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Antibiotic stewardship efforts require more individualized focus
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Efforts to reduce antibiotic overuse should incorporate a stronger, more individualized focus on the patient’s well-being, rather than the less tangible issue of antibiotic resistance, according to an editorial published in the Journal of Pediatric Infectious Diseases Society.
Fluoroquinolones are one of the most common classes of antibiotics; they make up 25 million adult prescriptions annually, according to data from the National Hospital Ambulatory Medical Care surveys. Yet fluoroquinolones account for less than 2% of pediatric prescriptions. This difference is largely due to opinions based on findings of animal studies conducted in the 1970s that showed damage to articular cartilage of weight-bearing joints in juvenile beagle dogs exposed to high doses of fluoroquinolone.
Despite these study findings, the AAP deemed fluoroquinolones as “reasonably safe in children” in 2011. There is extensive data to defend the AAP’s statement on fluoroquinolones, according to Adam L. Hersh, MD, PhD, of the University of Utah, in Salt Lake City, and colleagues, who wrote the editorial. Research suggests musculoskeletal adverse events, specifically arthralgias, may occur “slightly” more often in children treated with fluoroquinolones. Further, research has shown serious toxicity, including tendon rupture, is rare and may occur more often in adults rather than children.
Adam L. Hersh
The researchers said they believe the impact the animal study findings had on physicians’ practices, shown by the current low rate of children treated with fluoroquinolones, indicates physicians are more concerned about the patient’s well-being. In order to succeed in reducing antibiotic overuse, efforts need to focus on the patient rather than the broader, less intimate concept of antibiotic resistance.
“In the case of fluoroquinolone use in children, the true risk may have been lower than the perceived risk, but the impact on behavior is telling. If we better communicate true risks and benefits of antibiotic use and overuse to patients and physicians, they are likely to make better decisions, especially when treating conditions where the benefits of treatment are modest or nonexistent…The lesson of the fluoroquinolone experience — physicians treating children are responsive to concerns about direct patient harms that result from antibiotic use — can be harnessed and broadly applied as a core stewardship strategy,” the researchers concluded.
Disclosure: See the study for a full list of disclosures.
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