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Antibiotic Overuse in Retreat

Drug-resistant germs still a major menace, experts say

TUESDAY, June 18, 2002 (HealthDayNews) -- Pediatricians are prescribing fewer antibiotics for a handful of common childhood respiratory infections than they were a decade ago.

So says a new study, which suggests messages about drug-resistant germs are sinking in with both physicians and parents.

The number of antibiotic prescriptions for children under 15 fell from 46 million in 1989 to 30 million in 2000, the study found. Prescriptions per 1,000 patients fell by 40 percent between 1989 and 2000. The rate for prescriptions per 1,000 doctor visits -- a better gauge of physician behavior -- dropped by nearly 30 percent during the same interval.

Prescriptions to combat ear infections, sinusitis, bronchitis, sore throat and upper airway ailments also showed sharp declines. Orders per 1,000 children were off 43 percent during the period, and down 14 percent for every 1,000 visits to the doctor.

Although the incidence of the five diseases fell by about a third during the 1990s, the researchers said the downward trend in antibiotic use was real.

Despite the drop, the rate is "still probably too high," says Linda McCaig, a statistician at the National Center for Health Statistics and lead author of the study.

After all, McCaig says, the study showed many doctors still order antibiotics such as penicillin and erythromycin for the common cold, a viral condition that doesn't respond to bug-killing drugs. Similarly, the per-visit prescription rate for bronchitis didn't fall, either, though this illness often has viral roots, she adds.

The study found population-level declines in prescriptions for every ailment but sinusitis, which stayed steady. On a per-visit basis, drops occurred for throat inflammation and upper respiratory infections, but not for ear infections or bronchitis.

A report on the findings appears in tomorrow's issue of the Journal of the American Medical Association.

Experts estimate that as many as half of all prescriptions for childhood respiratory ailments are unnecessary.

A 1999 study by scientists at Boston University School of Medicine found that prescriptions for amoxicillin to treat ear infections soared from 4.2 million in 1980 to 12.3 million in 1992, a jump of nearly 200 percent.

The same study also found that ear infection orders for cephalosporins, a family of popular antibiotics, rose from 867,000 to 6.8 million, or 687 percent, over the same period. More than half the doctors in the study attributed drug overuse to pressure from parents.

Though generally not harmful, the superfluous drugs have led to hardier strains of germs, which now tolerate many formerly potent antibiotics.

Over the past decade, the threat of drug-resistant microbes has spurred public health experts to urge physicians to eschew antibiotics whenever possible. They have also brought a similar plea to the public and especially parents of young children, who have a high rate of antibiotic use.

In an unrelated study also appearing in the journal, researchers in Tennessee showed they could reduce pediatric antibiotic use significantly with a relatively simple intervention targeting local doctors, parents and the public.

The researchers credited the program, which used physician-to-physician presentations and simple, printed materials distributed in four counties, with an 11 percent drop in prescriptions for antibiotics over three years. Most were presumably unnecessary. The program was most effective for children aged 1 to 5, and among blacks.

Yet even as the use of antibiotics for respiratory diseases has fallen, antibiotic resistance is on the rise.

Dr. Michael Pichichero, of the University of Rochester, says it could be years or perhaps decades before reductions in prescriptions for antibiotics translate into less resistance among germs.

Yet Pichichero, author of an editorial accompanying the journal articles, cautions that the apparent decreases in prescriptions in the two studies might overstate the true decline.

Pichichero blamed antibiotic overuse on the combination of three forces: parental pressure, doctors' desires to prevent serious bacterial infections that sometimes lurk behind viral illnesses, and a malpractice system that exploits the first while punishing failures to catch the second.

To correct the problem, Pichichero advised doctors to have more patience with their patients. The vast majority of respiratory infections, including those caused by bacteria, get better in a week or so without treatment. So, the first step for both doctors and parents should be to hold off on the drugs for signs of improvement.

"As long as the physician remains available for follow-up, and provides symptom relief, this would be the proper way to proceed," he says.

What To Do

For an overview of drug-resistant bugs, check out the U.S. Food and Drug Administration. You can also learn more about overuse of antibiotics in children by visiting the American Academy of Pediatrics.

SOURCES: Linda F. McCaig, M.P.H., survey statistician, National Center for Health Statistics, Hyattsville, Md.; Michael E. Pichichero, M.D., professor, pediatrics, medicine and microbiology/immunology, University of Rochester School of Medicine, Rochester, N.Y.; June 19, 2002, Journal of the American Medical Association
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