Acute respiratory diseases in children in 70–90% of cases have a viral etiology.
Irrational prescription of antibiotics contributes to the formation of antibiotic resistance – one of the global problems of modern medicine.
After the formation of the microbial theory of diseases (L. Pasteur, R. Koch), it became clear that infections are caused by microorganisms.
In 1928, A. Fleming discovered penicillin – the first antibiotic, which began the era of antibacterial therapy.
However, viruses are non-cellular agents that replicate only inside the host cell, so antibiotics do not affect them.
Viral infection: clinical signs
The most common pathogens: rhinoviruses, adenoviruses, influenza viruses, RS-virus.
Clinical picture:
• acute onset
• low-grade or moderate fever
• rhinorrhea (often clear)
• pharyngitis
• dry cough
• general intoxication
Duration: 3–7 days (cough may persist for up to 2–3 weeks).
Treatment is symptomatic.
Antibiotics do NOT work

Bacterial infection: clinical markers
Common pathogens: Streptococcus pneumoniae, Haemophilus influenzae, Streptococcus pyogenes.
Suspicion of a bacterial process occurs when:
• fever for more than 5 days
• “second wave” of temperature
• local pain syndrome
• purulent discharge
• severe intoxication
HIGH CRP / leukocytes
Antibiotic “just in case”:
-will not help to recover faster
-may harm
-forms resistance of bacteria
Laboratory differentiation
Complete blood test:
-Leukocytosis with neutrophilosis – more often bacterial infection
-Lymphocytosis – more often viral
-Left shift of the formula – bacterial etiology
CRP:
• <20–30 mg/l – more often viral nature
• 60 mg/l – high probability of bacterial inflammation
Rational antibiotic therapy
Antibiotics are indicated for:
• acute bacterial otitis
• streptococcal tonsillitis (confirmed by test)
• bacterial pneumonia
• sinusitis with severe course
Not indicated:
• for acute respiratory viral infections
• for influenza
• in the first days of uncomplicated fever
Typical errors
• Self-prescription of antibiotics
• Prophylactic administration
• Premature termination of the course
• Changing the drug without indications
Prevention
• hand hygiene
• isolation of a sick child
• rational sleep regimen
• adequate hydration
Conclusion
In pediatric practice, the key is the clinical analysis of the child’s condition, the dynamics of symptoms and the validity of laboratory indicators.
An antibiotic is a therapeutic resource that should be used only for clear indications.
A rational approach today is preserved health tomorrow.
The main rule:
Virus → support of the body
Bacteria → antibiotic according to indications
Pediatrician, Associate Professor Tamara Kvaratskhelia