Despite Warnings, Antibiotics Still Overprescribed in Kids
By Dr. Natasha Bhuyan
Despite warnings from public health experts that overprescribing antibiotics could lead to difficult-to-treat "superbugs," doctors are prescribing antibiotics to children about twice as often as they are actually needed, a new study found.
Researchers at Seattle Children's Hospital examined past studies between 2001 and 2011 to see how doctors treated common childhood respiratory infections, conditions including sore throats, ear infections and sinusitis. They found that although only 27.4 percent of the infections were caused by bacteria and could therefore be treated with an antibiotic, a whopping 57 percent of them were actually treated with antibiotics.
That amounts to 11.4 million unnecessary prescriptions for antibiotics per year, researchers say. Antibiotics are no good against viral infections and have only been shown to work against bacterial infections.
Lead study author Dr. Matthew Kronman, a pediatric infectious disease specialist at Seattle Children's Hospital, said the results are disheartening, particularly because his team found no appreciable change in prescribing rates over 10 years.
"Whatever we are doing now, it isn't working," Kronman said. "We need to come up with new strategies to understand why this gap exists," he said referring to the gap between antibiotics needed and those that are prescribed.
The American Academy of Pediatrics, the top pediatrician's group in the United States, has periodically issued guidelines on the use of antibiotics in kids, notably in 2001 for sinusitis and 2004 for ear infections. But the demands of parents, as well as difficulties doctors face in quickly distinguishing between viral and bacterial infections, still fuels the trend.
Experts not involved with the research said their big fear is that they will eventually have no treatment options for superbugs. An estimated 2 million Americans are infected with antibiotic-resistant organisms, resulting in 23,000 deaths each year, according to a 2013 report by the U.S. Centers for Disease Control and Prevention in Atlanta.
But there are other reasons that antibiotics should only be used when they're needed.
"For some infections, like acute bronchitis, pharyngitis with a negative strep test, and URI, we know that antibiotics do not help you get better faster and are not needed," said Dr. Mark Ebell, a family medicine physician and professor at the University of Georgia College of Public Health in Athens. "Even sinusitis and [ear infections] may be caused by viruses and often resolve without antibiotics."
Ebell added that antibiotics can also hurt kids in other ways, such as causing nausea and vomiting. Antibiotics can also upset the delicate balance of gut bacteria, leading to diarrhea. In rare cases, they can lead to a debilitating allergic reaction called anaphylaxis, which can be life-threatening.
When antibiotics are necessary, however, they can be lifesaving. Patients with more severe symptoms - such as pain, worsening symptom or high fever - are more likely to benefit from an antibiotic, Ebell said.
Doctors overprescribe antibiotics for a variety of reasons, not the least of which is the difficulty in determining the exact nature of an infection when they see it.
"In several situations, the diagnosis is not very clear cut," said Dr. Mobeen Rathore, chief of pediatric infectious diseases at Wolfson Children's Hospital in Jacksonville, Florida, and professor at the University of Florida, who was not involved with the research.
All the more reason, doctors say, that parents should be aware of what to do if their child has a runny nose or a sore throat. For patients with the common cold, the best defense is to drink plenty of fluids, get rest and use over-the-counter medications for symptomatic control. Antibiotics should not be taken for mild to moderate sinus infections, unless symptoms last longer than seven days or worsen after clinical improvement, according the American Academy of Family Physicians.
Of course, parents should never hesitate to call their pediatrician or family physician with questions at the first sign of illness. But even then, it is good to ask questions as to the necessity of antibiotics.
"It's OK to ask your physician, 'Why are you prescribing an antibiotic for my son-daughter?'" Kronman of Seattle Children's Hospital said. "Have a discussion with your physician. Is an antibiotic really needed for this cold or are there other things we can try?"