Antibiotic Use in Children: Balancing Efficacy and Safety

Antibiotics play a crucial role in combating bacterial infections, but their use, particularly in children, requires careful consideration due to the potential risk of nephrotoxicity. Drug-induced nephrotoxicity is a significant concern, accounting for up to 60% of acute kidney injury (AKI) cases in hospitalized patients, with increased morbidity and mortality rates in children. Antibiotics are among the most common causes of this condition.

Dr. Sreenath S Manikanti, a senior consultant in pediatrics and neonatology, Kauvery Hospital, Bangalore, emphasizes that most fevers in children are viral and rarely necessitate antibiotic treatment if evaluated properly. “Indications for use of antibiotics in children are much less in outpatient practice,” he notes. In hospitalized children who require antibiotics, the risk of kidney injury can be mitigated by selecting the appropriate antibiotics and limiting their duration based on blood culture sensitivity. Certain antibiotics, particularly aminoglycosides, are known to be nephrotoxic and should be used with caution. Dr. Manikanti advises that “if they have to be used, monitoring the drug level and kidney function is essential.” He stresses the importance of judicious antibiotic use, avoiding combination antibiotics, and deescalating or stopping antibiotics as the child’s condition improves to prevent nephrotoxicity.

Dr. Prashanth Dheerendra, a consultant nephrologist, Apollo Hospitals, Bannerghatta, Bangalore, provides additional insights into the use of antibiotics in children. While antibiotics are often feared for their potential to cause kidney disease, Dr Dheerendra suggests that this risk is frequently overestimated. He outlines four key points to consider:

1. Most oral antibiotics are generally safe and unlikely to cause kidney problems.
2. Injectable antibiotics pose a higher risk of kidney damage and should always be administered under a doctor’s prescription.
3. Some injectable antibiotics are known to cause kidney damage when used for prolonged periods, making it crucial to monitor kidney function during their use.
4. Not all patients given antibiotics develop kidney problems. In stable patients, significant kidney damage due to antibiotics is a rare occurrence.

Dr Dheerendra identifies specific antibiotics well-known for causing kidney problems, such as amikacin, amphotericin, rifampicin, and colistin. He also highlights that in very sick hospitalized patients, multiple factors besides antibiotics, such as infection, low blood pressure, and bleeding, can impact kidney function.

In conclusion, while antibiotics are indispensable for treating bacterial infections, their use in children must be carefully managed to avoid nephrotoxicity. Proper evaluation, judicious selection and duration of antibiotic use, and regular monitoring of kidney function are essential strategies to ensure the safe and effective treatment of pediatric patients.