A question we hear frequently is: “Can you prescribe over-the-counter (OTC) antibiotics for kids?” Here’s what you need to know.

Why do kids need antibiotics?

Antibiotics are medications that treat infections caused by bacteria. Unlike viral infections, such as the common cold or flu, bacterial infections require targeted treatment to eliminate the harmful microorganisms that cause infections and illness. 

“Antibiotics function by targeting essential bacterial processes, leading to bacterial death or inhibition of bacterial growth,” explains Dr. Marcy Borieux MD, FAAP, Pediatrician at Summer Health. “They do not affect viruses or non-bacterial pathogens.” In other words, these medications work by either killing the bacteria directly or preventing them from multiplying and spreading within the body.

Children may need antibiotics when they develop certain bacterial infections. Common bacterial infections include:

• Strep throat (from Streptococcus bacteria)

• Bacterial ear infections 

• Urinary tract infections

• Bacterial skin infections 

• Bacterial pneumonia

• Food poisoning (like E. Coli or Salmonella)

• Lyme disease

• Bacterial conjunctivitis (pink eye)

• Bacterial pneumonia 

Children’s immune systems are still developing, so they are less efficient at fighting off the viruses and bacteria that cause infections or illness. That said, antibiotics should only be used when necessary. Your local or Summer Health pediatrician can help determine whether your child’s infection is bacterial and if antibiotics are the appropriate course of treatment.

Antibioptic treatment for ear infections

Children get ear infections when bacteria or viruses invade the ear. Most babies and toddlers will need antibiotics if they have an ear infection, but for children over 2, it depends on the severity of their symptoms. Babies and toddlers under 2 years old are more likely to be prescribed antibiotics, especially if they have a fever, significant pain, or infections in both ears. 

However, for children over 2, pediatricians often recommend a “watchful waiting” approach first—monitoring symptoms for 1 to 2 days to see if the infection clears on its own without antibiotics. This allows the child’s immune system to fight off the infection naturally.

Do antibiotics require a prescription?

In the United States, antibiotics are prescription-only medications and cannot be legally obtained over the counter. This applies to both adults and children. Most children’s antibiotics require a doctor’s prescription to ensure they are used safely and appropriately.

This regulation is in place to prevent the misuse of antibiotics, reduce the risk of antibiotic resistance, and minimize potential side effects. Antibiotic resistance occurs when bacteria evolve to resist the effects of medications that once killed them. These resistant bacteria can spread easily and become much more difficult to treat.

“Overuse and inappropriate use (like for viral infections) can contribute to the rise of resistant organisms, and expose patients to unnecessary side effects such as allergic reactions, gastrointestinal symptoms, and secondary infections like C. difficile colitis,” says Dr. Borieux.  

If your child needs antibiotics, the first step is to schedule a consultation with their pediatrician. The doctor will evaluate your child’s symptoms, make a diagnosis, and prescribe antibiotics if they are medically necessary.

Commonly prescribed antibiotics for children

Pediatricians prescribe antibiotics based on the type of infection, the child’s age, medical history, and any known drug allergies. Some of the most common types of antibiotics for children include:

• Amoxicillin: Often the first-line treatment for common bacterial infections such as otitis media (middle ear infections), streptococcal pharyngitis (strep throat), and certain types of pneumonia. 

• Amoxicillin-clavulanate: This combination antibiotic includes amoxicillin and clavulanate, which helps overcome certain bacterial resistance. It’s commonly used for infections that don't respond to plain amoxicillin, such as recurrent ear infections.

• Cephalosporins: A class of antibiotics that includes drugs like cephalexin and cefdinir. These are often used to treat skin infections.

• Macrolides: Antibiotics typically used in children who are allergic to penicillin.  

Allergies to antibiotic medications

Some children are allergic to antibiotic medications. While it’s common, many times the diagnosis is inaccurate. Penicillin allergies are the most frequently recorded drug allergy, with sulfonamides coming in second. Allergy overreporting is common because many recorded “allergies” are actually side effects (such as gastrointestinal upset), rashes from viral infections, or vague, nonspecific symptoms. Plus, once entered into a medical record, these labels often remain without re-evaluation, and childhood reactions are rarely re-tested in adulthood. 

Are topical antibiotics over-the-counter?

Topical antibiotics are applied directly to the skin or mucous membranes to treat localized infections, like skin infections. Many topical antibiotics (like bacitracin, polymyxin B, neomycin, or “triple antibiotic ointments”) do not require an antibiotic prescription because they are intended for short-term prevention and treatment of minor, superficial skin injuries (like small cuts, scrapes, mild burns) and the risk of systemic infection is low. 

Here are some guidelines to follow for topical antibiotics:

• Some topical antibiotics (like those containing neomycin) can cause skin irritation, so it’s best to skip them for small, uncomplicated wounds, if possible.

• Overusing topical antibiotics, even for minor injuries, can contribute to antibiotic resistance and cross-resistance in pathogens. In other words, the bacteria learn to outsmart the antibiotics and can make it harder to treat future infections.

• Many guidelines recommend antiseptics or plain petrolatum for clean wounds, unless signs of infection are present.

• Use topical antibiotics only when indicated, limit treatment to the affected area, and avoid prolonged or repeated courses.

Signs of bacterial infection 

If you’re unsure if your child has a bacterial infection, watch out for the following signs:

General systemic symptoms 

• Fever

• Chills/sweats

• Fatigue

• New or worsening cough

• Shortness of breath

• Sore throat

• Nasal congestion

• Painful urination

• Diarrhea

• Vomiting

• Abdominal pain

Site-specific symptoms

• Throat (bacterial pharyngitis): Fever, red/swollen tonsils with white patches, tender neck lymph nodes, palatal petechiae (red spots on the roof of the mouth), usually no cough.

• Skin/wound: Red, warm skin, swelling, pain, discoloration, pus, possible fever.

• Gastrointestinal: Diarrhea (sometimes bloody), abdominal cramps, fever, nausea, vomiting, dehydration.

• Lower respiratory tract: Cough, fever/chills, shortness of breath.

Keep in mind that In immunocompromised children, fever alone may be the only sign of a bacterial infection. 

Can Summer Health prescribe antibiotics?

Summer Health pediatricians can prescribe antibiotics for conditions that can be appropriately examined and diagnosed via telehealth. For some conditions, like pneumonia, strep throat, and ear infections, an in-person exam may be required. Your pediatrician will determine if an in-person clinic evaluation is required. 

If you have questions about antibiotics, reach out to your local or Summer Health pediatrician for support. Summer Health is a pediatric telehealth platform offering 24/7 care, providing answers for everything from urgent concerns to everyday questions about your child’s health.