Are antibiotics always needed to treat my child?

Dear Dr. Donya,

Recently, my 18-month-old son had a cough and flu. After visiting the doctor three times and receiving three different prescriptions, he recovered. Today, I noticed that his top row of teeth has turned yellowish. Is this a side effect from taking antibiotics? Is it true that medicine should always be taken with antibiotics? The doctor required us to visit him once the medicine finished (on the fourth day) to control its use.

Is medication required after a cough and flu are gone? Is it necessary for him to be immunized for hepatitis A?

-- Kim

Dear Kim,

1) The antibiotic that stains teeth is tetracycline and it should not be given to children under eight years of age. Try to deep clean his teeth by rubbing a clean cloth on them after every meal. If you have tried this and the stain is still there, you should check his food and drink.

For example, leaving his bottle in his mouth while he sleeps may cause cavities, and they can start with his teeth turning yellow. It may also be due to the presence of chocolate or soft drinks in his diet.

2) It is not true that all illnesses require antibiotics for treatment. Antibiotics are antibacterials so the doctor prescribes them for cases of bacterial infection, which are sometimes diagnosed from clinical signs. However, sometimes the infection starts with a virus, and then can become a super- infection on top of that a few days later.

For a diagnosis of the bacteria, a culture of blood, phlegm, urine or stools, depending on where the site of the infection is, needs to be taken. It takes at least three days in most Asian laboratories (advanced labs can do it in one day). Medicine is part art and part science, so doctors use a lot of statistics, experience and knowledge to make its diagnosis and treatment.

If you have any questions about what your doctor is prescribing, you should not hesitate to ask, because some doctors do not take the time to advise and educate their patients. Treatment for children is different from adults because children cannot describe how they feel and a doctor would like to observe the progression of the illness. That is why the doctor followed up with your child.

3) Hepatitis A is a food and water-borne disease and it is highly contagious if your child is in an unhygienic day-care center, school or food store. High-risk groups for hepatitis A infections are cooks, public cleaners and people with no immunity to the disease. In the past, most children were infected while they were in school, from about five years to seven years of age, and usually displayed mild symptoms.

Sanitation is better today, so children do not get infected and do not have immunization until they are adults. Hepatitis A in adults is more severe than in children. On the question of whether to vaccinate or not, I recommend immunizations for the following:

* Travelers going to areas where the disease is endemic;

* A person who is at high risk and has a chance at spreading infection; such as a cook, public cleaner, garbage collector and caregivers at day-care centers;

* Medical personnel and laboratory technicians;

* A person who has chronic hepatitis, especially hepatitis B;

* Children whose parents can afford the cost. They should be vaccinated after they are two years old or when they are in school because their immune response is better when they are younger.

The problem is the cost of the vaccine is still expensive for routine immunization of all children. This vaccine consists of two shots given six months apart. Immunity rises 14 days after the first shot and the efficacy is 94 percent. The protection time lasts for about 15 years to 25 years.

-- Dr. Donya