Pediatricians should just say no to drugs when considering prescribing antibiotics for conditions that don?t usually require them. That?s the position of public health officials who say that pediatricians are doing a better job of limiting antibiotic prescriptions but still have a way to go before reaching appropriate levels of use. Inappropriate use of antibiotics continues unabated in 3 of 5 acute respiratory infections. Find out which ones.
Just say no to drugs when considering prescribing antibiotics for conditions that don’t usually require them.
That’s the recommendation of the Centers for Disease Control and Prevention (CDC), which said that pediatricians are doing a better job of limiting antibiotic prescriptions but still have a way to go before reaching appropriate levels of use.
The CDC report said that antibiotic prescribing rates for children younger than 14 years who had visited physician offices decreased 24% from 300 antibiotic courses per 1,000 office visits in 1993 to 1994 to 229 antibiotic courses per 1,000 office visits in 2007 to 2008.
The study, which analyzed data from the National Ambulatory Medical Care Survey (NAMCS), looked at antibiotic usage for 5 acute respiratory infections (ARI) and determined that antibiotic prescribing rates declined 26% for pharyngitis and 19% for the common cold but did not change significantly for otitis media, bronchitis, and sinusitis. Overall, antibiotic prescriptions dropped 11% for the ARI-related office visits.
The CDC reported that 58% of the antibiotics prescribed by office-based physicians in 2007 to 2008 were for the 5 ARIs, even though those illnesses usually don’t require antibacterial treatment. Antibiotic prescriptions often are written because ARIs are “common outpatient diagnoses for which patient expectations, as well as physician behavior, contribute to inappropriate antibiotic use.”
In addition, antibiotics use for otitis media has not decreased significantly, despite American Academy of Pediatrics (AAP) guidelines, released in 2004, recommending watchful waiting when the child is otherwise healthy and does not have severe symptoms.
Rapid diagnostic testing for group A streptococcus is credited with lowering the unnecessary use of antibiotics. Introduction of pneumococcal conjugate vaccine and decreased office visits for ARI also contributed to the decline across the board.
However, “with expanding resistance profiles among common pathogens, treatment options are dwindling, and reducing inappropriate use of antibiotics is increasingly important,” according to the MMWR.
Underscoring the issue, a recent study from the United Kingdom found that antibiotics increase the risk in children of developing methicillin-resistant Staphylococcus aureus (MRSA) in the community. That study looked at youths aged from 1 to 19 years in the UK’s General Practice Research Database from 1994 to 2007.
“While close to half of children were diagnosed as having MRSA in the community without prior antibacterial drugs,” the researchers reported, “such agents are associated with a dose-dependent increased risk, concordant with findings in adults.”