Every day I face this decision with patients – the child has a cough, cold and fever for a few days, and is acting sick, but I don’t perceive any specific infection on exam. It’s easy to know what do to when I see an ear or throat infection, or hear bronchitis or pneumonia in the chest. But sometimes it’s not obvious if the child just has a bad cold or flu with fever, or has something bacterial that could use an antibiotic.

I faced this situation recently with Joshua. We were on a weekend trip, he’d had a cold and cough all week, and was running into his 4th day of fever. I couldn’t find any specific infection, but since he wasn’t doing very well we started an antibiotic. Sure enough, the next day he was somewhat better, and the day after that he was back to his own self.

I said to myself, “Duh, if you’d started the antibiotic sooner, Joshua would have gotten better sooner and we’d all have had a better trip.”

My wife said, “See. I wish we’d started the antibiotics sooner.”

I then told myself, “But this is exactly what I do with patients every day.”

So I wonder, when I don’t give someone antibiotics, and they get sicker, and THEN we start antibiotics, how many parents are mad that I didn’t treat sooner, and how many are grateful that I try to hold off on antibiotics until they really seem necessary. I’m still in business, so I guess there’s more of the latter than the former.

So when I see you in the office, and I ask you to hold off on the antibiotic for a day or two and see if your child improves on his own, be assured that this is exactly what I do with my own kids (most of the time, anyway!)

Dr. Bob