Antibiotics are commonly prescribed for children with conditions for which they provide no benefit, including viral respiratory infections. Broad-spectrum antibiotic use is increasing, which adds unnecessary cost and promotes the development of antibiotic resistance.
To provide a nationally representative analysis of antibiotic prescribing in ambulatory pediatrics according to antibiotic classes and diagnostic categories and identify factors associated with broad-spectrum antibiotic prescribing.
We used the National Ambulatory and National Hospital Ambulatory Medical Care surveys from 2006 to 2008, which are nationally representative samples of ambulatory care visits in the United States. We estimated the percentage of visits for patients younger than 18 years for whom antibiotics were prescribed according to antibiotic classes, those considered broad-spectrum, and diagnostic categories. We used multivariable logistic regression to identify demographic and clinical factors that were independently associated with broad-spectrum antibiotic prescribing.
Antibiotics were prescribed during 21% of pediatric ambulatory visits; 50% were broad-spectrum, most commonly macrolides. Respiratory conditions accounted for >70% of visits in which both antibiotics and broad-spectrum antibiotics were prescribed. Twenty-three percent of the visits in which antibiotics were prescribed were for respiratory conditions for which antibiotics are not clearly indicated, which accounts for >10 million visits annually. Factors independently associated with broad-spectrum antibiotic prescribing included respiratory conditions for which antibiotics are not indicated, younger patients, visits in the South, and private insurance.
Broad-spectrum antibiotic prescribing in ambulatory pediatrics is extremely common and frequently inappropriate. These findings can inform the development and implementation of antibiotic stewardship efforts in ambulatory care toward the most important geographic regions, diagnostic conditions, and patient populations.
Comments
Are Pediatricians Writing too Few Antibiotic Prescriptions
I have read countless articles on our overuse of antibiotics and their contributing to bacterial resistance. After being a pediatrician and treating adult kids in the US Army, I have been forced to rethink my position. I am 59 years old, grew up with chronic ear infections, had a T&A that was supposed to cure me, and remain sick with chronic sinusitis ever since! After countless painfull injections of PCN, and finally an oral amoxiciliin that saved my buttocks, I now realize that, since our soldiers returned home from Europe and Asia when I had a pediatrician, we/I had already been dealing with bacterial antibiotic resistance. Fast forward to the early 1980's, when I was doing my PL-1 training, along with many of our readers. More pneumonia, sepsis, and meningitis than I've seen since. Children were dying (as were adults!). How did we treat these sick children? Ampicillin and Chloramphenicol if you recall! Why 2 antibiotics then? I didn't know enough then to ask, but just followed protocol. Maybe there was still antibiotic resistance. Maybe there was more! Who knows? Then came the broad spectrum cephalosporins. It made our lives, as well as our patients' lives much easier. Many of the soldiers I had the honor of serving with, whom I had treated for most of the same problems I had been seeing in my Pediatric practice, had been sick their "whole lives!" I have come to find that this is the case in many, if not most, of the "malingerers" (we all know them-we get sick of seeing them again and again!)that keep brining themselves and/or their children in for repeated office visits, always with the same complaints. A one time easily curable condition, if it doesn't resolve on its own, or if we FAIL to recognize and treat (I prefer to say cure) it, could potentially go on to become a chronic disease. Now, we have become overwhelmed in society with chronic diseases that are thrusting the cost of health care out of control. Maybe, much of what we're struggling with shouldn't be a surprise, maybe we're dealing with "iatrogenic" problems, and we should not blame our diets, chemicals or pollutants, but we should be blaming ourselves for leaving 1 out of 3 of our patients sick, "treating" them rather than "curing" them. Is it worse for a particular patient to get an antibiotic he/she might not need, or is it criminal to withhold a treatment that can help cure our patient? "To treat or not to treat" has always been the question!
Conflict of Interest:
None declared