Antibiotics Without a Fever

The only way to know if there is actually an infection is present is to do a CBC and have elevated WBC counts. Without this, the doctor's diagnosis is very subjective and just because they call it an infection...it doesn't mean that it is. Fevers are present to fight off an infection. I know many people that have been diagnosed with pneumonia and never had a chest xray done. A chest xray is necessary in diagnosing pneumonia. Antibiotics are overprescribed and are causing very hard to treat superbugs.

It's really hard for you to know for sure whether the child has a viral, bacterial or even fungal infection. And, it's possible to have multiple infections at the same time. The best way to tell an infection is by the color of the nasal discharge, rather than fever. Not everyone runs a fever with an infection (I had pneumonia last fall that had bacterial, viral and fungal components and no fever). If the nasal discharge is yellow or green OR the doctor thought the child's lungs were not clear (i.e., the sinus drainage was causing fluid to build up in the lungs), then antibiotics are entirely appropriate - pneumonia can hit hard within 24 hours. If your niece is not better within about 3 days, then the abx aren't working and she could still be infectious (fever or not), in which case your SIL should really consider postponing the birthday party.

Is it possible your SIL misunderstood the diagnosis? Without knowing the extent of her symptoms and the pediatrician's evaluation (unless the MD stated it was viral), it's really hard to know why they wrote the Rx.

Almost all pediatricians are well-advised NOT to over-prescribe antibiotics because of increasing issues with resistance. No new antibiotics have come to market in many years (the most recent, Ketek, has been removed by the FDA), and to my knowledge, no new ones are currently in development, so when the ones we have stop working, we're all in big trouble.

Sometimes, it can be really difficult to distinguish between a viral and bacterial infection (depending on the strain of each and the part of the body affected). So, a pediatrician may choose to treat with antibiotics - especially if it's persistent and hasn't cleared on its own after several days.

Here's what Mayo Clinic and DukeHealth.org say about it:
http://www.mayoclinic.com/health/infectious-disease/an00652
http://www.dukehealth.org/health_library/advice_from_doct...

Hopefully, her daughter is doing better so you can make the trip and visit as planned.

I think you probably need more information to be certain about your niece in this specific instance. I agree with the others- fever or absence of fever means nothing. My son rarely runs a fever. My sister never does. Some kids are put on antibiotics quickly because they have histories of chronic infections and their doctors know they won't overcome it on their own. My sister is put on antibiotics for the slightest bit of sinus infection starting, because she has other health issues and the sinus infections won't go away on their own.

But Yes, I agree with you, antiobiotics can be overprescribed. It is hard to find a doctor that strikes a good balance. Some are adamant about waiting it out for a while to the detriment of the child, and some give them for everything and anything. I think it is terrible not to be able to trust your doctors. But so much of diagnosis is their best guess, and you have to just hope they take into account your child's history.

And no, you don't need an antibiotic for every infection. Your body is capable of fighting off some infections on its own. Before the invention of antibiotics, people didn't die or live their entire lives with a sinus infection. For the most part they fought them off. Sometimes they didn't and it progressed to something worse, but not always.

My son had a cold that turned into a sinus infection a few weeks ago. His doctor said that unless he got markedly worse, to wait 10 days before he would give antibiotics. And sure enough, it went away on its own. He has never been on antibiotics and he is still able to fight things off. Now if it was an ear infection, they would be quicker to treat it. But the body is an amazing thing if it hasn't had its immune system totally worn down. We treat colds the same way you do, and save the antibiotics for when they are really necessary. That way we won't have a resistance to them when we need them most. Antibiotics can absolutely be harmful.

If I could get one thing across to parents it would be that A FEVER, OR LACK OF ONE, MEANS NOTHING!!!
The only time any of my four kids get a fever is when the illness is a 24-48 hr. virus. MY 2nd and 3rd boys had so many ear infections that they both had tubes put in. Not ONCE did they ever get a fever with any of the ear infections. They never even got any cold symptoms with them. They were just miserable at night and I soon learned what that meant. My kids have had everything from ear infections, strep throat, sinus infection and pneumonia without so much as a low grade fever. My mom ran a home daycare for over thirty years and it still amazes me how many parents will dismiss a childs illness just because they do not have a fever. If I went by fever my boys would have hearing loss at this point. And honestly, I would rather have my kids around a child who is being treated with an antibiotic rather than a kid who has had a cold for over a week.
Honestly, I think it was a courtesy that your sister in law was honest with you. She could have just not told you like a lot of other people would do!

I myself have been given antibiotics w/o fever. It just depends on your nieces' breathing etc. She could have a bronchial infection which a fever doesn't always exist. If she is on antibiotics it only takes up to 72hrs. to take effect and after which time she cannot infect someone else. I have worked in the Healthcare System and this is a known fact. So if your family is scheduled to go to Tulsa and its beyond the 72hrs. you have no worries. Your children will not become infected. I do hope you make it there as I'm sure your niece would love to see you as well as your family. If your not scheduled to go prior to a wks. time your good to go. Have a wonderful time and enjoy w/o being worried. Yes your niece may still have a cough but the germ will not be transmitted to your children.

listen mama, they don't give enough antibiotics. in fact, they make you take a sick child to be checked 3-4 times before prescribing a lousy antibiotic. had they prescribed it the first time, my daughter would have not lost a hearing bone.
ear infections have never caused a fever for my daughter. pneumonia was as silent as nothing, yet it was diagnosed about multiple runs to the doctor. so please be careful what you say. plus whatever they have by the time you get there they'll be on antibiotics for 5 days. they won't be contagious anymore if that's what they're dealing with.
another thing about colds: they can cause sinus infection (you need an antibiotic for this), they can cause ear infections due to fluid accumulating (another antibiotic).
i wish doctors were so freaking careful when it comes to vaccines not antibiotics that if anything will help things not get worse, not inject our kids for things that don't exist anymore or are not harmful. gosh, you p.o-ed me big time

It could be that the doc knew that there was family coming in from all over and he felt that the antibiotic would help more than hinder - new germs, etc. coming in along with whatever she's got. Besides, if it is bacterial, after 24 hours on the antibiotic, she's not contagious any more - fever or no fever.
That said, YOU aren't there. YOU aren't the mother dealing a sick kid and people from out of town coming in for the weekend -- Oh the stress!! Your SIL took her daughter to the doc because she was sick not because she didn't have 1000 other things to do. You don't know if the child is prone to sinus infections or ear infections or strep for that matter.
(My daughter, now a teen, always gets a sinus infection if she gets a cold - and it can happen almost instantly. She has no symptoms - no fever, no headache, no ear ache - just a slight runny nose and a slight post nasal drip type cough!! She can be completely full and not complain one bit. It's very scary to see an xray of a 3 year old child (who has virtually no symptoms) with no clear area in her sinus cavities.)
So, thank her for going to the doctor, for being proactive, for being a thoughtful hostess.
YMMV
LBC

My thought is that perhaps there is something else going on? My kids have had strep throat, sinus infections, ear infections, and staph infections that needed antibiotics, but they had no fever.

Also, all of my children and myself have Asthma, and any respiratory virus is monitored very closely. We are not given antibiotics for a virus, but we watch closely for secondary infection (which is very common with asthmatics) and treat them aggressively. If there is any doubt, we go on the antibiotics. I do not believe in over-prescribing them either, I just feel like we can't answer without more facts. Perhaps the doctor noticed their lungs weren't clear? Perhaps they also had an ear infection? At any rate, they shouldn't be contagious when you get there, so that is the good news.

Finally, while I doubt this is the case with your SIL, I have met people that call everything an antibiotic whether it is a decongestant or an antihistamine. Again, not likely, but it does happen.

Have fun on your trip!