Antibiotics are one of the most commonly prescribed medications to children. As parents, we want to understand as much as possible of the things we put into our children’s mouths. In this article, we shed light on the use of antibiotics in children.
What is an antibiotic?
Antibiotics are medications used to treat infections caused by bacteria — not viruses. That means if your children catch a cold or flu, antibiotics are not required because they are not caused by bacteria.
Using antibiotics when they are not the right medications will not help and may even cause more harm than good. Check out our article on antimicrobial resistance here.
Nevertheless, doctors will find out if antibiotics are the right treatment for your children before prescribing them. Antibiotics are commonly prescribed to the following infections:
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Acute sinusitis
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Acute otitis media
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Pharyngitis
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Urinary tract infection
Some of the infections mentioned can be caused by viruses as well, so don’t be surprised if your children have these conditions but the doctor did not prescribe any antibiotics.
When antibiotics are not required, the doctor would prescribe other medications to relieve the discomfort of your children, such as medications for fever, cough or pain.
Commonly prescribed antibiotics for children
There are many types of antibiotic treatments with different properties, such as:
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Different dose — The dose of antibiotic prescribed by the doctor depends on the infection of your child, as well as your child’s age and body weight. The dose of antibiotics taken by children may be different from the adult’s.
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Different frequency of taking — Some antibiotics require a twice-daily dosing, others may require three times or even four times per day.
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Antimicrobial spectrum — The reason we have so many types of antibiotics is because we have many, many types of bacteria to fight against. Antibiotics have specific activities against specific groups of bacteria only. They will be useless if used against other types of bacteria. Your child’s doctor will know the kind of antibiotics that are suitable for certain infections.
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Different dosage forms — Antibiotics can come in tablets, capsules and liquid. For younger children who cannot swallow tablets, liquid antibiotics are usually given. Names such as suspension, syrup and solution are all liquid forms.
There are many types of syrup antibiotics available, such as:
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Augmentin® suspension / Fleming® suspension - amoxicillin trihydrate + potassium clavulanate (Available in 228mg/5ml and 457mg/5ml)
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Ampicillin trihydrate (Available in 125mg/5ml)
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Cefuroxime Axetil (Available in 125mg/5ml)
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Cephalexin suspension (Available in 125mg/5ml and 250mg/5ml)
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Cloxacillin Sodium (Available in 125mg/5ml)
In certain cases, antibiotics tablets would be given and the children’s parents would be asked to disperse the tablets in liquid and administer them to the children. An example of such an antibiotic is Bactrim® (Sulfamethoxazole 400 mg and trimethoprim 80 mg).
Administering antibiotics liquid to children
There are a few things to take note when administering liquid antibiotics to children:
Reconstituting antibiotics liquid
Many liquid antibiotics do not come in liquid form but rather in granules, and parents are required to mix them with water to form the liquid before giving to children (this process is known as reconstitution). Such formulation is necessary because many antibiotics are not stable in liquid form for a long time, hence they should only be made into liquid form just before giving it to patients.
Different brands and types of antibiotics may have slightly different directions on how to reconstitute the liquid antibiotics. Your pharmacist would tell you the correct steps to reconstitute them. Here’s an example on how to reconstitute Zinnat®, a cefuroxime axetil 125mg/5ml suspension:
Source: Zinnat® product leaflet
Giving antibiotics liquid
Similar to giving liquid medications to your children, it’s important that you follow exactly the doctor’s instructions on the dose and frequency of the antibiotic prescribed.
Liquid medication is often prescribed in terms of volume, e.g. Give 2.5ml twice daily. To properly measure the liquid medication, use the dropper, syringe, medicine cup, or dosing spoon that comes with the medicine. If the medicine does not come with a dosing tool, ask your pharmacist or doctor to give you one to use. Never use teaspoons, tablespoons, or other household spoons to measure medicine. This is because household tools can vary a lot in terms of size, which can significantly affect the actual amount of medication you give your child.
In addition, be extra cautious when reading the amount of medication to give. For example, be careful when you see a period (“.”). Do not misread “0.5 ml” as “5 ml” and vice versa, as it can be a matter of treatment failure (due to giving too little medication) or toxicity (due to giving too much medication) in your children.
Image credit: healthychildren
Also, make sure you read the syringe properly. Read the measurement at the right position of the plunger (the ‘black rubber’ in the syringe), and be aware of how much volume each line represents.
Image credit: registerednurseRN
If the syringe is 10ml in size, each line represents a 0.5ml increment.
Image credit: registerednurseRN
On the other hand, if the syringe is 5ml in size, each line represents a 0.2ml increment.
Image credit: registerednurseRN
Storage of reconstituted antibiotics suspension
After reconstituting the antibiotic suspension, you may keep the suspension in the refrigerator (2°C to 8°C, do not freeze), but how long should you keep them? That depends on the manufacturer’s information of the product. In general, amoxicillin and cloxacillin suspensions can be kept in the refrigerator for up to 7 days, whereas for cefuroxime suspension is 10 days. Clarify with your pharmacist the length of storage of the antibiotic suspension after reconstitution.
Do not keep the antibiotic suspension and reuse them beyond the suggested time frame, as the antibiotic may have lost its effectiveness already. Also, your children’s infection in the future may be different and require a different kind of antibiotic, thus you should always bring your children to see a doctor if you suspect infection. Do not give any antibiotic or medication to your children without consulting a healthcare professional first.
A word from DOC2US
If you have any questions related to antibiotics use in children, you can consult our professional doctors and healthcare professionals on DOC2US. DOC2US is a mobile application that allows you to talk to a doctor or any healthcare professionals via text chat at any time and from anywhere. For better communication, you can even send our online doctor images or voice messages related to your medical inquiry.
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