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Most Sore Throats & Runny Noses Do Not Need Antibiotics

Updated: May 29, 2023

A tip I share with most of my clients is if your child has more than one symptom - cough, runny nose, sore throat - then it is almost always viral. A single symptom is indicative of a local infection is more often bacterial. When little ones have discomfort though, parents often expect testing and antibiotics, but when they have a virus, these are not only not helpful, but can be harmful.



Antibiotics do Not Fight Viruses


Most childhood infections are caused by #viruses which can make your child feel very sick. If your child has a virus, antibiotics will not help them feel better or even keep others from getting sick. The common cold and flu, RSV, and COVID-19 are all viruses. Most sore throats of course, are caused by viruses, especially when there is also a runny nose or cough.


Chest colds, even those with thick, sticky phlegm or mucus that last a while, are more often caused by viruses. Cigarette smoke and pollution can increase a child's risk of getting one of these viruses, but bacteria is typically not the cause.


Most sinus infections, or #sinusitis, are caused by viruses. Congestion, post-nasal drip, and pressure in the face are common with sinusitis. This typically resolves on their own without antibiotics. Mucus that is yellow or green does not necessarily mean your little one has a bacterial infection. Ear infections even are more often caused by viruses, and do not need antibiotics.


Antibiotics have Risks


Side effects from antibiotics are significant and a common reason that children go to the emergency room. Diarrhea, vomiting, abdominal pain, various rashes, allergic reactions, and antibiotic resistance are common. Some allergic reactions can be serious and life-threatening. When antibiotics aren't prescribed properly or when given too often, they can cause bacteria to become super narley and then tougher and tougher antibiotics are needed.


Consider Other Options


Antibiotics kill bacteria but they do not treat symptoms of an illness, such as ear pain, #fever, cough, or congestion. Fever is treated with an "anti-pyretic" such as ibuprofen or acetaminophen. Pain can also be treated with ibuprofen or acetaminophen (associated with increased incidence of asthma). Congestion is helped with use of a humidifier and a spoonful of dark honey can help with a cough. Our botanical medicine program can help you corporate additional, more natural remedies into your medicine cabinet.


When Are Antibiotics Helpful?


Certainly antibiotics have their role, such as for strep throat (for prevention of Rheumatic fever) based on a rapid strep test or test culture. If your child's breathing started to get better and then worse again with new fever or new symptoms, this may be a bacterial form of pneumonia or sinusitis. Pertussis is yet another reason (coughs that make you almost vomit).


Streptococcal Pharyngitis


Group A beta-hemolytic streptococcal infection causes about 15 to 30 percent of sore throats in children and about 5 to 15 percent in adults, more commonly in later winter and early spring. When there is absence of cough, but a sore throat, tender lymph nodes in the neck, maybe even discharge near the tonsils, and a fever then strep is a potential. Viral infections have many symptoms, runny nose, itchy eyes, fatigue, cough and sore throat and may even have fever, but when the symptoms are all pointing towards the throat, a local bacterial infection is much more likely.


Strep is contagious, more often impacting those five years to fifteen years, with an incubation period of about 24 to 72 hours. It really is pretty uncommon younger than 3 years of age. If there is pain in the lymph nodes more towards the back of the neck, think mononucleosis, especially if there is also significant fatigue. Hand-foot-and-mouth disease should be considered if you see lesions in the mouth, sometimes even on the hands and feet.


When we look in the throat, when the symptoms are viral, the tonsils are not enlarged unless this is already baseline, and there is no discharge. Strep though causes the white patches on the tonsils, the discharge, and mononucleosis will swell the tonsils so that they may even touch the hanging ball, or uvula in the back of the throat.


Before treating for strep, it is important to get tested because if antibiotic therapy doesn't work, you want to know what you are actually treating, which will be altered by the antibiotics. Oral penicillin V is the antibiotic of choice, or amoxicillin which is better for the littler ones. If you have an penicillin allergy, a first-generation cephalosporin is often recommended, such as Keflex or clindamycin.

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