Thinking About Antibiotics

When it comes to practical information about antibiotics, no one is more instructive than Dr. Michael Pichichero, a pediatric infectious disease specialist in Rochester, NY.

By Dr. Robert B. Golenbock

At the risk of being accused of plagiarism, then, I’d like to summarize some thoughts of his from a recent article he wrote for pediatricians. (ID CONSULT. Why We Treat Infectious Diseases with Antibiotics. Pediatric News, December, 2023.)

The first point is that while we often complain that antibiotics are being overused, there are some very specific reasons for using antibiotics to treat common children’s infections. We will focus on two: strep throat and ear infections.

Strep throat is a bacterial disease caused by many strains of streptococcus bacteria. While many sore throats are caused by viruses that can’t be treated by antibiotics, strep can be treated. But first we have to do a strep test. Treating strep can prevent complications that include rheumatic fever, which can cause heart disease, and a kidney disease called glomerulonephritis, also very serious. Other complications we can avoid include Sydenham’s chorea, a persistent movement disorder, and PANDAS, a sudden onset of tics or obsessive-compulsive disorder that may persist for years.

If strep isn’t treated properly, the bacterial infection may lead to tonsillitis, sinusitis, and other serious infections like impetigo or more serious infections like necrotizing fasciitis (flesh-eating disease) or toxic shock syndrome. Even if strep throat doesn’t progress, it will clear up faster on antibiotics and reduce the risk of spreading to others.

Ear infections are so common that we sometimes don’t consider how important it is to treat them properly. While an ear infection can be part of a viral disease, proper examination can identify the signs of pus and swelling that indicate a high probability of a bacterial infection. Around the world, where children may not have access to proper medical care, ear infections are the number one cause of acquired deafness in children. The complications of these untreated infections can include infections that spread to other parts of the head like mastoiditis, sinusitis, meningitis, and brain abscess. There is also a complication that we don’t see much in the United States called cholesteatoma, in which debris behind the ear drum organizes and proceeds to destroy the eardrum and the little ear bones that allow us to hear. And again, even when a bacterial ear infection spontaneously resolves, treating properly will shorten the course – and relieve the pain.

Careful consideration of treatment options in children, particularly in children who can’t talk yet, is clearly important. Pediatricians go through difficult decision-making for persistent fluid in the middle ear, where the loss of hearing temporarily may yet cause speech delay; for sinusitis, where antibiotics are not always useful; and for cough, where the long list of causes makes proper evaluation a necessity before any kind of treatment.

Pages and pages have been written on these subjects. You can believe that a superficial review of the internet may not yield the answers you seek. If you have questions, your pediatrician can help you understand how they arrived at a diagnosis and treatment plan. Then do your child a favor and follow the plan. Sometimes taking antibiotics for a shorter course than prescribed is worse than not taking them at all!

Robert B. Golenbock, MD, is currently retired. He has cared for children in the Danbury area for 43 years, including at the Center for Pediatric Medicine. The CPM is located at 107 Newtown Rd, #1D, Danbury, CT, 06810. For more information, please call (203) 790-0822 or visit