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- 10. Children and Antibiotics: Cutting Back on Inapporopriate Prescriptions. - Top
- Children and Antibiotics: Cutting Back on Inapporopriate Prescriptions.
Author/s: Maryann Napoli
Health Facts
Issue: March, 1999
Popular Myth: Antibiotics should be prescribed for a viral illness in order to prevent it from developing into a bacterial infection. At the very least, antibiotics will speed recovery.
Reality: Antibiotics neither shorten the course of acute illness nor prevent secondary bacterial infections.
-Linda F. McCaig and James M. Hughes, M.D., Centers for Disease Control and Prevention (JAMA, 1/15/95).
The widespread, often inappropriate, prescription of antibiotics has caused a worldwide health crisis. Drug-resistant strains of bacteria have emerged because antibiotics kill only some organisms leaving others to multiply and evolve into strains that are untreatable. According to the U.S. Centers for Disease Control and Prevention (CDCP), Patients infected with drug-resistant organisms are more likely to require hospitalization, have a longer hospital stay, and die (JAMA, 1/18/95). The pharmaceutical industrys response has been to go back to the lab and produce a more powerful, broad-spectrum antibiotic which in turn becomes ineffective. The CDCP reports that the use of older antimicrobial drugs such as penicillin has decreased, while there has been a major increase in the prescription of the newer, more expensive drugs, such as amoxicillin and the more expensive and broader-spectrum drugs like cephalosporins. In the past decade there has been a concurrent dramatic rise in cases of ear infection (otitis media) in children and acute and chronic sinusitis in people over the age of 15 years. In short, the bugs are winning.
Medical journals periodically report dire warnings to physicians and to the public. Both have been faulted for the misuse of antibiotics. Though these drugs are clearly ineffective against viral infections like the common cold, more than one-fifth of all antibiotics prescriptions in the U.S. are written for upper respiratory tract infections or bronchitisconditions that are almost always viral, according to a 1998 government report. The overuse of antibiotics in young children has become a major source of concern, particularly the overprescription of antibiotics for acute otitis media (AOM). This is the most common bacterial infection in children and the leading reason for prescribing outpatient antibiotic therapy.
Last month, Pediatrics, the journal of the American Academy of Pediatrics, published the results of a survey of 915 pediatricians. Nearly half reported that parents always, most of the time, or often pressure them to prescribe antibiotics when their children are ill but antibiotics are not indicated. One-third of the pediatricians said they succumb to the pressure. The survey was conducted by Howard Bauchner, M.D., professor of pediatrics, and colleagues at Boston University School of Medicine, who estimate that an astounding 30 million antibiotic prescriptions will be written this year for children with AOM. This figure, based on the massive increase in prescriptions since 1980, primarily consists of the two antibiotics most commonly prescribed for AOM, amoxicillin and cephalosporin. The corresponding increase in the incidence of AOM has been attributed to widespread day care attendance, improved access to medical care, and overprescription of antibiotics. Most alarming, Streptococcus pneumoniae, the chief bacterial culprit in the development of AOM, has shown a pattern of resistance which, according to Dr. Bauchner and colleagues, has profound implications for pediatrics.
In a telephone interview, Dr. Bauchner was asked how necessary antibiotics are for children with AOM, which is a bacterial infection. There is substantial amount of data to show that eight or nine out of ten children older than two years will get better on their own, answered Dr. Bauchner, who explained that this finding came from a meta-analysis which pooled the results of several studies. Antibiotics do work for a few children.
Even if parents accepted the odds that their children will recover without antibiotics, many of them mistakenly believe that these drugs must be given to alleviate pain. Pain remains an issue, but antibiotics are not effective against pain, he explained. Antibiotics will not be any more effective in managing pain than over-the-counter drugs like Tylenol, Advil, or Motrin. A 1997 analysis of six clinical trials in which children were randomly assigned to receive antibiotics or a placebo (dummy pill) found the antibiotics did not reduce the incidence of subsequent ear infections or temporary hearing loss (due to fluid in the inner ear).
Dr. Bauchner advises parents of older children to see a doctor if the child is not better in two days. For children younger than age two or children with recurrent ear infection not many doctors will withhold antibiotics. Still, he cautioned, Whether children are given antibiotics appropriately or indiscriminately, there is an increased risk of pneumococcus infection, the most common causative agent for AOM, he cautioned. Thats why we are trying to reduce the number of prescriptions. Emphasis of the new campaign of the American Academy of Pediatrics is to get parents to stop demanding antibiotics for runny noses, coughs, cold, and most sore throats, all of which are viral infections and antibiotics are inappropriate. As for the common belief that viral infections should be treated with antibiotics to prevent the development of a bacterial infection, the American Academy of Pediatrics warns parents that antibiotics for this purpose may lead to infection with resistant bacteria.
What you can do:
-Read When Antibiotics Fail: Restoring the Ecology of the Body by Marc Lapp, Ph.D. (Berkeley, CA: North Atlantic Books, 1995). Dr. Lapp examines the steps that can be taken to control bacteria and enhance the bodys natural defenses.
-Learn what some European countries have done to reduce the rate of unnecessary antibiotic prescriptions for children. Steps taken in the Netherlands over ten years ago, for example, have resulted in a low rate of antibiotic resistant infections without a corresponding increase in complications like mastoiditis or meningitis (see HealthFacts, 7/97). Some doctors advise making a child comfortable with an over-the-counter eardrop solution containing benzocaine (a local anesthetic) and Nyquil, which contains acetaminophen and a decongestant to alleviate pain and congestion. In most children, ear infection is merely one symptom of a cold.
-Try giving your child gum sweetened with xylitol. A Finnish study of 306 preschool children found a 40% reduction in the incidence of otitis media in those who chewed xylitol gum every day as compared with those who chewed gum sweetened with sucrose (see HealthFacts, 12/96).
COPYRIGHT 1999 Center for Medical Consumers, Inc.
COPYRIGHT 2000 Gale Group
- Updated: May 19, 2001
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