Departments
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Week of 5 September 1997 |
Vol. I, No. 2 |
Feature Article
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BU pediatrician investigates Are parents giving children too many antibiotics?by Marion Sawey Bacterial resistance to antibiotics could be increasing in part because the drugs are being overadministered to children, according to research by Howard Bauchner, associate professor of pediatrics at Boston University School of Medicine. A recent survey of parents and pediatricians carried out by Bauchner and former colleague Diane Palmer, now a pediatrician at Mass General Hospital, found that one in five parents admitted giving antibiotics to their children without informing or consulting their doctor. In interviews with 400 parents, the researchers also discovered that parents were often not aware that antibiotics are appropriate only for the treatment of bacterial, as opposed to viral, infections. The survey further found that pediatricians felt some pressure from parents to prescribe antibiotics. "It is a little worrying that about one-third of the physicians surveyed acknowledged that they do prescribe antibiotics at least occasionally when they are not appropriate.
The concern is that overprescription is at least part of the cause behind the rising resistance to antibiotics of the bacteria pneumococcus, the leading bacterial cause of ear infections, pneumonia, and meningitis among children. The scale of the problem, Bauchner says, is underlined by the enormous growth in antibiotics prescriptions written for children, particularly for ear infections, which reached 30 million in 1996, an increase of 150 percent since 1982. "We still don't know if the reason for that jump is an increase in real disease, improved access to day care, which exposes children to more infection, or unwarranted antibiotic use. Investigating the third of these factors, our research was the first in which parents and doctors were interviewed to see if what has long been suspected -- that parents have misconceptions about antibiotics and pressure doctors to prescribe them -- is true." Three messages for parents emerge as a result of the research findings, he says. "First, they should recognize that there is a difference between bacterial and viral infections and that antibiotics should be used only in the treatment of bacterial disease. Most childhood infections are, in fact, viral, with the exception of ear infections. "Second, when parents are done with an antibiotic, they should throw it out. In that way they are not tempted to use it when they think their child is first becoming ill. "Third, as it can be hard for parents to tell the difference between bacterial and viral infections, they should take an ill child to see their physician. If the child turns out to have a viral infection, they should not put pressure on the doctor to prescribe an antibiotic." Reeducating the public as to the correct use of antibiotics will not be easy, Baucher admits. "Part of the difficulty is that when they are appropriate, antibiotics can be lifesaving. We spent 20 years touting the benefits of antibiotics, and clearly they were critical in promoting the health of Americans. On the other hand, I think we are now recognizing that we need to be more reasonable, more targeted in our use of the drugs." Physicians, too, need to be aware of the problems of overprescription, he says. "Most hospitals now have a much more restrictive use of antibiotics, guided by infectious disease experts who try to target the antibiotic to the bacterial illness. However, this is much harder to achieve in the outpatient setting, where we are relying on physicians alone to understand the need to use narrow-spectrum antibiotics and then only when indicated." The survey points out that in a busy practice or emergency room it is less time-consuming for a doctor to write a prescription than to engage in a lengthy discussion with parents about the natural history of an upper-respiratory infection, diarrhea, or sore throat. However, Bauchner's research points to signs that some parents are beginning to question the use of antibiotics. "Bacterial resistance has been widely discussed in the press, and many parents are becoming knowledgeable about the issue of resistance," he writes in the survey. "Forty percent of parents in this study had read an article about antibiotics. It may be possible to tap into growing parental concern by educating parents about appropriate indications and the risks and benefits of antibiotics. If parents can better understand the role of antibiotics in the treatment of disease, they may exert less pressure on physicians to dispense antibiotics inappropriately." As a step in the education process, Bauchner is currently developing for distribution nationwide an interactive video for parents on the subject of antibiotics. His survey with Palmer, which involved 400 parents and 61 pediatricians in Massachusetts, was published in Pediatrics, the journal of the American Academy of Pediatrics, in June. |
