Babies and Antibiotics

When your little one is sick, it's natural to want your pediatrician to give her something that will make her feel better fast, like an antibiotic. These prescription medications are extremely effective at killing bacteria. But depending on your baby's symptoms and illness, they may not be the right choice. "Antibiotics are only effective against bacteria, which means they're useless against viral ailments like the flu and colds," says Iona Munjal, M.D., director of the Pediatric Antimicrobial Stewardship Program at The Children's Hospital at Montefiore Medical Center in Bronx, New York. We talked to the experts about how and when antibiotics can help a baby.

High Fever :

A fever indicates that the body's immune system is fighting off germs," says Dr. Munjal. This is a good thing, but temperatures that spike too high (100.4° for babies younger than 3 months; 102° for ages 3 to 12 months) may signal a more serious bacterial infection. If this is the case, antibiotics such as ampicillin or cefotaxime, or both, may be required.

Pneumonia :

It's difficult to determine whether the cause of this lung infection is viral (perhaps due to an upper respiratory infection) or bacterial. Symptoms of pneumonia usually start with fever, coughing, shortness of breath, and/or vomiting. Because infants have a higher risk of complications from pneumonia, including death, pediatricians often prescribe antibiotics such as amoxicillin, ampicillin, and penicillin, even if they aren't positive that it's a bacterial infection.

Pertussis (whooping cough) :

Antibiotics are most effective when started within the first week or two of this respiratory disease, when early symptoms include a mild cough or fever, before the signature whooping cough begins. Azithromycin is typically the first choice for treating pertussis; other options include clarithromycin and erythromycin.

Ear infections :

If your older child has an ear infection, your doctor may wait 7 to 14 days to see if it clears up without treatment. But infants are the exception. "A baby can't tell you how much pain he's in or if he's feeling worse, which is why most pediatricians prescribe an antibiotic like amoxicillin," says Allison Bartlett, M.D., a pediatric infectious disease specialist at La Rabida Children's Hospital in Chicago. Signs your baby may have an ear infection include ear tugging or pulling, excessive irritability or crying, sleeping difficulties, and high fever.

Urinary tract infections :

These infections occur when fecal or other bacteria enter the bladder or kidneys. Fever is typically the only sign of a UTI in an infant, but some other symptoms can include irritability, vomiting, or diarrhea. "A urine culture can confirm the diagnosis and identify which bacteria are causing the infection," says Dr. Bartlett. "This helps the doctor choose the best antibiotic to target those specific bacteria.

Other infections :

Infants rarely develop strep throat (which involves symptoms of fever, sore throat, and trouble swallowing) or sinus infections (or excessive nasal congestion along with a fever or cough) that require antibiotics.