Too Much of a Good Thing?

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

"I know of two young children recently hospitalized with invasive bone and joint infections caused by resistant strains of strep pneumonia, which is usually only associated with things like ear infections. These strep infections turned out to be totally antibiotic-resistant. Both of these children had previously been given antibiotics for relatively minor illnesses," says Dr. Murray.

In response to this troubling issue, the American Academy of Pediatrics is trying to get the word out that both physicians and parents have a role to play in lowering children's risk for acquiring potentially dangerous antibiotic-resistant diseases. According to the AAP's public awareness campaign, antibiotics should be prescribed for children judiciously and sparingly. But according to some parents, their own pediatricians continue to present them with a prescription for antibiotics every time their child has a sniffle.

Recent statistics released by the AAP support this perception. Authors from the Boston University School of Medicine state that in 1980, over 4.2 million prescriptions were written for the oral antibiotic amoxicillin to treat ear infections. In 1992, the number had grown to over 12.3 million--an increase of 194 percent. In 1980, 876,000 prescriptions for cephalosporins--another common oral antibiotic--were written to treat ear infections; in 1992 the number was over 6.8 million--an increase of 687 percent. Based on this data, the authors estimate that in 1998, thirty million prescriptions will have been written for treating ear infections

"I am very wary of over-use of antibiotics. I know that they shouldn't be given for viral illnesses, like a cold or the flu, but whenever my daughter gets a runny nose, her pediatrician seems determined to put her on antibiotics," says Lori Aiken, a Kansas City, Missouri mother of a five-year-old. "I privately question the wisdom of this, but I don't know what to say to him about it. He intimidates me. Most of the time we just never get the prescription filled and she gets well all on her own anyway."

According to Dr. Murray, parents should always respectfully question their child's physician when he writes a prescription for antibiotics. Research reported in the February, 1999 issue of the medical journal Pediatrics revealed that many pediatricians believe that parents actually expect their pediatrician to prescribe antibiotics each time their child is ill. In the Pediatrics study, forty percent of the pediatricians surveyed indicated that ten or more times in the past month a parent had requested an antibiotic when the physician did not feel it was indicated. Forty-eight percent 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. In follow-up questions, approximately one-third of physicians reported they occasionally or more frequently comply with these requests. Seventy-eight percent felt that educating parents would be the single most important program for reducing inappropriate oral antibiotic use and fifty-four percent indicated that parental pressure contributed most to inappropriate use of oral antibiotics. The authors of this study concluded that pediatricians acknowledge prescribing antibiotics when they are not indicated and that pediatricians believe educating parents is necessary to promote the judicious use of antibiotics. Clearly, it's important that parents and their pediatricians are able to communicate clearly and easily with one another concerning this important topic.

"Pediatricians need to get the message that--with the current antibiotic- resistance problem--it is simply no longer okay to prescribe antibiotics every time a child has a runny nose or a little fluid behind the ear. Doctors shouldn't just hand out a prescription because they are too busy to explain the situation to the parents," says Dr. Murray. "And parents need to be aware that the great majority of ear infections and respiratory infections in infants and young children are viral, not bacterial. Antibiotics should not be prescribed in these situations. Parents have to learn to advocate for their child in the doctor's office to protect them from improper prescriptions for antibiotics."

Dr. Murray suggests that parents of a child whose doctor wants to prescribe antibiotics should ask plenty of questions, including whether the illness is viral or bacterial and whether--even if it is bacterial--their child might safely recover without antibiotic use. Parents themselves can also learn more about how to tell the difference between a simple cold and a true bacterial infection.

"A sticky nose, as opposed to a runny one, is more likely to be an infection," explains Dr. Murray. "And parents should ask for a throat culture before giving their child antibiotics for a sore throat. Even the most skilled pediatrician can't usually tell if a child has developed strep throat simply by looking. When it comes to fluid in the ear, a doctor needs to look for symptoms that the ear is actually infected before prescribing antibiotics. These can include a bright red eardrum, fever, irritability, crying. . . . The pediatrician should check the eardrum itself to see if it isn't moving."

After a parent has asked all the appropriate questions and feels confident that the antibiotics prescribed for her child are truly necessary, it's critical that she then make sure the child takes the medication exactly as ordered by the pediatrician. Children should finish the full course of antibiotics, even after they have begun to feel better. This ensures that all targeted bacteria are eradicated, with none surviving to become resistant. And parents should never self-treat a child's illness using another family member's antibiotic prescription. Antibiotics are developed to target specific bacteria. Using the wrong medication could actually strengthen strains of harmful bacteria in a child's body.

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