When do children with respiratory illnesses need antibiotics?

Scientific evidence shows that respiratory infections are caused by many factors, with about two-thirds being viral. Antibiotics do not kill viruses, and improper use can cause children to experience allergies, diarrhea, fatigue, etc.

According to Dr. Nguyen Tien Dung, former head of the Pediatrics Department at Bach Mai Hospital (Hanoi), the main cause of respiratory illnesses in children is viruses. However, the number of antibiotic prescriptions always exceeds the proportion of respiratory infections caused by bacteria.

There are many reasons for prescribing antibiotics. First, it's often because the patient's family requests them. Many people consider antibiotics a "cure-all": sore throat, fever, runny nose... they immediately think of using antibiotics. In addition, doctors may have limited time for examinations, leading to uncertain diagnoses or insufficient time to explain to the family why antibiotics aren't necessary.

Illustrative image: NP

According to Dr. Dung, given the limitations of diagnostic testing, accurately assessing clinical symptoms is crucial for predicting the likelihood of bacterial infection in patients. Comparative clinical evidence shows that only 60% of patients with sinusitis lasting more than 10 days are due to bacterial infection. Otitis media with effusion in children is mostly non-bacterial. Upper respiratory tract infections of unknown location and acute bronchitis in previously healthy individuals are primarily viral.

For example, pharyngitis can be caused by viruses or streptococcal bacteria. If it's viral, children usually have symptoms such as conjunctivitis, runny nose, cough, diarrhea, and a viral-like rash. If it's streptococcal, the patient usually has a fever above 38.5°C, swollen and painful lymph nodes in the neck, headache, petechiae on the palate, abdominal pain, sudden onset of the illness (less than 12 hours), and secretions from the throat and tonsils.

The World Health Organization recommends considering streptococcal pharyngitis if a child has at least the following signs: red throat, swollen tonsils, white discharge, and swollen and painful lymph nodes in the neck. “If only the throat is red, it’s usually a viral pharyngitis. Children with streptococcal pharyngitis need proper and sufficient antibiotic treatment to prevent complications such as acute rheumatic fever, which can affect the heart and is very difficult to treat later,” Dr. Dung said.

Viral infections do not require antibiotics; the illness will resolve on its own. Supportive treatment is necessary to help children recover quickly. Using antibiotics in these cases will not speed up recovery but may cause fatigue, loss of appetite, and even prolonged diarrhea or allergies.

Incorrect or inappropriate use facilitates the widespread and persistent emergence of antibiotic-resistant bacteria. Antibiotics are considered a "reserve" for truly critical situations, therefore they should not be overused. When sick, you should see a doctor instead of self-medicating, especially with antibiotics. When taking medication, you must adhere to four rules: correct indication, dosage, duration, and method of use.

According to VnExpress