Antibiotic resistance is a global health threat. Antimicrobial-resistant infections currently claim 700 000 lives a year globally and by 2050 antimicrobial resistance could result in a loss of 10 million lives a year. This will result in more deaths than people dying from cancer.

Using antibiotics wisely is a critical message in an era of increasing antibiotic resistance and other complications relating to the abuse of antibiotics in our modern world.

Africa has a high burden of infectious diseases, including a large portion of bacterial origin. High levels of antibiotic resistance already exist in South Africa, mostly due to inappropriate antibiotic management and consumption. Such is the threat of antibiotic misuse and resistance that many programmes are now in place to drive down antibiotic use for obvious viral infections.

In this regard, a child with a ‘viral upper respiratory tract infection (URTI) and fever should be able to be diagnosed from the clinical pattern of disease. This includes a temperature, runny nose and mild aches and pains. Nobody who has a ‘cold’ should get an antibiotic.

There may well be a place for an antibiotic in a URTI in a child if the pattern is consistent with acute otitis media (fever, earache and red drum), acute bacterial rhinosinusitis (purulent nasal secretion 7-10 days after a ‘cold’ and facial pain) or tonsillitis. Most sore throats do not need antibiotics.

When an antibiotic is deemed necessary, even then, antibiotic stewardship recommends a new philosophy of antibiotic prescribing, when in most cases a high dose and short course is recommended.

A final comment on the importance of avoiding unnecessary antibiotic use in young children is the emerging association between antibiotic use in pregnancy and young children and ‘dysbiosis’ (or change) in the microbiome. The consequence of loss of a healthy microbiome in early life is an association with chronic inflammatory diseases throughout life. These include allergy, asthma, obesity, metabolic syndrome and diabetes.

Professor Robin Green is Chairman of the School of Medicine and Director of Paediatric Services at the University of Pretoria.

According to the World Health Organization, World Antibiotic Awareness Week is commemorated annually in November “to increase global awareness of antibiotic resistance and to encourage best practices among the general public, health workers and policy makers to avoid the further emergence and spread of antibiotic resistance.” World Antibiotic Awareness Week 2019 is commemorated between 18 and 24 November.