TUESDAY, March 19 (HealthDay News) -- Black children are less
likely than other children to be given antibiotics and less likely
to be given the most powerful antibiotics to treat acute
respiratory tract infections, new research suggests.
Does this represent a previously unrecognized bias against black
children? Probably not, said the researchers and other experts.
Instead, it's more likely that non-black children are getting more
antibiotics than they should be.
"We hypothesize that this discrepancy reflects over-prescribing, both for all antibiotics and for the relative proportion of broad-spectrum antibiotics, to non-black patients, rather than under-prescribing to black patients," wrote the researchers led by Dr. Jeffrey Gerber, of the Children's Hospital of Philadelphia, who added that more study of this pattern should be conducted.
Dr. Allison Bartlett, a pediatric infectious disease specialist
at LaRabida Children's Hospital in Chicago, agreed. "The fact that
black kids are given fewer antibiotics and fewer broad-spectrum
antibiotics may come across as a bad thing to the casual reader,
but perhaps it's not an issue of under-treating black kids, but
over-treating non-black kids," she said.
Another expert who was not involved with the study, Dr. Roya
Samuels, a pediatrician at Cohen Children's Medical Center in New
Hyde Park, N.Y., said that, at first glance, "this comes across as
quite a controversial topic. But, I don't think we're dealing with
a predilection to not prescribing to black children. Rather, there
is still non-judicious use of antibiotics in the pediatric
population as a whole, and non-judicious use tends to occur more in
the non-black population."
Results of the current study were released online March 18 and
will appear in the April print issue of
Gerber and colleagues undertook the study because racial
disparities have been found in other areas of health care, but the
issue hadn't been thoroughly studied in a pediatric primary care
setting, according to background information in the report.
The study included data from 25 primary care pediatric practices
in Pennsylvania and New Jersey. The practices had a total of 222
From a total of more than 600,000 office visits, the
investigators found that there were more than 100,000 visits that
included a prescription for an antibiotic. To help account for
factors that might influence the way a physician chose to treat a
particular patient, the researchers excluded visits for people with
antibiotic allergies and those who'd had a recent history of
antibiotic use from their data.
That left just over 81,000 visits that ended with an antibiotic
prescription. Almost 30,000 of those visits ended with a
prescription for a broad-spectrum antibiotic, which means a
powerful antibiotic that kills a variety of bacteria. In general,
antibiotic use recommendations suggest using the most
narrow-spectrum antibiotic possible to help prevent antibiotic
When the researchers broke the data down by race, they found
that 29 percent of visits by non-black children ended with an
antibiotic prescription compared to 23.5 percent for black
children. When an antibiotic was prescribed, black children were
about 12 percent less likely to receive broad-spectrum
Black children were also less likely to receive a diagnosis that
might justify an antibiotic prescription, such as strep throat, a
sinus infection or an ear infection. Both Bartlett and Samuels said
that they were a bit confused by the strep throat findings, as an
objective test is available to diagnose strep. The study authors
said they were not aware of any biological reasons that could
account for these findings. All of the experts suggested this was
an area that needed further research.
The authors said that the doctor-patient relationship may play a
role in some of these findings. Parents of non-black children may
state that they expect antibiotics more often, or doctors may
expect that these parents will want antibiotics for their child,
which may influence their prescribing decisions, they
Both Samuels and Bartlett said that black parents probably don't
need to be concerned by these findings. But, Bartlett added that
all parents should "be strong advocates for their children. We're
very fortunate that we have antibiotics to help when we need them,
but there are a lot of times we don't need them, and we need to
give a child's body time to heal on its own."
It's OK to ask your child's doctor why he or she is prescribing
an antibiotic, or why not, according to Samuels.
"Physicians are your partners," said Samuels. "They're healers and teachers, and parents need to understand the thinking behind a clinical decision. Parents also need to know that every medication can potentially cause an allergic reaction and every medication can have adverse effects. Antibiotics need to be prescribed with great care and thought," she said.
Learn more about appropriate antibiotic use from the
for Disease Control and Prevention.
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