Despite long-standing recognition by clinicians and the public, the problem of inappropriate antibiotic prescribing is, unfortunately, persistent. Inappropriate antibiotic prescribing not only harms our communities by contributing to the spread of antibiotic-resistant infections, but it also directly harms patients by leading to adverse drug events, unnecessary costs, and serious complications, such as Clostridium difficile colitis. Inappropriate antibiotic prescribing encompasses several domains (Table 1). The most important is unnecessary antibiotic prescribing (or overuse), which refers to prescribing an antibiotic when it is not indicated (eg, for a viral infection). At least 30% of all antibiotics prescribed in outpatient settings in the United States are considered unnecessary; this estimate rises to 50% for respiratory tract infections, which collectively are responsible for the largest number of antibiotic prescriptions overall.1 But there are several other important types of inappropriate antibiotic prescribing, including prescribing for an unnecessarily prolonged duration, selecting an unnecessarily...
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April 2017
Commentary|
April 01 2017
Inappropriate Antibiotic Prescribing: Wind at Our Backs or Flapping in the Breeze?
Adam L. Hersh, MD;
aDivision of Infectious Diseases, Department of Pediatrics, University of Utah, Salt Lake City, Utah; and
Address correspondence to Adam L. Hersh, MD, PhD, Division of Infectious Diseases, Department of Pediatrics, University of Utah, 295 Chipeta Way, Salt Lake City, UT 84108. E-mail: adam.hersh@hsc.utah.edu
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Matthew P. Kronman, MD
Matthew P. Kronman, MD
bDivision of Infectious Disease, Department of Pediatrics, University of Washington, Seattle, Washington
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Address correspondence to Adam L. Hersh, MD, PhD, Division of Infectious Diseases, Department of Pediatrics, University of Utah, 295 Chipeta Way, Salt Lake City, UT 84108. E-mail: adam.hersh@hsc.utah.edu
POTENTIAL CONFLICT OF INTEREST: The authors have indicated they have no potential conflicts of interest to disclose.
FINANCIAL DISCLOSURE: The authors have indicated they have no financial relationships relevant to this article to disclose.
Pediatrics (2017) 139 (4): e20170027.
Article history
Accepted:
January 05 2017
Citation
Adam L. Hersh, Matthew P. Kronman; Inappropriate Antibiotic Prescribing: Wind at Our Backs or Flapping in the Breeze?. Pediatrics April 2017; 139 (4): e20170027. 10.1542/peds.2017-0027
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My concern as a 'veteran' general pediatrician is witnessing the inappropriate prescribing of antibiotics, with little attention being paid to AAP guidelines on issues like otitis media and community-acquired respiratory infections. It seems to philosophically boil down to the question of individual decision-making by the health provider versus what is in the best interest of the public. As a reflective piece, the practitioner and trainee need to think about not only is this really evidence-based treatment for this particular patient, but also what is best in the context of the public well-being. Regarding otitis media. not only do I see practitioners and residents treating children over the age of two years with antibiotics versus medications for pain and low-grade fever as recommended by the AAP, I see antibiotic treatment prescribed for a red tympanic membrane where the diagnosis of otitis media is not even accurate. Another area of concern is use of antibiotics when a respiratory illness doesn't resolve quickly enough for the parents' expectations, sometimes pushing the pediatrician to prescribe a Z-pack without evidence of any bacterial involvement. Until we ingrain in trainees that when treating patients they need to think about the impact of their treatment regimens not only on their own patients but also on the overall population , we are not going to resolve this gap in the overuse of antibiotics..
There was a period of time in my career in general pediatrics that judicious antibiotic use was one of the top goals for pediatric medicine. This is no longer the situation. With the advent and proliferation of walk-in clinics and telemedicine services that provide care for children, the medical community has abandoned antibiotic stewardship. It is actually very difficult to determine exactly when it is safe to withhold antibiotic treatment in a febrile child. It is much easier and maybe safer to over treat children with antibiotics if the medical provider lacks the clinical experience and judgement required to make the most accurate medical assessment. The idea that these after hours care facilities will improve and decrease the inappropriate use of antibiotics seems unrealistic and the medical community as a whole should become more accustomed to the ever increasing misuse of antibiotics.