A study by the U.S. Centers for Disease Control and Prevention (CDC) reports that pediatric emergency room visits for antibiotic-related adverse events averaged 47,628 per year between 2019 and 2023.

This type of medication was implicated in more than a third of pediatric visits for adverse events adverse effects.

The research, published in the Journal of the Pediatric Infectious Diseases Society, provides significant data:

Changes in prescribing trends

Researchers highlight a decrease in antibiotic prescribing in recent years, partly due to the impact of the COVID-19 pandemic. In 2023, an increase in emergency room visits was estimated at 73,095 cases. “Although overall antibiotic prescribing has declined in recent years in the United States, especially among children, opportunities to reduce harm remain,” the study authors wrote. Experts suggest that the risks of adverse reactions should be considered when prescribing antibiotics, promoting an observational approach in the absence of clear diagnoses. Symptoms of Allergic Reactions to Antibiotics: The most common symptoms of allergic reactions to antibiotics in children include skin rashes such as hives or urticaria, intense itching, and skin redness. Other common signs include swelling of the face, lips, or throat, along with respiratory symptoms such as difficulty breathing, wheezing, or coughing.

Differentiation. Do not confuse with common side effects such as watery diarrhea or stomach upset, which do not preclude future use of the antibiotic. Allergic reactions usually appear minutes to days after the dose.

Alternatives to Antibiotics

In pediatric infections, several alternatives or complements to antibiotics can be considered, especially when the cause is viral,Mild or when the goal is to reduce unnecessary antimicrobial use.

Observation and symptomatic management. In many respiratory infections (viral pharyngitis, bronchitis, mild acute rhinosinusitis), the main treatment is symptomatic management (antipyretics, hydration, nasal saline, rest) and avoiding antibiotics, because most are viral in origin. Deferred antibiotic therapy (prescribing, but indicating that it should only be used if the condition worsens) reduces antibiotic consumption without increasing complications in uncomplicated respiratory infections.

Prevention with vaccines and hygiene measures. Vaccines (pneumococcal, Haemophilus influenzae type b, influenza, measles, etc.) prevent serious bacterial and viral infections, decreasing the need for antibiotics. Handwashing, adequate ventilation, breastfeeding, and avoiding exposure to tobacco smoke reduce the frequency of respiratory infections in children.

Immunomodulatory and complementary therapies.

Some immunomodulators or supplements (e.g., certain extracts of Echinacea purpurea) have been shown in studies in children to reduce the incidence of viral respiratory infections and, therefore, the use of antibiotics, although the evidence is still limited and they should be used with caution. Other plants or natural products with antimicrobial properties (garlic, thyme, oregano, etc.) have been studied in the laboratory, but they do not replace antibiotics in confirmed bacterial infections, and their use in pediatrics requires medical supervision.

Microbiota-targeted therapies and new strategies. Managing the gut microbiota (selected probiotics) can help prevent certain infections (e.g., antibiotic-associated diarrhea or recurrent respiratory infections), although the effect is moderate and depends on the strain used. Future alternatives such as bacteriophages, endolysins (“enzybiotics”), and monoclonal antibodies, which could treat resistant bacterial infections, are being explored in research, but they are not yet routinely used in pediatrics.

When alternatives should NOT be used.

In clear and potentially serious bacterial infections (bacterial pneumonia, meningitis, sepsis, streptococcal pharyngitis with treatment criteria, osteomyelitis, etc.), antibiotics remain the essential treatment and should not be replaced by unproven alternatives.

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