Too Many Kids Get Antibiotics, Study Finds

Nov. 8, 2005 — -- Despite pleas from health officials, pediatricians are prescribing antibiotics unnecessarily, according to a new study by Boston's Brigham and Women's Hospital and Harvard Medical School.

The study analyzed nearly 4,000 records of children who visited medical offices with sore throats. Most of the time, a sore throat is caused by a viral infection, which has no treatment. But in about 15 percent to 30 percent of cases, the sore throat is caused by a streptococci bacterial infection, which can be detected with a throat culture and treated with antibiotics.

The researchers found that doctors prescribed antibiotics 53 percent of the time -- far exceeding the expected 15 percent to 30 percent prevalence of strep throat, according to a study in the Nov. 9 issue of the Journal of the American Medical Association.

Moreover, the study found that doctors were not testing for strep very often -- only about half of the time -- and that in 27 percent of cases, the drug given was not recommended for strep infections.

This goes against the recommended treatment guidelines, said Dr. Jeffrey Linder, the lead author of the study. Ideally, a doctor treating a child for a sore throat will first test the child for Group A streptococci infection, known as the GABHS test. If the test is positive, the doctor should prescribe penicillin or a related antibiotic; if the test is negative, the child's parents should not be given any antibiotics.

But in too many cases, children weren't being tested and were given antibiotics anyway, Linder noted. This does more than just increase the potential for drug-resistant bacteria, he said.

"The kid is being exposed to medicine that they don't need," he said. "There's no benefit to it and all the risks -- everything from mild reactions like upset stomach, diarrhea and rash to an anaphylactic reaction," which is a massive inflammatory response by the immune system.

If their child does have a strep infection, parents need to know that penicillin, a cheap and widely available antibiotic, works just fine, he said.

"The bug that causes step throat is always sensitive to penicillin," Linder said. "There is very little reason to be giving anything other than penicillin or amoxicillin, unless the kid has (a drug) allergy."

Unnecessary prescribing of antibiotics is an issue the Centers for Disease Control and Prevention in Atlanta has long been trying to eradicate through the "Get Smart: Know When Antibiotics Work" campaign. Information for parents can be found at http://www.cdc.gov/getsmart/.

Many patients expect to leave a doctor's visit with a prescription, said Ray Bullman, executive vice president of the Maryland-based National Council on Patient Information and Education.

"It's natural to expect the doctor to begin treating a sick child right away, and a prescription is a usual expectation, as two-thirds of office visits result in a prescription," he said. "But such expectations, as may other issues, are perhaps helping drive prescribing when not warranted by confirmed test results."

There was a silver lining in the study, Linder noted. In 1996, 66 percent of visits ended with an antibiotic prescription. So doctors are getting the CDC's message, although some still are not heeding it, he said.

"I think a lot of the over-prescribing is a sincere desire on the part of the doctor to want to do something," he said.