There's no doubt that antibiotics are a good thing. They save lives every day. We can, in part, attribute our longer lifespans, reduction in infant mortality and childhood deaths from life-threatening infections, and the near elimination of childbirth-related maternal deaths from infections in hospitals to antibiotics. As a medical doctor I am grateful to be able to prescribe them for serious bacterial and other appropriate infections, for example Lyme disease. As with many things, however, more is not always better. And this is certainly the case with antibiotics.
The average child in the United States will receive between and 10 and 20 courses of antibiotics by the time he or she is 18 years old. (2) We are so accustomed to antibiotics being prescribed for childhood illnesses that we assume that they are as safe as they are common. But this is far from the truth. We are now learning the hard way that the common overuse of antibiotics, both as medicines and in our foods (they are given to cattle and poultry to keep them "healthy" until they are slaughtered for food; antibiotics also promote growth in these animals by the same mechanisms that their chronic use increases the risk of obesity in humans) is responsible for two major health problems: global antibiotic resistance to serious infections, and damage to the human microbiome.
This growing awareness that antibiotic overuse is dangerous for both public and personal health requires us to drastically and immediately rethink and adjust our antibiotic use. In doing so we can prevent our children from developing life-long chronic illnesses associated with microbiome damage, some of which rival the seriousness of the bacterial infections that used to threaten them, and we can reduce the major global threat of antibiotic resistance we all face.
Antibiotics, Your Child's Microbiome, and Chronic Disease
Antibiotics kill bacteria. The problem is that they not only kill off the bad guys (and as you'll see below, because of antibiotic resistance, they are doing this less effectively!); they kill off the good ones, too. When we give antibiotics to children at a young age or frequently enough, some of the good guys may never fully recover. These good gut flora, and their composite, our microbiome, are essential for more functions that protect and support our health than we'd ever imagined until recently. We now know that microbiome damage directly and significantly increases the risks of our children developing long-term health problems including: food, environmental, and seasonal allergies, eczema, asthma, ulcerative colitis, Crohn's disease, obesity (even when they're not over-eating), diabetes, and cardiovascular disease. (1) (4)
Antibiotics are given to between 30 and 50 percent of all women during pregnancy or labor. (2) Mom's exposure to antibiotics perinatally also negatively affects the breast milk microbiome, which is part of what is supposed to help colonize baby's gut with beneficial flora. (5) Additionally, 34 percent of babies in the U.S. are born by cesarean. These babies miss out on the important inoculation their gut flora is meant to receive through natural exposure to mom's vaginal flora, thus compounding the problem. Our babies thus begin their antibiotic exposure even before birth, and as a result damage to their formative microbial populations begins before they've had a chance to establish their optimal gut flora. If your baby was born by cesarean section, or if you did need to have antibiotics in labor, no need to be worried! Start your baby on a probiotic in the day or so after birth. Data has shown that while we can't necessary restore the native flora baby might have had, we can prevent eczema, allergies, and asthma with early probiotic treatment. (6)
By age 24 months, 69 percent of children in the U.S. have received at least one systemic antibiotic course, though the average is 2.3 courses for ear infections, bronchitis, sore throat, and other common childhood illnesses. Yet according to the Centers for Disease Control, and other official reports, at least 50 percent and as many as 70 percent of the antibiotics prescribed for children for these and other symptoms/conditions are unnecessary and inappropriate. (3)
Reactions to antibiotics are responsible for at least 140,000 hospital visits annually in the US. (3) One in every five emergency department visits due to a medication reaction is due to antibiotics, and in kids under 18 years old they are the most common cause of drug reactions. When a child takes an antibiotic that is not needed, not only is she or he getting no benefit; she or he is exposed to all the risks of harm and the use of that medication adds to antibiotic resistance.Why are antibiotics overprescribed? There are four main reasons:
- Doctors think that parents expect an antibiotic prescription when they bring their child in for a sick visit -- and many do -- leading to 50 to 70 percent of the antibiotics that are prescribed. (4)
- Doctors are afraid to get sued should an infection that they didn't treat with an antibiotic turn out to be more serious than anticipated.
- Doctors don't feel that they have time to explain the problems with antibiotics to parents in the time allocated for a child's sick visit, whereas it is quick and easy to prescribe an antibiotic.
- Doctors aren't knowledgeable about alternatives to antibiotics and want to prescribe something they think will help.
The Centers for Disease Control and Prevention (CDC) has been on a several decade-long campaign to get physicians to reduce their antibiotic overprescribing. While there has been about a 20 percent decrease in antibiotic prescribing over the past 20 years as a result, the rates of overprescribing remain shockingly high, according to the CDC and other researchers. (3)
Antibiotic Resistance: A Global Health Threat
We are in the midst of a global health crisis -- antibiotic resistance, which is a direct result over the overprescribing and inappropriate prescribing of antibiotics, and the overuse of antibiotics in the meat industry.
Antibiotic resistance is not something that develops just in the individual -- that is, it's not just that you become resistant to that antibiotic -- it means that the bacteria themselves have learned to outwit the antibiotic so that the antibiotic is no longer effective in treating anyone who is infected with the resistant strain.
Each year in the U.S. alone over 2 million Americans acquire serious infections with bacteria that are now resistant to some or all of the antibiotics that we have to treat those organisms, and at least 23,000 people die each year as a result of antibiotic resistance. (3) Global leaders in public health have declared that these "nightmare bacteria" pose a catastrophic threat to every person in the world!
Five Steps to Preventing Antibiotic Overuse In Your Child
- Promote health in your children: Preventing recurrent upper respiratory infections including coughs, colds, sore throats is an important and logical step you can take to prevent antibiotic overuse. Less need for them = less use of them! A healthy diet of natural foods with plenty of good quality protein, good quality fats, plenty of fresh vegetables, and low sugar, reduction of chronic stress, playing outside and getting dirty to get exposure to natural probiotics in the soil, and regular hand-washing with soap and water (don't use antibacterial soaps -- these also contribute to antibiotic resistance), along with a multivitamin that contains adequate iron, vitamin D, essential fats, and zinc, all support optimal immunity. The gut can also be nourished and the microflora supported with a probiotic.
- Choose organic for your meats and dairy: While it may not be feasible for you to serve your family an entirely organic diet for economic reasons, at least use only antibiotic-free meats and poultry, and organic dairy. These are where the heavy antibiotic exposures come from in the diet -- so it's where you can make your money count most toward reducing antibiotic exposures.
- Know your options -- Get Smart: The CDC has a website called Get Smart that is dedicated to preventing antibiotic resistance through preventing antibiotic overuse. You can find information on the primary infections for which antibiotics are overused, how to know when your child really does need an antibiotic, and how to avoid unnecessary use. Included is also information on comfort measures and medical alternatives for common symptoms ranging from cough and sore throat, to fever and ear infections. I don't necessarily agree with all of the CDC's alternative treatment recommendations, particularly the liberal use of Tylenol and ibuprofen, which have their own potentially serious side effects, but the overall information is very useful and also provides solid information to bring to your child's doctor's appointment to share with the pediatrician in case there is disagreement over whether the antibiotic is necessary and appropriate.
- Know your rights: Doctors are not infallible nor are we omniscient. And not all doctors are aware of the importance of avoiding antibiotic overprescribing, so some may may insist on the prescription in spite of the CDC's guidelines. If you cannot reach agreement with your pediatrician, you have the right to seek another opinion or to change doctors. You should not be coerced into giving unnecessary antibiotics to your child. If your pediatrician is, however, insistent, find out why -- she may have a different perspective on your child's symptoms and of course the CDC guidelines are just that -- clinical judgment is also important.
- Use natural treatments for the symptoms of common childhood illnesses whenever possible.
1. Bailey LC et al. Association of antibiotics in infancy with early childhood obesity. JAMA Pediatr 2014 Sep 29
2. Blaser, M. Stop the killing of beneficial bacteria. Nature. Vol 476, 393-94. Aug. 2011.
3. CDC. Antibiotic Resistance Threats in the United States, 2013. US Dept of Health and Human Services, Centers for Disease Control and Prevention.
4. Dooling KL et al. Overprescribing and inappropriate antibiotic selection for children with pharyngitis in the United States, 1997-2010. JAMA Pediatr 2014 Sep 29
5. Williams, F. (2013). Breasts: A natural and unnatural history. New York: W.W. Norton.
6. Osborn DA, Sinn JK. Probiotics in infants for prevention of allergic disease and food hypersensitivity. Cochrane Database Syst Rev. 2007;17: CD006475.
Aviva Romm, M.D. is a Yale-trained, Board Certified Family Physician, midwife, and herbalist helping extraordinary women live their best lives through optimal health. An award-winning author and the leading international authority on botanical, integrative and functional medicine for women and children, she combines her unique backgrounds to guide women in transforming their health -- and their lives. She is also a leader in the revolution to shift the current medical system into one that respects the healing capacities of the body and nature. Dr. Romm has bridged her interests in traditional medicine with her knowledge of science for over 30 years, specializing in the impact of stress, food and lifestyle on food cravings, weight, immunity, hormone imbalances, and women's chronic health concerns. She also provides comprehensive guidance on natural fertility, pregnancy, and birth, and pediatrics. Dr. Romm practices Functional Medicine for Women and Children at The UltraWellness Center with Dr. Mark Hyman in Lenox, MA. Visit her website www.avivaromm.com for free access to her e-book, Herbal Medicines for Kids: Taking Charge of Your Child's Health... Naturally.