After a fever or cold, parents and doctors often want and recommend a blood test. High white blood cells among them, along with high lymphocytes, do not indicate a bacterial infection; only when there is also high neutrophils may a bacterial infection be considered. The site of infection should be determined based on history and examination, and appropriate treatment should be selected. It is very rare to have both bacterial and viral infections, but of course the simultaneous use of antibiotics + antivirals should not be common. (Terminology: C-reactive protein (CRP) correlates with total white blood cell count, erythrocyte sedimentation rate and polymorphonuclear (neutrophil) leukocyte count. It can help to identify the type of infection and can be used in the differential diagnosis of bacterial and viral infections: in bacterial infections, CRP levels are elevated, while in viral infections, CRP is not elevated or is mildly elevated. (Physicians can target medications based on CRP results.)
Fever is the result of inflammation, and the cause of inflammation can be checked at the hospital. Inflammation includes a variety of factors such as viruses, bacteria, mycoplasma, and allergies. Never assume that a red throat, runny nose, or cough must be a bacterial infection. It may be a bacterial infection only if the routine blood test leukocytes exceed at least 15 x 10*9/L and CRP (C-reactive protein) exceeds 30. Never amplify a bacterial infection and cause misuse of antibiotics.
A child with fever and an examination showing a congested pharynx and a low white blood cell count in the blood should support inflammation of the upper respiratory tract due to a viral infection. At this point, antibiotics cannot help, as they are only for severe bacterial infections. For viral infections, there are no good drugs available worldwide for treatment. I personally do not recommend treatment with antiviral drugs, including aerosol therapy, for children with viral upper respiratory tract infections.
If the fever is due to a viral infection, there is no need for antibiotics, much less intravenous antibiotics. People should not think that intravenous infusion is an effective way to reduce fever. The use of antibiotics during a viral infection is what causes disorders in the intestinal flora, causing dysbiosis, which in turn can easily lead to the possibility of secondary bacterial infections, and for respiratory symptoms such as coughing and runny nose, oral medications are available, or nebulization is used.
Should we consider using antibiotics earlier to prevent viral infections because we are concerned about the possibility of bacterial infections in combination with viral infections? Infants and children with normal resistance to viral respiratory infections are rarely complicated by bacterial infections. In some cases, the reason for the late complication of bacterial infections is the close contact with patients with bacterial infections during the illness. For example, frequent visits to the doctor and infusions during the flu. There is no need for antibiotics to prevent bacterial infections!
Generally, fever caused by viral infection will be repeated for 3-5 days; fever caused by bacterial infection needs to control the infection before the body temperature can return to normal.
2. Cough.
Among the causes of fever, infection is a common cause, but it does not mean that bacteria are the main cause. In other words, antibiotics are not the main drug for treating fever unless it is confirmed that the cause of the fever is a bacterial infection. The same is true for cough; only coughs caused by bacteria require antibiotics. Do not recognize antibiotics as a good medicine for fever and cough. The vast majority of common fevers and coughs are due to viral infections.
Respiratory infections (whether viral, bacterial, or mycoplasma, etc.) initially cause edema of the respiratory mucosa, and as the infection is controlled, the edematous areas begin to improve and turn into secretions. Respiratory secretions can irritate the respiratory tract and trigger a cough. Therefore, the appearance of cough in the later stages of respiratory tract infection is an inevitable development. It can be resolved by oral or nebulized phlegmolytic drugs, but it takes several days. Antibiotics are not effective during this time.
Viruses are the main factor causing upper respiratory tract infections. When a child develops a cough, do not assume that early, intravenous route antibiotics will quickly control the cough. If the secretions are not drained quickly, secondary respiratory bacterial infections can very easily occur. For respiratory tract infections caused by viruses, nebulized inhalation saline or “phlegm-forming” drugs can dilute the phlegm, facilitate the clearing of the respiratory tract and promote rapid recovery from the disease.
3. Diarrhea.
When diarrhea, the diagnosis should be combined with the onset process and stool routine + occult blood. If there is pus and blood in the stool and the stool routine shows more than 15-20 white and/or red blood cells per high-powered field, bacterial infection should be considered and stool culture should be done at the same time; if there is dilute watery stool and no or occasional red/white cells in the stool routine, viral infection or complication of lactose intolerance can be considered with medical history; if there is blood in the stool, food allergy or surgical problem can be considered.
In the case of diarrhea, parents should take a stool specimen, if possible, and send it to the hospital for testing within two hours. Bacterial infection is suspected only if the stool specimen shows white blood cells or pus cells exceeding 10/high magnification. If there are only a few white blood cells, it only indicates mild damage to the intestine. For rotavirus, rotavirus antigen can be detected by stool testing, which is also easier to diagnose. If any positive result is absent, indigestion should be considered.
Diarrhea is caused by irritation of the intestinal tract and is mostly associated with infections in childhood. Viral infections such as rotavirus now outnumber bacterial infections. Whether it is a viral, such as rotavirus, or a bacterial infection, diarrhea has already occurred when it appears. If antidiarrheal medication is used as soon as possible, it will force the virus and bacteria to stay in the body, causing a large amount of toxin absorption and aggravating the symptoms of systemic toxicity. Probiotic intervention should be used as soon as possible to make the germs and toxins empty.
Diarrhea caused by bacterial, viral and other infectious factors often has a fever first and is preceded by vomiting. After fever and vomiting, the first bowel movement may not be diarrhea, but it will be immediately followed by diarrhea. In diarrhea caused by bacterial infections, mucus or even pus and blood-like material is often seen in the stool, and the amount of stool is limited each time.
The most important things parents need to do in case of diarrhea: 1. Send the stool specimen to the hospital for examination as soon as possible (within 2 hours). In addition to the stool routine, there should be rotavirus antigen and perhaps a stool bacterial culture. 2. Take antipyretic medication if the temperature exceeds 38.5 degrees. 3. Prevent dehydration. Drink lightly sweetened saline in small amounts several times. If there is no urination within 4 hours, you should go to the hospital for fluid infusion.
In infant diarrhea, bacterial enteritis occupies a minority, so the chance of antibiotic use should be rare, do not abuse antibiotics!!! It is common to see viral infections, such as rotavirus gastroenteritis. For enteritis caused by viruses, a few white blood cells or red blood cells/high magnification may also be found in the stool routine, but there is no specific medicine. The real treatment includes: prevention and treatment of dehydration; probiotics to inhibit and destroy the virus, etc.
4. Hand, foot and mouth.
Hand, foot and mouth disease is a typical viral infection caused by an enterovirus and is figuratively named because it mainly invades the hands, feet, pharynx and perianal area. It starts with a high fever, followed by a rash in these areas. It is not necessary to use antibiotics until there is a clear co-infection with bacteria. Even early use of antibiotics is not effective in preventing bacterial infections. Drink plenty of fluids during the initial fever and use antipyretics appropriately. During the period of mouth ulcers, give your child as much cool water or thin rice as possible to ensure as much intake as possible to get through the difficult days. If oral intake is difficult to ensure, consider intravenous rehydration.
If you examine your child’s pharynx and find many bright red vesicles on top of a congested and edematous pharynx, it should be herpes pharyngitis. Herpes pharyngitis can exist alone or as part of HFMD as a result of a similar viral infection. This condition appears to be serious and is still not an indication for antibiotics. Encourage your child to drink small amounts of water several times to achieve a flushing effect on the throat to avoid secondary bacterial infections.
Hand, foot and mouth disease or herpes cheek infection are both viral infections and antibiotics should not be used. Both diseases cause herpes, rashes, and partial “secondary infections” in the pharynx. If there is a secondary bacterial infection in the pharynx, most likely antibiotics will have to be added. The most effective way to prevent secondary throat infections is to encourage your child to keep drinking water and flushing the throat. Antibiotics only treat bacterial infections, not prevent them.
5. Vaccines.
The vaccine itself is an inactivated form or partial component of a virus or bacteria, and entering the body will inevitably stimulate the immune system, resulting in a reaction similar to a viral or bacterial infection, but weaker than being sick. It is purely normal for blood tests to reflect infection-like changes. Therefore, do not rely on blood tests for treatment after vaccination. Further, it is very inappropriate to recommend antibiotics and antiviral drugs knowing that the vaccine has been administered (when you encounter high fever, you can take antipyretic drugs, but never use antibiotics and antiviral drugs).
6. Asthmatic bronchitis.
Asthmatic bronchitis is mostly caused by viruses or allergies, rarely bacterial infections, and manifests as acute coughing and wheezing and/or fever. In addition to the use of antipyretics as appropriate according to body temperature, the main treatment is expectorant therapy that relieves the bronchospasm causing coughing and wheezing and assists in sputum removal, mostly by nebulized inhalation airway therapy. Antibiotics are only for serious bacterial infections, and antivirals are generally not used in the treatment of asthmatic bronchitis.
7, how to take antibiotics correctly: for bacterial infections, if antibiotics are used, they should be used in sufficient quantity and for sufficient time. The course of antibiotics should generally be 5-10 days. Azithromycin is recommended for three days because this drug has a long metabolic cycle and can be taken for six days in a row.
8, whether it is hand, foot and mouth disease, or herpes cheek infection, or other viral or bacterial infections, as long as the temperature returns to normal, it means that the acute phase of the disease has passed, and began to enter the recovery period. There may be some follow-up symptoms during the recovery period, such as cough (after respiratory infection) and rash (early childhood emergency rash). There will be a certain number of days of follow-up. Some symptomatic medications can be used during this period.
9. The severity of the infection is not based on viral or bacterial infection as a criterion, but the degree of infection should be used as an indicator. Blood tests such as routine blood and C-reactive protein can reflect the degree of infection. In fact, the degree of difficulty of the child is the best indicator of the severity of the infection. If your child is in good spirits, there is no need to be more than anxious even if the fever is high; if your child is in poor spirits, you should see a doctor even if the fever is not present.