Pediatricians Urged to Prescribe Antibiotics Carefully

More than 1 in 5 pediatrician visits result in an antibiotic prescription, and a new report urges prescribers to carefully consider whether these prescriptions are warranted.

According to a new report released by the American Academy of Pediatrics (AAP) and the Centers for Disease Control and Prevention, prescribers and parents should think twice before using antibiotics to treat upper respiratory tract infections in children.

Despite the fact that antibiotics increase the risk for adverse effects, increase medical costs, and contribute to antibiotic resistance, more than 1 in 5 pediatrician visits still results in an antibiotic prescription. Many of these prescriptions are given to children with upper respiratory tract infections, even though most such infections are viral and do not require antibiotics. To reduce the amount of antibiotics given to children for common upper respiratory tract infections, the new report, published online in Pediatrics on November 18, 2013, presents strategies for appropriate antibiotic prescribing for acute otitis media, acute bacterial sinusitis, and streptococcal pharyngitis.

Before antibiotics are prescribed for these infections, the report suggests that clinicians first determine whether the infection is bacterial or viral. Doing so can be difficult as symptoms are often similar, but strict criteria should be applied to ensure appropriate antibiotic use. For acute otitis media, the AAP recommends antibiotic use if a child has severe eardrum bulging or mild eardrum bulging accompanied by pain. Younger children with bilateral infections and more severe symptoms are also more likely to benefit from antibiotics. Bacterial sinusitis should be diagnosed in children who present with persistent, worsening, and severe upper respiratory tract infections. In children with sore throat, physicians should determine whether symptoms are caused by group A Streptococcus before prescribing antibiotics. However, only children with 2 or more symptoms should be tested for Strep throat, as 15% to 20% of children are carriers of the infection and will test positive even if they do not have an active infection.

If a bacterial infection is determined to be likely, the report suggests that prescribers next weigh the benefits and potential risks of antibiotics. Benefits can include increased cure rate, symptom reduction, and prevention of complications and infection spread. Potential harms include drug-related adverse events, increased risk of Clostridium difficile colitis, antibiotic resistance, and the cost of the drug.

When a physician determines that the benefits of antibiotic therapy outweigh the risks, the report recommends that narrow-spectrum drugs be used at an appropriate dose for the shortest possible duration. The recommendations also suggest that a wait-and-see approach, in which clinicians observe children for worsening symptoms before initiating antibiotic use, may be appropriate for children with less severe symptoms.

Although the report is primarily focused on antibiotic use in children with upper respiratory tract infections, the authors conclude that the recommendations can be used to improve antibiotic prescribing more generally. “These principles can be used to promote educational efforts for physicians, amplify the messages from recent clinical guidelines, assist with communication about appropriate antibiotic use to patients and families, and support local guideline development for judicious antibiotic use,” they write.