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Antibiotic overprescribing remains a problem in pediatrics
Hersh AL. Pediatrics. 2011;doi:10.1542/peds.2011-1337.
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Almost one-quarter of all antibiotics written by pediatricians in the United States from 2006 to 2008 were given for conditions that probably did not warrant antibiotics at all, according to a study published online recently.
Adam L. Hersh, MD, PhD, and colleagues of the University of Utah looked at the National Ambulatory and National Hospital Ambulatory Medical Care surveys that included almost 65,000 outpatient visits by children aged younger than 18 years. The researchers found that in about one in five of those visits, pediatricians prescribed antibiotics, 23% of which were written for patients who had respiratory illnesses such as bronchitis or influenza.
Therefore, more than 10 million antibiotic prescriptions may be written for conditions that are not warranted, and this is more likely to lead to resistance and could actually cause more harm, according to Hersh and colleagues. The researchers noted certain trends for patients who were given antibiotics, despite having viruses, including being younger, having private insurance and living in the South.
According to the researchers, their findings could have larger implications for antibiotic stewardship programs. These programs “have been shown to be effective interventions for improving antibiotic-prescribing patterns in hospital settings, including reducing overuse of broad-spectrum antibiotics. Broader development and implementation of programs specifically tailored to ambulatory care settings is a public health priority,” they wrote.
This is particularly important, according to the researchers, because about 50% of the antibiotics prescribed were “broad-spectrum” drugs, and more judicious use of these antibiotics is sorely needed to prevent resistant bacteria.
Disclosure: The researchers report no relevant financial disclosures.
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Ellen R.The study by Hersh and colleagues published describes trends in antibiotic prescriptions for all children younger than 18 years of age who visited ambulatory care settings during 2006 to 2008. This study updates several other similar investigations using the same database. The authors found that most prescriptions of antibiotics were for respiratory conditions. This is not surprising, as the most common reason that children visit their primary care providers relates to respiratory complaints.
In this study, the respiratory illnesses for which children were treated were divided into those for which antibiotics are appropriate (such as acute otitis media [AOM] and acute bacterial sinusitis) and those in which antibiotics should be withheld (because they are caused by viruses), such as nasopharyngitis and bronchitis. The disappointing news is that antibiotics are frequently prescribed for conditions in which they are not indicated, and furthermore, that this is the category in which broad-spectrum antibiotics (rather than narrow-spectrum antibiotics) are most likely to be prescribed. Even more distressing is the information that among antibiotics used inappropriately, azithromycin is the most common.
Azithromycin is attractive to practitioners and families because it is prescribed in a short course and as a single daily dose. Unfortunately, it is among the antimicrobials most likely to result in a dramatic and sustained alteration in nasopharyngeal flora. In addition, macrolide resistance to Streptococcus pneumoniae is an increasing problem, and azithromycin is ineffective against Haemophilus influenzae. Accordingly, azithromycin should almost never be prescribed for any respiratory infections (eg, AOM or acute sinusitis) other than very specific entities for which it is the drug of choice, such as, Bordetella pertussis, Mycoplasma, Legionella, Chlamydia and Campylobacter. Program development fostering the practice of judicious use of antibiotics needs to be continually re-enforced for the practicing community of physicians.
Ellen R. Wald, MD
Infectious Diseases in
Children Editorial Board member
Disclosure: Dr. Wald reports no relevant financial disclosures.
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