Tips for prescribing antibiotics to children

Child playing with toys

15 November 2019

Dr Sanjay Patel, Paediatric Consultant, Southampton Children’s Hospital

Infections in children are extremely common and result in over 50% of primary care activity in children under five years of age. Yet young children have far lower rates of suppurative complications than older children, even when antibiotics are not prescribed.

 Although parental anxiety about missing a serious infection is driving this increasing activity, the absolute risk of a child having a serious bacterial infection has markedly reduced since the introduction of conjugate vaccines to the routine childhood immunisation schedule against haemophilus (1992), meningococcus (1999) and pneumococcus (2006).

Parents seek a consultation because it provides a proper ‘health-check’ and in their opinion, removes any ‘health-threat’. They lack confidence in distinguishing self-limiting illnesses from serious ones but believe that clinicians can and want advice on what symptoms to look out for and when to seek help.

'Addressing parental concerns during a consultation results in significant reductions in future re-consultation rates'

Although they do not generally seek antibiotics, parents often believe that antibiotics are required to treat ‘severe’ infections rather than to treat bacterial infections. They often believe that features suggesting a severe infection include high fever, prolonged duration of symptoms and degree of impact on the child (sleep or school). Parents’ perception of susceptibility also plays a role in their expectation for antibiotics (younger, underlying health issues).

There is good evidence to show that addressing parental concerns during a consultation results in significant reductions in future re-consultation rates, as well as marked reductions in antibiotic prescribing. The Healthier Together website has  examples of safety netting and parent information sheets, see

It is extremely difficult for a clinician to confidently distinguish a mild or moderate bacterial infection from a viral illness. Yet we remain determined to maintain this distinction. This partly stems from our firmly held belief that if a bacterial infection is not treated with antibiotics, the patient is likely to come to harm.

Explain your opinion in terms of objective markers of severity to allay parental anxiety

There is a very real risk that by focusing on whether an infection is caused by a bacteria or virus (and then trying to justify why a patient does not need antibiotics in terms of “it’s just a virus”), we don’t effectively address the reasons why the parent sought a consultation. Explaining your opinion in terms of objective markers of severity (red, amber, green criteria) and providing the family with clear information about what to watch out for (safety netting) is probably a far more effective way of allaying parental anxiety. Use of the TARGET Treating your Infection RTI leaflet can help facilitate these conversations.

Clinicians should consider adopting a severity of illness approach when deciding whether to prescribe antibiotics rather than relying on their ability to distinguish bacterial from viral infections. This is the approach advocated by NICE in the Antimicrobial Prescribing guidelines.

If antibiotics are needed, a pragmatic approach is required. Prescribers should use an antibiotic that is palatable and minimises dosing frequency to optimise adherence. Penicillin V and flucloxacillin suspensions are not tolerated well because of their taste. 

Find courses & events

The item has been added to your basket.

Continue shopping

Go to basket

This item is out of stock.

Continue shopping

The item is out of stock.

Yes Continue shopping

An error occured adding your item to the basket:

Continue shopping