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Flu or Flu-like illness in chronically ill or disabled children

Side effects of antibiotics

Antibiotics are used to treat bacterial infections. There are lots of different types of antibiotics. The length of time antibiotics need to be taken can vary but the prescribed course always needs to be completed. Some children may need to take a course of antibiotics for a week or less, others for longer and some children may take a low dose of antibiotics frequently (also known as antibiotic prophylaxis) to prevent infections.  

Like all medicines, antibiotics may cause side effects. People react differently to antibiotics and some children may tolerate some antibiotics better than others. The most common side effects of antibiotics are diarrhoea, feeling sick or vomiting. These should pass once the course of antibiotics has been completed.

Some of the parents we spoke to, like Waj and Jo, said their children had not experienced any side effects, or only very mild ones, from the antibiotics they had taken.
 

Lyndey’s children who all have asthma usually have a five day course of antibiotic treatment. They experienced no side effects apart from slight diarrhoea when they were babies.

Lyndey’s children who all have asthma usually have a five day course of antibiotic treatment. They experienced no side effects apart from slight diarrhoea when they were babies.

Age at interview: 35
Sex: Female
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Any side effects, any negative effects that they’ve had on antibiotics?

No, not really. When they were younger, it might make their nappies a bit more runny but it’s not it’s not that severe. Yeah, you’d barely notice it really.

Okay. So they’ve tolerated it well from that point of view.

Yeah, they’re, it’s quite a good refined drug isn’t it. I think. It’s only a five-day-dose as well, that they get routinely, yeah. 
Other parents said their children sometimes experienced diarrhoea while taking antibiotics, but not always. Clare noticed that her daughter sometimes experienced side effects when taking Amoxicillin. Adam’s son sometimes has vomiting and diarrhoea.  

Even though children may experience side effects, it is important to finish a course of antibiotics and to take them as instructed.
 

Henry sometimes has diarrhoea when he takes antibiotics. His GP advised that the antibiotics are still working despite the diarrhoea and to complete the course.

Henry sometimes has diarrhoea when he takes antibiotics. His GP advised that the antibiotics are still working despite the diarrhoea and to complete the course.

Age at interview: 44
Sex: Female
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Yes, we have had some instance of affecting the diarrhoea and if you query that with the GP they still are quite keen for you to continue taking them and not to change the antibiotics. So that is quite hard to deal with when you're constantly having to take something that, you know is having that reaction.

Yeah

But from what I've been told from GPs the antibiotic is still taking effect and doing what it should be doing and that is a side-effect, not an allergic reaction.
Some children developed more severe digestive system problems, such as colitis and lactose intolerance. Their parents wondered if long term use of antibiotics had contributed to these problems. Jack has been taking prophylactic antibiotics for two years and he has developed colitis.
 

Nia wonders if long term use of antibiotics led Daniel to develop lactose intolerance. His paediatrician did not know.

Nia wonders if long term use of antibiotics led Daniel to develop lactose intolerance. His paediatrician did not know.

Age at interview: 27
Sex: Female
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The other thing that I’m aware of in Daniel is that I do believe that antibiotics have perhaps led to him developing lactose intolerance. He has been diagnosed with lactose intolerance which he didn’t have until he was about 9. There is a link between the commensal bacteria that live in your gut and things like lactose intolerance. However I feel if he hadn’t been given those antibiotics in the past for his ear problems and for his chest problems he would have been significantly more unwell, and that’s more of a risk than being lactose intolerant for example.

However overusing antibiotics can lead to digestive problems, diarrhoea because it not only do the bad bacteria you know become affected by the antibiotics, also your commensal bacteria do as well which obviously isn’t ideal, so I have been, I have thought a lot in the past about whether long term use of antibiotics might lead to some kind of problem in the future, you know digestive problems for example in the future. But then you think in the here and now if I say that we don’t use the antibiotics, is that going to lead to you know a more serious chest problem? Is that going to lead to becoming significantly more unwell? It is a difficult decision to make. I feel very much led by the GP. If my GP is saying I want to prescribe them then he must feel it’s necessary. I know GPs are encouraged strongly not to give antibiotics unless absolutely necessary so if he’s recommending it he must feel that it’s necessary.

And does he get any bad, has he ever had any bad reaction to the antibiotic?

No, no.

So he tolerates it?

The only thing we’ve noticed as we say he had periods of diarrhoea and stomach pain when he was about 8 and they diagnosed lactose intolerance.

Yes.

Now we don’t’ know whether the lactose intolerance was caused by an episode of gastroenteritis, because having stomach pain and diarrhoea could be gastroenteritis, and that that’s led to the lactose intolerance. Or whether the use of antibiotics over the 8 years of his life at that point had caused the lactose Intolerance.

Yes.

We don’t know.

I:    Yeah, yeah. 

All I know he wasn’t lactose intolerant up until that point.

Have you raised this with the doctor, this…?

We, well they sent us to get the diagnosis of lactose intolerance we had to go and see a paediatrician again at the hospital. I think I did discuss it with them, but the answer was they didn’t know.

Right.

“We don’t know the cause, all we know is he has lactose intolerance.” And then they sent us to see a dietician who gave advice about diet.

I suppose in a way if the lactose intolerance has been caused by antibiotic use I think it’s a small price to pay for having a child who is otherwise okay, and hasn’t had you know a really, a bout of pneumonia that’s cause him to you know to get to the point you know, children do die of, of things like pneumonia and chest infections. You know so if we hadn’t used antibiotics in the past you wonder what could have happened. So I suppose lactose intolerance although it’s a bit irritating, it’s not the worst consequence that could have happened.
While parents accepted that their child needed to take antibiotics to recover from their illness and to prevent them from become seriously ill, there was also some concern about the long term effect on their child’s digestive system. Probiotics are thought to help restore the natural balance of bacteria in the gut but they are not suitable for all children *1. Fiona was worried about whether antibiotics were having an effect on her daughter’s digestive system and she was considering getting advice from a dietician about probiotics.
 

Eliza tolerated amoxicillan well but she had side effects with other antibiotics. Probiotics prescribed by a dietician improved her health.

Eliza tolerated amoxicillan well but she had side effects with other antibiotics. Probiotics prescribed by a dietician improved her health.

Age at interview: 46
Sex: Female
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Any side effects of the antibiotics?

Bit of an upset tummy. But some were better than others. As I say, the one that we ended up with, which I think was amoxicillin, she was okay with that. Other ones made her quite unwell, but that one seemed to be okay. 

When she was taking a lot of antibiotics we were prescribed by a dietician some probiotics, which made a massive difference to her health. And also, I don't know if it was coincidence or not, but it seemed to stop the, the constant vomiting that she had as well. And I do wonder if there was a link between her vomiting an awful lot and the fact that she took a lot of antibiotics. So we were well aware of the fact that they were doing very vital work, but also not so good for her general health. And our hearts always used to sink a little bit when we knew she'd have to go on a course of antibiotics, because it just, you could see, it was not great for her. But she needed it. 

You said that the probiotics were a massive help. In which way?

She just stopped being sick. We didn't start taking them until she was about 12 months old, I think. And she'd been, just been sick every day. As if she had food poisoning or something. Since she was born, more or less. And as soon as she started taking the probiotics, that really calmed down. So, but it may have been coincidence, because it took her a long time to learn to sit up, as well. And it could all have just been connected with the fact that she had very low muscle tone, and  those kinds of things as well.

And how were you giving the probiotics?

We would, we had capsules. So we'd break them apart and sprinkle them in yoghurt, and just feed them to her on a spoon.

Okay. Do you still use them?

No.
Allergic reaction

Some people have an allergic reaction to antibiotics and need to have this recorded in their medical records. A few of the parents we talked to said their child had experienced an allergic reaction to a particular antibiotic. Rebecca’s son came out in a ‘huge rash and covered in black, it looked like black bruises’ after taking a low dose of Amoxicillin for a couple of weeks. He changed to Clarithromycin and did not experience any further reactions. Alfie had taken various antibiotics but he only had an allergic reaction to Vancomycin where he developed ‘red mounds’ on his hands and they were itchy. Alex usually has a flare up of his eczema when he is taking antibiotics. Alessio found out he is allergic to the artificial colouring in antibiotics. Now he takes other antibiotics without colouring.
 

Rahma’s son had a severe allergic reaction shortly after being given an injection of amoxicillin when he was three years old.

Rahma’s son had a severe allergic reaction shortly after being given an injection of amoxicillin when he was three years old.

Age at interview: 58
Sex: Female
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Have they given him antibiotics?

He’s, he’s allergic with amoxycillin so they have something else they give to me to give him. So it’s not like normal antibiotic because he is allergic with amoxycillin so they have, they give him another things. So it takes time to recover.

How did they find out that he is allergic to amoxycillin?

Yeah. He was one day, he was sick, high fever and, and I take him to GP. GP give him injection. When he give him injection after 20 minutes he become to swollen. You know, everywhere, everywhere so the GP tell me, “You have to take him to the hospital. So I take him to the hospital. He is sleeping to the hospital that two, three nights he was sleep there. I think.

And what happened at the hospital?

I think they take, yeah they take some tests and they say he was allergic with amoxycillin. 

Ok.

Yeah so that time they, they write to the computer his, in history they say he can’t have amoxycillin. 

So the GP gave him the antibiotics because he had a chest infection?

Yes, yes that, yeah.
Allergic reactions to antibiotics are recorded in a child’s medical records to make sure that particular antibiotic is avoided in the future. Usually there will be another type of antibiotic the child can take.

See ‘Parents concerns about taking antibiotics’ and ‘Parents views on the benefits of antibiotics’.

* Probiotics for the prevention of antibiotic-associated diarrhoea in children- Cochrane.org
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