Common Infections of Childhood

The most common disease of childhood is the acute infection - the cough, cold, earache or sore  throat.  On average, children get five or six such infections per year and their natural incidence is between the ages of one to eight years of age.  These infections are normal, desirable and an integral part of childhood development.
The usual response to an upper respiratory infection is much more dramatic in the young child than in the adult. There may be a sudden onset of absolute lethargy, fever, rash, an outpouring of mucus, and an abundance of lymph nodes in the neck, underarm and groin.

This dramatic response reflects the very vitality of the life force in children and indicates their ability to mount an effective immune response.

There is a surprising lack of scientific evidence supporting the use of many popular pharmaceuticals in upper respiratory tract infections.  Also, before giving any pharmaceuticals to infants and young children, it is important to consider that the rate of spontaneous recovery from many acute infections is much higher than in adults and usually occurs in a relatively short period of time.

Children often just need a nudge in the right direction.  Rest, quiet and plenty fluids will support the normal immune response and help the body toward recovery.  However, children do also at times suffer serious infections and it is essential to seek a medical assessment of their condition prior to any ‘wait and see’ approach.

Australia has one of the highest rates in the world for prescribing antibiotics to children less than six years of age; despite the fact that the scientific literature condemns their overuse.

Antibiotic therapy is not without risk.  It is estimated that approximately one child in ten may develope an allergy to an antibiotic.  This may vary from mild to life threatening - rash, fever, bronchospasm, seizures, headache, hallucinations and anaphylaxis.

A recent audit by the Australian National Prescriber Service looked at 30,000 patients with upper respiratory tract infections and bronchitis.

Among general practitioners, there was a huge 90% reduction in the number of antibiotic prescriptions for the common cold.

However, it was found that only 45% of uncomplicated cases of bronchitis were handled within the guidelines; 55% were given antibiotics.

90% of children with acute tonsillitis were given antibiotics.

80% of children with acute middle ear infection were given antibiotics.

The Fam Pract 2000 reported a study of clinical predictors for prescription of antibiotics by General Practitioners in children.  It showed that they are influenced to use antibiotics by symptoms of productive cough, sore throat and fever for which no evidence of efficacy exists from the literature.

The Sydney Morning Herald reported “There is serious concern about the contribution that enthusiastic pharmaceutical companies are making to antibiotic overuse.  Marketing promotions to doctors encourage their use for respiratory infections whilst hospital-based microbiologists preach rational prescribing. 75% of all antibiotics prescribed outside hospital are for respiratory tract infections 90% of which are viral in origin.  General Practitioners seem to be more influenced by marketing ploys and doctors are described as ‘Prescribers’ "

A Canberra study discovered that children who had a recent course of antibiotics were twice as likely as others to harbor low levels of drug resistant bacteria. This could be a problem if the bacteria then cause a clinical illness because that infection could potentially be life threatening.  Also others, coming into contact with the child are at risk of infection.

Another Australian study involved 461 pre-schoolers.  Parents kept a diary of illness, doctor visits and medications.  Also, every six months, a swab was taken from the child’s nose.

It was found that almost 50% of the children carried pathogenic bacteria and 14% of those were resistant to antibiotics.

This rate doubled if the child had taken antibiotics in the previous two months.

However the good news was that after six months, the risk of carrying resistant bacteria diminished.

Therefore, it appears that drug resistance in the community could be quickly controlled by reducing antibiotic use.

It is clear that accelerated patterns of bacterial resistance mandate decreased use of antibiotics. Bacteria have an uncanny ability to learn new mechanisms of resistance and a large part of this ‘education’ of bacteria has undoubtedly been fuelled by overuse of antibiotics for trivial respiratory infections.

There is an ever-increasing incidence of antibiotic-resistant organisms, ‘super-bugs’ that we can no longer treat.

The ‘post – antibiotic’ era seems to be upon us.