An estimated 55 percent of antibiotics prescribed for children with respiratory illnesses aren't needed. However, Asian-American and Latino parents are much more likely than white and black ones to expect their doctors to prescribe the drugs for their children, according to new findings by Dr. Rita Mangione-Smith, a pediatrician at the University of California at Los Angeles.
"The [education] message just isn't being pitched in the right way to reach these communities," she says.Mangione-Smith's survey also found that doctors appear to make their decisions to write prescriptions based on what they perceive to be the wishes of parents.
Antibiotics only work against bacterial infections and have no impact on viruses, which commonly cause colds. For several years, U.S. health officials have sounded the alarm that overuse of antibiotics cause germs to mutate, making them more resistant to antibiotics.
As milder antibiotics fail, a sick child "may end up with a much stronger antibiotic that could have a lot more side effects," says Elissa Maas, vice president of community health with the California Medical Association Foundation.
From October 2000 to June 2001, doctors working with Mangione-Smith surveyed 570 Los Angeles-area parents who visited the doctors' offices because their children had colds or other respiratory illnesses.
According to the survey, 70 percent of all parents believed antibiotics were either definitely or probably necessary to treat their children. However, only 36 percent of the doctors thought the parents expected antibiotics to be prescribed. They were especially unaware of the expectations of Latino parents.
"This probably has to do with how parents from these different cultures communicate with doctors -- some may be more willing to say what they want than others," Mangione-Smith says.
Latino parents were 2.5 times more likely than white parents to expect antibiotics; Asian-American parents were 3.5 percent more likely.
Blacks in the survey were as likely to expect antibiotics as whites, suggesting the knowledge gap for certain minority groups may be related to their recent immigrant status, Mangione-Smith says.
"We need to do a lot of work to figure out how to make the message culturally appropriate for groups of parents who are not originally from this country, and may be coming from a completely different mind set," she says.
The doctors surveyed prescribed antibiotics 65 percent of the time if they perceived that parents expected them. That number dropped to 47 percent if they were uncertain about the parents' wishes. They only prescribed the drugs 12 percent of the time if they thought parents didn't expect them.
Other studies have reported similar findings concerning the wishes of doctors to make parents or patients happy when they ask for antibiotics.
The new survey results suggest education efforts need to focus on more than the "soccer moms" who were targets in the past, says Maas, of the California Medical Association Foundation, which has its own antibiotic education program.
"All of the research up until now has focused on the behaviors of more middle class, English-speaking people," she says. "Most people had not looked across cultures."
The Latino communities might be a special challenge because some antibiotics come unregulated across the Mexican border, and may be distributed to parents in underground pharmacies known as "botanicas," Maas says.
"The danger is if they expect it and don't get it from the doctor, they may get it somewhere else and no one knows," Maas says.
Mangione-Smith was to report her findings yesterday at the Pediatric Academic Societies' annual meeting in Baltimore.