Antibiotics in Reserve (AIR)

“Watchful Waiting” and “Antibiotics in Reserve” (AIR):

For further information regarding Antibiotic Resistance and how to avoid it, you can connect to guidance from the Public Health Agency of Canada here.

This information for parents is provided to help you look after your child’s health and well-being, while decreasing or avoiding the use of antibiotics where safely possible. It is my intention to involve you in the decision-making regarding the treatment of your child’s illness as much as possible and appropriate.

At the time of your child’s visit to the office you will have received a diagnosis based on history and physical examination – and, rarely, on laboratory data if they were needed to make a diagnosis (blood work, urinalysis, chest radiograph). Your child may have been diagnosed with an upper respiratory tract infection (common cold, throat infection, rhino-sinusitis, acute middle ear infection, bronchitis, or UARTIC (undifferentiated acute respiratory tract infection with cough – not known whether bacterial, mycoplasmal or viral).

At the time of the visit your child may have been diagnosed with a viral illness – so far uncomplicated by a bacterial super-infection (croup, bronchiolitis, viral bronchitis).

If I am confident, based on clinical findings, that your child suffers from a streptococcal infection I will usually prescribe antibiotics to prevent rheumatic fever, a rare but potentially life-threatening complication of streptococcal infection. I will do a throat swab or blood-work if I believe the child does not have strep, decide not to treat, but do not want to miss a streptococcal infection.

If it is decided during your visit to the office that antibiotics are necessary to treat a bacterial infection – and that it would not be in your child’s best interest to take the risk of delaying such treatment – antibiotics will be prescribed and you will be advised to give them as directed.

If a prescription for ”Antibiotics in Reserve (AIR)” was given today, please start the medication only if your child seems to be getting significantly worse, looks sicker rather than improves, or has still significant ear pain, discharge from the ear or high fever after 48 – 72  hours of observation. If there is cough, the antibiotic should not be started if the cough takes a long time to improve but can be started if the cough gets much worse, particularly if there is fever or the child looks sicker. Trust your intuition! We have found that about 70% of children who are given Antibiotics in Reserve (AIR) will not require taking them. We have found that physicians prescribe antibiotics when parents tell them that their child is getting worse (looking sicker, higher fever, worsening of symptoms); we published this study a long time ago. (Self-reported prescribing of antibiotics for children with undifferentiated acute respiratory tract infections with cough. Davy T, Dick PT, Munk P.: Pediatr Infect Dis J. 1998 Jun;17(6):457-62).

Thus we feel very comfortable with parents making the decision to start AIR without necessarily returning to the office. Please call the office and let me know if you start the antibiotic should your child’s condition get worse.

Please consider the following general advice to help your child:

  • For fever, pain and discomfort, please use oral acetaminophen (Tempra® or Tylenol®) every four hours; the dose is 10-15 mg/kg/dose (please also refer to the dosage chart for acetaminophen); alternatively, ibuprofen (Advil®) can be used every 6 to 8 hours, but there may be a higher risk for complications and kidney problems with increased creatinine if Advil is used for more than a few days (for appropriate dosing, please refer to the dosage chart for ibuprofen). For this reason I generally recommend the use of acetaminophen and the avoidance of ibuprofen for paediatric patients.
  • For ear pain, you may purchase Auralgan® ear drops over the counter; place the little blue bottle into a cup with hot water to warm up the drops; place your child on a comfortable surface with the healthy ear down and instill as many drops of the oily liquid into the painful ear as will fit to fill the canal – you will note air escaping from the canal as the drops flow in; keep the child in this position for 5 minutes if possible; when the medication touches the ear drum, the drum will be anesthetized and the pain will disappear. This can be repeated as needed.
  • Please call the office if you have any questions. We will be happy to see your child again in follow-up if you have any concern whatsoever. Antibiotics in reserve are given to increase the parents options, not to keep them away from medically indicated visits!
  • For coughs, you can try a non-prescription, naturopathic cough remedy from Europe called “Helixia®” available in the pharmacy in our building; many parents have reported that they found it helpful, and we have never seen any side-effects from using it.