Antibiotic prescribing for children halves over 10 years
Issue No:
Child Health Monitor, Volume 3, Issue 6
June 2002
Background:
Antibiotic overuse by children is an increasing concern for parents and health professionals. Concern by parents is often driven by the worry that antibiotics suppress the immune system, a belief for which there is so far little good evidence. Concerns by health professionals are driven by worries about the rise of bacterial resistance. The overuse of common antibiotics such as amoxycillin is unmistakably increasing resistance to these antibiotics in the community, meaning that more powerful second line antibiotics increasingly have to be used for simple infections. This has a cascade effect, resulting in the slow erosion of doctors’ ability to treat serious infection.
Much of the problem is thought to be general practitioners over-prescribing antibiotics for simple infections such as colds, which are predominantly viral in nature, meaning that they don’t respond to or require antibiotic treatment. Blaming the GP is not helpful, as they are often prescribing in response to great pressure from the patient, who wants something to take away their symptoms. Patients who attend the GP for a cold or flu (upper respiratory tract infection or URTI) are often not satisfied unless they take away an antibiotic. Educating the public as well as GPs as to the dangers of antibiotic overuse, is obviously important.
The problem of antibiotic resistance has been around for over 10 years, and a considerable amount of education for GPs and the public about antibiotic use, has been already put in place. The time has now come to examine whether this education has had the desired effect. These authors used US national data to assess changes in antibiotic prescribing for children and adolescents under 15 years of age, over the past 10 years.
Findings:
These researchers used data from the US National Ambulatory Medical Care Survey, which contains information on prescriptions to children provided nationally from around 3000 office-based doctors (mostly paediatricians and family care doctors) in the USA. They calculated rates for overall antibiotic prescriptions per 1000 children/ adolescents and rates for different conditions such as ear infections and URTI. The data scaled over a decade, from 1989 to 2000.
They found that the overall rate of antibiotic prescription per 1000 children dropped over the 10-year period, from 838 per 1000 children per year (just under one antibiotic for every child each year) in 1989, to 503 per 1000 per year in 2000 (one in two children getting antibiotics every year). In 1989, one in three visits to the doctor by children resulted in a prescription, dropping to just over one in five in 2000.
For common respiratory infections (including ear infections, URTI, bronchitis and sinusitis), the prescription rate dropped from 674 to 379 per 1000 children per year between 1989 and 2000, a drop of 43%. The biggest drop was in antibiotic use for throat infections and URTI, with little change in use in ear infection or sinusitis.They concluded that education for GPs and parents is working to reduce antibiotic prescribing in children and young adolescents.
Problems:
This is good news and good data. Almost every American child had an antibiotic prescription every year in the late 1980s. But by 2000, this had dropped to one in two children, which is an impressive drop. Strangely, the drop in antibiotic use for respiratory infections was very significant, at just under 50%. This begs the question as to which conditions were responsible for the big drop. The assumption has always been that it was URTIs and ear infections that were most commonly the source of antibiotic over prescribing.
Reference:
McCaig et al. Trends in Antimicrobial Prescribing Rates for Children and Adolescents. JAMA June 2002; 287:3096-3102.
Action Points:
- There is no good evidence that antibiotics suppress the immune system in children.
- Antibiotics are not required for the majority of upper respiratory infections (colds) in children or adolescents. See your doctor if you are worried, but be aware that an antibiotic prescription is probably not necessary.
Reproduced with permission of ChildHealthMonitor.org, which translates pediatric journal articles into everyday language providing comprehensive information on research breakthroughs ranging from general nutrition to rare diseases. A great resource for busy Pediatricians and also for parents who want to learn how best to care for their children's medical and parenting problems.
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