Do most coughs and colds in children need antibiotics?

What the evidence says

The Canadian Paediatric Society is clear: colds are caused by viruses, and antibiotics will not help a child recover faster. Antibiotics should only be used if a child develops a separate bacterial illness, such as an ear infection or pneumonia, not for the cold itself. Choosing Wisely Canada, working with national physician groups, specifically recommends against antibiotics for uncomplicated sore throats, bronchiolitis, uncomplicated ear infections, and colds that seem viral, since these infections resolve on their own and antibiotics offer no real benefit in these cases.

This matches guidance from the American Academy of Pediatrics, which notes that most upper respiratory infections are viral and require no antibiotics, and that overuse contributes to antibiotic resistance and side effects without helping the child feel better. A cough can reasonably last several weeks after a cold even without any bacterial infection, so a lingering cough alone isn't a reason for antibiotics. If your child has a high fever that doesn't improve, worsening symptoms after initial improvement, ear pain, or breathing difficulty, it's worth a doctor's assessment to rule out a bacterial complication.