MONDAY, Nov. 18, 2013 (HealthDay News) -- American children get
too many unnecessary antibiotic prescriptions for upper respiratory
infections, a medical group says. Now the organization is urging
both providers and parents to take steps to ensure that antibiotics
are used only when truly needed.
More than one in five pediatric office visits results in an
antibiotic prescription, according to the authors of a new report
from the American Academy of Pediatrics (AAP). And about 10 million
antibiotic prescriptions are written every year for upper
respiratory infections that likely won't improve from antibiotic
In addition, physicians often prescribe broad-spectrum
antibiotics. These are medications that can kill a wide variety of
bacteria, rather than narrow-spectrum drugs that target certain
types of bacteria. Narrow-spectrum drugs generally are preferred so
bacteria don't become resistant to broad-spectrum drugs that may be
needed to battle more serious infections.
"Our primary goal is the best outcome for a child," said lead report author Dr. Mary Anne Jackson, a member of the AAP committee on infectious diseases. "The best treatment for a child doesn't always include an antibiotic."
Although some progress has been made in reducing the amount of
unnecessary antibiotic use, it's still a problem, said Jackson,
division director of infectious disease at Children's Mercy
Hospitals and Clinics, in Kansas City, Mo.
Unnecessary antibiotic use puts children at risk of side effects
or a potential allergy to the medications, and increases the risk
of antibiotic resistance, Jackson said.
The new report details the appropriate times to prescribe
antibiotics for upper respiratory infections, which includes sinus
infections, ear infections and strep throat.
"This clinical report from the AAP, done in conjunction with the U.S. Centers for Disease Control and Prevention, looks specifically at upper respiratory infections, because these are a common area where antibiotics are used injudiciously," Jackson said.
According to the report, however, upper respiratory infections
are also an area where it can be difficult to distinguish whether
the cause is viral or bacterial. Antibiotics won't be helpful if an
upper respiratory infection is caused by a virus.
"[The report recommends] using stringent clinical criteria to establish the diagnosis before prescribing antibiotics," Jackson said.
For example, in the past, many children were routinely given
antibiotics if they had fluid in their ear. But fluid in the ear is
common, Jackson said, and on its own doesn't require antibiotics.
The new report recommends looking in the ear to see if the eardrum
is bulging significantly, and assessing how much pain a child is
having before considering antibiotics. If the eardrum shows
moderate or severe bulging, or if it's mildly bulging and the child
is in pain, antibiotics might be useful.
Strep throat is another common childhood infection that can lead
to an overprescription of antibiotics. The new report recommends
that doctors don't test for strep throat unless a child is showing
two or more symptoms of infection. About 15 percent to 20 percent
of children are carriers of strep, and will test positive for the
bug even when they don't have an active infection.
Another significant concern is the use of inappropriate
antibiotics for certain infections. Amoxicillin is a good first
treatment for ear infections, sinus infections and strep throat.
Penicillin also is a good first-line treatment for strep throat,
according to the report. Broad-spectrum antibiotics aren't
necessary, and have the potential to cause more side effects.
Jackson said azithromycin often is prescribed for ear and sinus
infections, but it's not an effective antibiotic to treat the
bacteria that cause those infections.
One pediatric expert praised the new report.
"While there are no absolutes in medicine, this report has a lot of ideas and concepts that, if applied, will decrease the use of unnecessary antibiotics," said Dr. Kenneth Bromberg, chairman of pediatrics and director of the Vaccine Research Center at the Brooklyn Hospital Center, in New York City.
Bromberg said some patients may be more likely to adopt a
wait-and-see approach to taking antibiotics for an infection, such
as those who have a medical home. This means they have a
primary-care physician with whom they have an ongoing
On the other hand, Bromberg said, people who rely on urgent-care
facilities may be less willing to see if an infection starts to get
better on its own, because of the time or cost involved in having
to return for care a second time if an infection doesn't
The new report and recommendations were released online Nov. 18
and in the December print issue of the journal
Learn more about when antibiotics are needed and when they're
not from the
U.S. Centers for Disease Control and
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