Antibiotics Used to Treat "Just in Case" - Bad Idea

About once or twice a month I come across a situation that drives me a little crazy.

It usually happens on a Monday or Tuesday. A mom comes to the clinic because she took her child to an acute care center or an ER on Sunday (because I don't work on Sundays) with a sore throat or a runny nose.
Whoever saw her child started him on an antibiotic.

I always ask the mother what the diagnosis was and I am told "tonsillitis" or "upper respiratory illness.

" I ask "was your child tested for strep or anything else?" Usually the answer is "no," but she was told it could be strep or some other infection and the child should be started on an antibiotic "just in case". I have to tell you that in no medical book will you find a diagnosis called "just in case".
It doesn't exist.

I double checked before I wrote this just to make sure. If it existed it would be right between Junctional nevus and Juvenile Ankylosing spondylitis (now those are diagnoses you can really get your teeth into, complete with pictures). But alas, no Just in Case to be found. To make it all the more interesting, a fair number of these kids develop a side effect to the antibiotic.

Some get diarrhea (just what you need on top of the problem they started with).
Occasionally a child will actually get a good case of hives or serum sickness (look this one up, it's a good read). Of course a child can have an anaphylactic reaction which is a potentially fatal allergic reaction but fortunately I have not personally seen this happen. And of course now I have to treat a child for a side effect caused by a treatment which was never justified in the first place. Don't get me wrong, I am not anti-antibiotic.

They are wonderful drugs that have saved countless lives when used properly. My own father survived a massive infection because his doctors used antibiotics when they needed to be used.

The problem is that they are really thrown at just about everything these days and they are not benign drugs.
My point is that if a doctor wants to prescribe an antibiotic for your child then you need to insist that they tell you what it is they are treating or at least what they think they are treating.

If they mention strep insist they test your child for strep.

By the way, strep cannot be diagnosed by smelling the child's breath or by just looking at the throat (really, nobody is that good).

If they think your child has pneumonia ask them why they think so.

If they say your child has a urinary tract infection insist on a urine culture so your doctor can verify the presence of an infection.
Insist on knowing why your child needs antibiotics, period.
Demand an intelligent answer.

Lastly, have your child seen by your primary care physician as soon as they are available.

They will want to evaluate the child themselves, just in case. This article is intended to inform and educate only and is not intended to be interpreted as medical advice.