Antibiotics can be used as life-saving therapies, but many experts believe they are prescribed more frequently than they should be. This practice puts individuals at risk of dangerous side effects and exposes the public to drug-resistant bacteria.
To better understand how antibiotics should be prescribed, Dr. Matthew Kronman, an infectious disease expert at Seattle Children’s Hospital and a member of Seattle Children’s Research Institute’s Center for Clinical and Translational Research, led a study published today by the American Academy of Pediatrics, addressing how antibiotics are used to treat common respiratory infections. He discovered there are approximately 11.4 million unnecessary antibiotic prescriptions written to children and teens each year in the United States.
We asked Kronman the following questions to learn more about the overprescribing of antibiotics and his recently published research:
Why aren’t antibiotics appropriate to treat all respiratory infections?
Kronman: Respiratory infections are one of the most common reasons children and adolescents receive prescriptions for antibiotics, but not all of these illnesses benefit from antibiotic use. Antibiotics are only effective in treating bacterial infections. Many respiratory infections are viral, and therefore, not helped by antibiotics.
Why are you concerned about unnecessary antibiotic prescriptions?
Kronman: Overprescribing antibiotics affects both individuals and society as a whole. Each time a person is prescribed an antibiotic they risk having a severe reaction to the medicine. These reactions bring approximately 30,000 visitors to emergency rooms across the country every year. Antibiotics can also cause diarrhea or clostridium difficile colitis (C. diff), and early childhood exposure has even been associated with the development of asthma and Crohn’s disease.
People who take antibiotics are also more likely to have future infections caused by resistant bacteria, which are harder to treat and may lead to hospitalization. The more these resistant bacteria circulate in our society, the more these strains could be passed from person to person, resulting in infections caused by resistant bacteria even in those without antibiotic exposure.
While doctors are aware of these concerns, antibiotic prescription rates have not decreased in the past decade. If we continue to overuse these medicines, we are going to find ourselves in the same boat as we were in before antibiotics were invented – with deadly infections we cannot treat.
How often are clinicians prescribing antibiotics?
Kronman: In our study, antibiotics were prescribed in more than half of all respiratory infection cases – 57% – but only 27% of these infections appear to be caused by bacteria. Thus, more than half of the time antibiotics were prescribed unnecessarily.
What do you think is causing the over prescribing?
Kronman: There are likely many factors contributing to this overprescribing. At times, clinicians do not have the tools necessary to distinguish viral from bacterial illnesses, with the exception of the rapid strep test for strep throat. We desperately need easy, tests that can be performed right in the exam room to determine when a patient has a bacterial infection if we are going to prescribe antibiotics more effectively.
Additionally, parents may pressure clinicians to prescribe antibiotics, or clinicians may assume parents want them to prescribe antibiotics. When doctors have limited time to see each patient, it can be easier to give parents the prescription they want than to educate them on the proper use of these drugs.
Are antibiotics more likely to be unnecessarily prescribed for certain infections?
Kronman: We looked at five different types of respiratory infection – ear infection, sore throat, sinusitis, bronchitis and upper respiratory infection. It’s widely understood that upper respiratory infections are almost always caused by viruses and these patients rarely benefit from being treated with antibiotics, and yet, clinicians prescribed antibiotics to 24% of the cases we looked at. Bronchitis is also rarely caused by bacteria in children, yet 71% of these patients were prescribed antibiotics.
What can clinicians do to avoid overprescribing antibiotics?
Kronman: This study demonstrates that far fewer respiratory infections are caused by bacterial infections than clinicians may think, meaning most of these infections do not benefit from antibiotics. That is a major factor to weigh in clinical decision-making about whether or not to prescribe antibiotics for respiratory infections, with the goal of reducing antibiotic prescriptions overall.
What should parents and families consider when seeking antibiotics for their child?
Kronman: Parents should remember that antibiotics are not always necessary to treat a cold, a sore throat or an ear infection. It’s okay to question your provider if they prescribe antibiotics and to consider whether your child can recover without them.
Antibiotics hold awesome power but we need to use them more selectively.
Resources:
- Antibiotics: When Do They Help?
- Antimicrobial Stewardship at Seattle Children’s Hospital: Progress in Protecting Patients
- CDC: Antibiotic / Antimicrobial Resistance
- CDC: Know When Antibiotics Work
- Seattle Children’s Research Institute’s Center for Clinical and Translational Research
