Most bugs don’t need drugs

I am borrowing this slogan from an advertising campaign in which we are trying to educate the public that most infections are caused by viruses and not bacteria. The distinction is important, since antibiotics only work against bacterial infections. Most infections however, are caused by bugs known as “viruses” and these are the diseases that we need to fight off ourselves. We can use medicines for support, but not to “cure” infections caused by viruses.

Examples of diseases caused by viruses are chicken pox, the flu, and most common colds. I am not advocating an anti-antibiotics position, but we have found over the years that bacteria can build-up resistance to certain antibiotics, so it helps us to reduce this risk if we try to only prescribe it when indicated (for a great read on this, please visit Caring for Kids).

Ear infections

A lot of parents will visit my office with their child who is complaining of ear pain. Indeed, often this will be a sign of an ear infection. However, a lot of parents are surprised when I tell them my instinct is not to give a prescription for antibiotics for this. I will give the same explanation here as I do to the parents in my clinic: the vast majority of ear infections are caused by viruses and these viruses cannot be killed by antibiotics. The important thing with treating the ear infection is good pain control which usually can be achieved with a combination of an oral drug such as ibuprofen (Advil) or acetaminophen (Tylenol) combined with local ear drops that will numb the eardrum for a few hours (Auralgan ear drops, for example).

It is important to know that there are cases where antibiotics are certainly warranted: in the very young (less than 6 months old), when there is high fever (greater than 39 C or 102.2 F) or when there is persistent pain for greater than 48 hours that has not responded to the previously mentioned medications.

Please consult your physician if you are unsure of your child’s condition. It is always better to be safe than sorry.

Throat infections

Similar to ear infections, most throat infections (be it tonsils or the pharynx that are infected) are caused by viruses – roughly about 70% are viral and 30% are caused by a bacteria called Group A Streptococcus bacteria (“strep throat”). It is important to know the risk factors that make it more likely that the infected throat could be caused by “Strep” bacteria: high fever, sore throat (some describe it as feeling of razor blades), swollen lymphnodes, chills, absence of cough are some of the symptoms that may indicate the cause is strep throat. Strep throat, if confirmed, indeed does require a 10-day course of antibiotics. The treatment for sore throats starts with treatment of the pain: usually Advil, popsicles (to freeze the throat for a bit) and lots of fluids (to keep the throat from drying out) can help with the pain.

If you are unable to consult your own physician, and are going to an ER or medicentre, please make sure to ask the attending physician to swab your throat (if they haven’t done so already) for Strep throat, before you start the antibiotics they may prescribe to you. It is important for us to document every Strep throat infection.

Common colds and coughs

These are the most common viral infections your child will get in their younger years. A runny nose (with or without a cough) and perhaps mild fever. There are literally hundreds of viruses that can cause colds. They are quite contagious (both through hand contact and by breathing small particles in) but are typically harmless and can last anywhere between 3-10 days. They can cause fevers too, usually less than 39 C, but there are some viruses that can give fevers with temperatures higher than 40 C (most notably influenza virus or the “flu”).

Oftentimes the kids will be coughing as well when they are sick with a cold. This is not a sign of pneumonia, but rather that the mucus from the nose is dripping in the back of the throat causing the kids to cough. This phenomenon is known as “postnasal drip”. It is typically worse at night because the kids are lying flat. Treatments for this can include raising the headpart of the bed, using saline nose drops/washes and – for older kids – steaming. An old-fashioned trick you may want to try, is cutting an onion in half and putting that half-onion on a saucer plate next to the bed overnight (an old trick my grandma used to do for my mom, and my mom did for us). It is something about the aroma of the onion that loosens the mucus and often clears the nose (similar to using a drop of Eucalyptus oil in that boiling pot of water you are steaming your head over). It does cause the bedroom to smell a bit in the morning, but if it may help your child – why not try it?

Over-the-counter cough medicines that are being sold are NOT effective in the treatment of these coughs. Remember, the cough is caused by the mucus dripping in the back of the throat, and the cough medicines do not help with that (for more information on cough-medicines, please see Caring for Kids on the topic of OTC medicines). Sometimes, I will prescribe my patients some codeine liquid to take before bedtime. This is a prescription cough medicine that will not cure anything, but is a good cough suppressant for those kids that cannot sleep at night due to the excessive coughing. It is available by prescription only.

Pneumonias can occur in children. The child will typically start with having a common cold and then suddenly something changes: suddenly there is a very high fever, the cough changes and/or they have trouble breathing. If you suspect your child has this, or ar worried about this, please consult your child’s physician.


  1. Most infections are caused by viruses which do not respond to antibiotic treatments.
  2. The treatment of ear infections and throat infections can often start with adequate treatment of pain.
  3. If your child has high fever, looks unwell, has trouble breathing or you are worried, please consult your child’s physician.

And remember: Most bugs don’t need drugs!

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