Too Much of a Good Thing?

Parents, pediatricians, and the growing threat of childhood antibiotic resistance

In the not-so-distant past, a quick glance into the medicine cabinet of any family with young children likely would have revealed one or more partially-finished bottles of "the pink stuff"--sticky, bubble-gum-flavored prescription antibiotics that pediatricians once handed out like candy to treat everything from ear pain to an upset tummy to a runny nose. Today, however, the Centers for Disease Control (CDC) and the American Academy of Pediatrics (AAP), as well as other public-health agencies, have launched informational campaigns warning that decades of rampant over-prescription of antibiotics by physicians, along with improper utilization by patients, has led to a serious problem: an alarming rise in potentially deadly bacterial illnesses which no longer respond to formerly effective antibiotic treatment.

Physicians have known since the advent of the modern age of antibiotics that the capability exists for disease-producing bacteria to evolve into untreatable strains. Only four years after pharmaceutical companies began mass-producing penicillin in 1943, scientists first encountered certain microbes that would no longer respond to the new "miracle medicines." This is because, in any given population of bacteria, a few members will naturally have the genetic ability to resist antibiotics. With repeated exposure to antibiotics, these naturally resistant bacteria are encouraged to grow and flourish, while the bacteria which respond appropriately to antibiotic use are demolished. Eventually, only the antibiotic-resistant bacteria remain, creating dangerously untreatable strains of various diseases. These antibiotic-resistant bacteria can make the host individual sick and, in many cases, can then be transmitted to other people as well. Alarmingly, an increasing variety of bacterial illnesses, including certain strains of pneumonia, tuberculosis, and salmonella, have now spawned antibiotic-resistant progeny.

"There was complacency in the 1980s," according to Dr. Michael Blum, FDA medical officer, quoted in an interview with the FDA's consumer magazine. "The perception was that we had licked the bacterial infection problem. Drug companies weren't working on new agents. They were concentrating on other areas, such as viral infections. In the meantime, resistance increased to a number of commonly-used antibiotics. . . . In the 1990s, we have come to a point for certain infections that we don't have (antibiotic) agents available."

Across the country, doctors and hospitals are seeing a steady rise in cases of antibiotic-resistant disease in both children and adults. For example, according to a report in the Journal of the American Medical Association, between 1979 and 1987, only 0.02 percent of pneumococcus bacteria in the United States were found to be penicillin-resistant. Today, however, at least 6.6 percent of pneumococcus strains are resistant, and that percentage is rising. The FDA reported that in 1992 alone, 13,300 hospital patients died of bacterial infections that should have been curable with the use of antibiotics. Certain bacteria, such as Staphylococcus aureus (commonly known as "staph infection"), have now developed resistance to almost all antibiotics. Until recently, one antibiotic--Vancomycin, known as "the antibiotic of last resort"--remained generally effective against these potentially deadly staph bacteria. In the past several years, however, frightening cases of vancomycin-resistant bacteria have appeared in hospitals across the United States.

Children have a unique risk for antibiotic-resistant disease due to the fact that pediatricians and parents tend to over- and misuse antibiotics for many common childhood ailments such as ear infections, thus allowing resistant germs to colonize. According to the AAP, the more antibiotics prescribed for a child over time, the higher the chance the child will become infected with resistant bacteria. Alternately, children without a history of excessive personal antibiotic use can contract antibiotic-resistant bacterial illnesses from other people in their immediate environment who have themselves been overexposed to antibiotics. Either way, the results are the same: illnesses that can't be stopped with what should be the appropriate medications.

According to Dr. Dennis Murray, Chief of Pediatric Infectious Diseases at Michigan State University in Lansing, and a member of the American Academy of Pediatrics' Committee on Infectious Diseases, pediatricians are now seeing the disturbing results of decades of routine and often inappropriate antibiotic use in their young patients.

"Pediatricians are more and more frequently finding that even simple infections will no longer easily respond to antibiotics," explains Dr. Murray. "For example, the bacteria most likely to cause ear infections are now often found to be antibiotic-resistant. In areas of rural Kentucky, up to thirty percent of bacterial ear infections are resistant to some degree. In some inner cities, such as in Memphis, forty to fifty percent are antibiotic-resistant. "

Janet Greenlee of Colorado Springs, Colorado is the mother of a two year old who has suffered from repeated ear infections. She says that her son's ear problems appear to no longer respond to any antibiotic.

"When he first began getting infections, amoxicillin would work for a short time. Then it stopped working and we moved up to something stronger. Now we have tried just about every antibiotic available and his pediatrician says that we have run out of options. He says we will have to have ear tubes put in. That's fine, but I worry whether antibiotics will work if my son ever needs them for something more serious, like a hospitalization," says Greenlee.

According to Dr. Murray, Greenlee's concern is not without merit. He says that he and other members of the AAP's Committee on Infectious Disease are now encountering situations in which children who were exposed to antibiotics for relatively minor illnesses--such as sinusitis or even for viruses--are later becoming ill with more serious, life-threatening infections which fail to respond to antibiotic treatment.

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