If someone asked you if a viral infection should be treated with an antibiotic, your answer would be a resounding no, but in the setting of not knowing with absolute certainty if a virus is the cause for a child’s respiratory symptoms, the possibility of prescribing an antibiotic increases. Such is the case in the emergency department—but under what circumstances? One possibility is that a patient’s race or ethnicity may bias the decision making one way or the other to use antibiotics. To look into this hypothesis, Goyal et al. (10.1542/peds.2017-0203) share with us this week a retrospective cohort study looking at patient encounters in seven emergency departments using data gleaned from the Pediatric Emergency Care Applied Research network Registry. Almost 40,000 patient encounters are included in this study. The good news is that only 2.6% of these patient received antibiotics for criteria suggestive of a viral acute respiratory infection (ARTI), but the bad news is that racial and ethnic differences were found with non-Hispanic white children being more likely than non-Hispanic black or Hispanic children to receive the prescription for an antibiotic. Why is this happening and how do you integrate this data into other reasons to overprescribe such as parent expectations or provider perceptions of what they think parents expect. To provide further insight into the findings in this study, we asked Infectious Disease and Emergency specialist Dr. Marvin Harper (10.1542/peds.2017-2185) to comment on this study and the role of implicit bias in our clinical decision making. Hopefully this blog can bias you to read both the study and commentary and then reflect on how much implicit bias influences your clinical decision making. Perhaps just being aware of such biases may be what it takes to further lower the inappropriate prescribing of antibiotics when not indicated such as for viral illnesses in the emergency room or primary care office setting.
