Q: Should I give antibiotics for a cold and stomatitis with fever, considering a history of C. diff?

Medically reviewed by Sang Hyun Ahn, MD

Content edited by Myeongchan Kim, MD

This post is a dramatization of a question and answer session experienced by our actual medical reviewers. Please note that this content is for informational purposes only and does not constitute medical advice. Always consult with a qualified healthcare professional for any health concerns or before making any decisions related to your health or treatment.

Question:

My child has had a cold (clear runny nose, sneezing, congestion) and stomatitis (a large, red, bruise-like spot on the roof of the mouth) for about five days. They have been taking symptom-relief medication since Monday. On Friday afternoon, a fever started (38.7°C, so I gave a fever reducer). By Saturday morning, it went down to 38.2°C, and it has been fluctuating just under 38.1°C without medication since.

A major concern is my child's medical history: they had Clostridioides difficile (C. diff) infection four times over the summer and were treated for relapses until early November.

At our Saturday clinic visit, a 3rd-generation antibiotic was prescribed. The doctor mentioned they would prefer my child take it, but knowing my concerns about C. diff, they said to just take the prescription and decide if I want to give it. I've read that antibiotics aren't typically used for stomatitis. Since the doctor left the choice up to me, I am very torn. Should I give the antibiotics or hold off?

Answer:

It is completely understandable that you are worried, especially given your child’s challenging history with recurrent C. diff infections.

Based on the symptoms you described, the combination of red spots on the roof of the mouth and cold symptoms is highly suggestive of viral stomatitis (such as early herpangina or hand-foot-and-mouth disease). Because these are caused by viruses, antibiotics are not effective against them.

When are antibiotics typically needed?

Antibiotics are generally reserved for situations where a bacterial infection is suspected. This includes:

• Bacterial pharyngitis (such as strep throat, often with pus on the tonsils and severe throat pain)

• Complications like an ear infection (otitis media) or a sinus infection (bacterial sinusitis)

• A high fever that persists for more than 3 to 4 days, which might indicate a secondary bacterial infection

What to do in your current situation:

Since the fever only started recently (on day 5 of the cold) and the symptoms generally align with a viral course, holding off on the antibiotics for now is a very reasonable and safe choice. Given your child's significant history with C. diff, avoiding unnecessary antibiotics is crucial to preventing another relapse.

How to care for your child at home:

• Hydration is key: Offer small, frequent sips of liquids. Cold drinks, ice chips, or popsicles are great and can also help soothe a sore mouth.

• Diet: If their mouth hurts, stick to soft, bland foods that won't irritate the sores.

• Fever management: Only use fever-reducing medications if your child is visibly uncomfortable or in pain. The fever itself is helping their body fight the virus.

• Monitor: Keep a simple log of their fever patterns, food/fluid intake, wet diapers or bathroom trips, and any changes in the spots in their mouth.

When you should consider starting the antibiotics:

You should consider filling the prescription and starting the antibiotics—or taking your child back to the doctor for a re-evaluation—if any of the following occur:

• The fever continues or begins to spike higher by day 3 or 4 of the fever (Monday/Tuesday).

• Throat pain becomes so severe that your child refuses to swallow even small amounts of liquid or their own saliva.

• New symptoms appear, such as ear pain or thick, yellow/green nasal discharge lasting several days.

• Your child becomes lethargic or goes more than 8 hours without urinating.

When you do follow up with your pediatrician, it would be helpful to ask if they believe the spots are strictly viral, and whether starting a probiotic might help reduce the risk of a C. diff relapse if antibiotics eventually become strictly necessary.

Red Flags (Seek immediate medical attention):

Please take your child to be evaluated immediately if they show signs of rapid or difficult breathing, go more than 8 hours without urinating, are severely lethargic and won't make eye contact, or if their throat or ear pain suddenly and severely worsens.

For now, focus on keeping your child hydrated and comfortable. Monitor their fever pattern over the next couple of days, and consult your pediatrician again if symptoms persist or worsen.

For extra peace of mind and clear guidance when tracking your child's symptoms, the FeverCoach app is always there to help.

fevercoach.us

Apple App Store

Google Play

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