that bacterial infection has taken some time to settle in. So it's not going to be better immediately. With the amount of time though, the child's not responding, then it could be that they have a bacteria that's resistant to the particular antibiotic they've been prescribed. So if their fever persists, certainly if their condition is getting worse, like if they're having more ear pain, ear drainage, if their respiratory status worsens, they're breathing more rapidly and difficulty, then you would definitely want to touch base with your physician. In the meantime, we try to treat the fever and keep them hydrated and try to maintain a baseline.

Host: Yeah. And specifically about an allergic reaction, like what are the signs of that and what should we do, you know, in the moment?

Um,

Dr. Snyder: Sure. So an allergic reaction usually shows up as a significant rash, like hives or welts. It's a rash like you probably have never seen before. And depending on the severity of the reaction, they can even have further effects, you might see some swelling around the lips or the face. We're talking about a pretty significant reaction there. In the immediate case, we would give the child some Benadryl.

So that's always good to have on hand for allergic reactions and that can help to calm that down hopefully relatively quickly.

Host: Yeah, we've definitely gone through some Benadryl in my house over the years. So let's assume that a child is allergic to a known antibiotic, something that they've been prescribed before. Are there other options or is a child who happens to be allergic to amoxicillin or something like that, they just no medications for them. How does that work?

Dr. Snyder: So I mentioned earlier, there's different classes of antibiotics. So amoxicillin would be in the penicillin family. Then there are cephalosporins, which are, you might say like, they're the third cousin to penicillins, but there's only about maybe a 25% chance of a child allergic to amoxicillin might be allergic to a cephalosporin. The sulfa drugs are also completely different structurally and the Zithromax and erythromycin are also completely different. So there are always other options, if a child has had a reaction to a particular antibiotic.

Host: Yeah, that's good to know. Obviously we're all just, just want to help our kids get better, you know, as quickly as we can. And it's been really educational today, doctor, and then I always enjoy when I do things like this. I can really identify having had kids, myself andbeen to the peds office so many times in my lifetime. As we wrap up here, doctor, what would be your takeaways when it comes to antibiotics? You know, when they're appropriate, when we might consider some home remedies, just in general, for folks listening, for parents who are listening, what are your take aways?

Dr. Snyder: The first thing we try to do when there is an infection, is to decide if it is more likely to be viral or bacterial. The viral side is more things like the runny nose and cough and low grade temperature. Then on the bacterial side would be more of a focal complaint like the ears or the throat, usually a higher temperature, but not always.

Usually the child appears more ill. The child with a cough and a sore throat compared to a child with strep throat, they present very differently. The child with the strep throat always looks significantly ill. So it's, has a little bit to do with the degree and also if a child just has a temperature of 102 and a sore ear versus having runny nose and that, you're more likely to think they probably have a bacterial infection.

Host: Yeah. See what you mean and good to understand the distinction here for parents today, you know, between viral and bacterial infections. And you did mention that viral can become bacterial at some point. But good to know that we have experts, doctors, nurses, antibiotics, different classes, and so on because we just want to help our kids.

So doctor, thanks so much for your time today and you stay well.

Dr. Snyder: You're welcome. Thank you.

Host: And to schedule an appointment with a pediatrician, visit Franciscandocs.org. And if you found this podcast helpful, please share it on your social channels and be sure to check out the full podcast library for additional topics of interest. This is the Franciscan Health Doc Pod. I'm Scott Webb. Stay well, and we'll talk again next time.