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Why Most Sore Throats, Coughs & Runny Noses Don’t Need Antibiotics

​If your child has a sore throat, cough, or runny nose, you might expect the doctor to prescribe antibiotics. But most of the time, children don't need antibiotics to treat a respiratory illness. In fact, antibiotics can do more harm than good. Here's why:

Antibiotics fight bacteria, not viruses.

  • If your child has a bacterial infection, antibiotics may help. But if your child has a virus, antibiotics will not help your child feel better or keep others from getting sick. Antibiotics kill bacteria and cure infections caused by bacteria, such as strep throat. Viruses are completely unaffected by antibiotics.

  • Colds and flu are caused by viruses.

  • Chest colds, such as bronchitis, are also caused by viruses. Bronchitis is a cough with a lot of thick, sticky phlegm or mucus. Cigarette smoke and particles in the air can also cause bronchitis. But bacteria are rarely the cause.

  • Most sinus infections are also caused by viruses. The symptoms are a lot of mucus in the nose and post-nasal drip. Mucus that is colored does not necessarily mean your child has a bacterial infection.

In most cases, antibiotics will not help your child.

  • Antibiotics do not work against colds, flu, or bronchitis, because they are viruses.

  • Sinus infections can sometimes be caused by bacteria, but usually the infection clears up on its own in 10 to 14 days.

  • Many common ear infections also clear up on their own without antibiotics.

  • The majority (70%) of sore throats are caused by a virus, but some sore throats, like strep throat, are caused by bacteria. Symptoms include fever, sore throat, redness, and pain with swallowing. However, most children who have these symptoms do not have strep throat. Strep throat cannot be diagnosed just by looking at the throat. Your child should have a rapid strep test to confirm that it is strep throat, along with backup culture if the rapid strep test is negative. If the rapid strep test is positive or the backup culture is positive, the doctor will prescribe an antibiotic.

Antibiotics have risks.

  • Adverse drug reactions from antibiotics are a common reason that children go to the emergency room.

  • Antibiotics can cause side effects, like diarrhea or vomiting, and about 1 to 5 out of every 100 children have an allergy to an antibiotic. Some of these allergic reactions can be serious and life threatening.

  • Overusing antibiotics to treat infections when they are not needed also encourages more resistant bacteria to grow. The resistant bacteria do not respond to antibiotics. This is sometimes called antibiotic resistance. The resistant bacteria can spread from your child to other family members and friends, causing infections that are more difficult to cure and more expensive to treat.

Antibiotics are a waste of money if used incorrectly.

  • Most antibiotics do not cost a lot, but some do. But money spent on medicines that are not needed is money wasted—especially if your child has an adverse drug reaction to the medication. In severe cases, treatment of infections that are antibiotic-resistant can cost thousands of dollars.

When does your child need antibiotics?

Your child may need antibiotics if:

  • A bacterial form of pneumonia or whooping cough is diagnosed by your child's doctor.

  • Symptoms of a sinus infection do not get better in 10 to 14 days, or they get better and then worse again.

  • Your child has a yellow-green nasal discharge and a fever of at least 102° F for several days in a row without any improvement in their symptoms.

  • Your child has strep throat, after using strict criteria to determine if testing is indicated and based on a positive rapid strep test or throat culture. Antibiotics should not be prescribed unless one of these tests shows the strep throat bacteria. Strep cannot be diagnosed just by looking at the throat.

Editor's Note: The American Academy of Pediatrics (AAP) released a list of specific tests or treatments that are commonly given to children, but are not always necessary, as part of the Choosing Wisely® campaign, an initiative of the ABIM Foundation. Antibiotics and cough and cold medicines were identified; the full list gives more detail as to the reasons for taking a closer look at each treatment, and cites evidence related to each recommendation.

Additional Information & Resources:

Last Updated
American Academy of Pediatrics (Copyright © 2016)
The information contained on this Web site should not be used as a substitute for the medical care and advice of your pediatrician. There may be variations in treatment that your pediatrician may recommend based on individual facts and circumstances.
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