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Why We Love Amoxicillin
June 10, 2013
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Have you ever wondered why amoxicillin is the first-line antibiotic we select for ear infections, sinus infections, and strep throat? Sometimes amoxicillin seems to get a bad rap because some people feel that it “never works” for them, but amoxicillin is actually a great antibiotic for the majority of children. Here are some of the reasons why:

1. Amoxicillin is in the penicillin family of antibiotics. It covers the most common bacteria that cause ear infections, sinus infections, and strep throat. It may also be effective for pneumonia.
2. It is fairly narrow-spectrum, meaning that it does not kill off so many of the other bacteria in the body. This is important because most bacteria in our bodies help to keep us healthy. Killing of those helpful bacteria is what causes us to develop stomachaches, diarrhea, and yeast infections while taking antibiotics. Amoxicillin is less likely than most other antibiotics to cause these side effects.
3. It tastes good. Children frequently request the “pink bubblegum medicine!” (One question you may ask is why we use amoxicillin instead of plain-old penicillin. The reason: penicillin liquid tastes terrible!)
4. It is inexpensive. A 10-day course of amoxicillin can be obtained for $4-8 at Walmart and for free at Meijer.
5. It doesn’t have to be refrigerated (although it tastes better if it has been, so it’s recommended to keep it in the fridge when possible).

So why do some people say “amoxicillin never works” for them? For children who have been on repetitive antibiotics (or who are in daycare with other children who have been on repetitive antibiotics), bacteria can become progressively resistant. This means it requires higher doses of an antibiotic or broader-spectrum (“stronger”) antibiotics to kill the offending bacteria. For children requiring repeated antibiotic courses in a short period of time, we typically try to alternate antibiotics, as this seems to help decrease the development of resistance (i.e. it keeps the bacteria “guessing”). One general rule we follow is that if a child has been on amoxicillin within the previous 6-8wks, then we will choose something stronger for a subsequent antibiotic course. However, if it has been more than 6-8wks since the last antibiotic course, then resistance has often waned, and we will try to move back to using amoxicillin.

One source of confusion for many people is the use of amoxicillin for strep throat vs. ear infections and sinus infections. It is typically only with ear and sinus infections that resistance to amoxicillin is a problem. The bacteria that causes strep throat (group A streptococcus) is almost universally susceptible to amoxicillin, so even children who do not have good results with amoxicillin for ear and sinus infections should be able to take amoxicillin for strep throat. You may also notice that the dosage we use for strep throat is lower than the dosage we use for ear and sinus infections. This is because the group A streptococcus bacteria is easier to treat.

One situation in which you may see us use a broader-spectrum antibiotic first-line for ear or sinus infections is when these infections are accompanied by “pink eye.” The presence of “pink eye” often indicates a more resistant bacteria is at work and amoxicillin might not be the best antibiotic choice (although sometimes it may still work).

Of course, it is important to keep in mind that all antibiotics must be used judiciously to remain effective. I am always surprised that so many people are anxious to have their child put on antibiotics — the expense, the inconvenience, the side effects! I’ll take a virus any day over a bacterial infection that requires antibiotics for my own children. It is always interesting to me that people think we pediatricians are so lucky because we can prescribe antibiotics anytime we want for our own children. Trust me, our children get antibiotics far less than the average child because we do not want our children on them! And when my child does need an antibiotic, I prefer amoxicillin over the others.

Important things to remember to help avoid unnecessary antibiotics for your child:
1. Antibiotics do not treat viruses. Viruses make us miserable for a while, but eventually our bodies fight them off without help. They “run their course.”
2. Colds typically last 1.5 – 2wks, and sometimes as long as 3wks. If your child is not miserable or running a fever with cold symptoms at 2wks, give it another week and see if things do not resolve on their own. If a cold lasts longer than 3wks, your child should be seen.
3. Yellow or green nasal mucus does not indicate a need for antibiotics. Viruses cause yellow and green mucus just as often as bacteria do.
4. Viruses can cause sinusitis (symptoms of headache, facial pressure, etc.).
5. Older children with ear infections will get better on their own 80% of the time. If your child is at least 2yrs old and is having only mild symptoms of an ear infection, you can try giving it a few days at home to see if things will improve without treatment. Obviously if your child is having significant ear pain or fever, he/she should be seen in the office.

6. Bronchitis is usually viral and does not require antibiotics.
7. Please do not pressure us to prescribe antibiotics! We really do want you to be happy with the care your child is receiving, and if we feel that you are not going to be happy without an antibiotic, it puts us in an unenjoyable emotional quandry if we do not think an antibiotic is needed. Also, if you are hoping to avoid antibiotics, please verbalize this to us, as it takes off some of the pressure we feel to prescribe something and try to make the child magically better!

So to summarize: We want to avoid antibiotics when possible. When we do need antibiotics, we want to use the most narrow-spectrum antibiotic possible so as to decrease the risk of side effects and resistance. And these are just a few of the things we’re thinking about when considering how to treat your child!

Michelle Bennett, M.D., F.A.A.P.
Pediatric & Adolescent Associates