I work hard (as do most doctors) to avoid prescribing antibiotics when unnecessary. The reason? I’m concerned about both the short term effects (diarrhea, rash, allergies) and long term effects (drug resistance, altered normal bacteria and microbes on our bodies) of antibiotic use in children. As we learn more about health and about the role of “good” bacteria in wellness preservation, I suspect we will feel more and more compelled to avoid antibiotics in children. Less is often more.
There are certain medical conditions that benefit greatly from antibiotics (Strep throat, pneumonia from bacteria, kidney infections, some severe skin infections, for example). Hands down, antibiotics save lives and prevent terrible infections when bacteria are to blame. But antibiotics are not without risk. And, we know that antibiotics do no good for children when viruses are the cause of the infection. The use of antibiotics when unnecessary, contributes to “unnecessary [health care] costs, avoidable adverse events, and the development of antibiotic-resistant infections” a study published today reminds.
The hard part for parents (and pediatricians) is knowing when bacteria are to blame and when they are not.
Because of that, antibiotics may be prescribed unnecessarily. Also, as I have said before, it’s a lot easier to prescribe Amoxicillin (the most commonly prescribed antibiotic in children) than it is to explain the rationale for not using it, the role of viruses in cough, sore throats, & colds, and the typically frustrating ongoing snot that is the reality for most children in the winter time . If only we had a better cure for the common cold! For the meantime, rest, time, humidifiers, and honey to suppress cough just never feel like powerful weapons to parents. Even though most of the time they really are. Children are remarkably good at clearing infections caused by the typical viruses that cause colds.
A study published this morning found that ongoing use of antibiotics for children in ambulatory clinics remains staggeringly high. Looking at data from 2006 to 2008, researchers found:
- Antibiotics were prescribed during 1 out of every 5 visits in ambulatory pediatric patients (with a pediatrician, family doc or nurse practitioner) for all types of acute care visits.
- 50% of the antibiotics prescribed were broad-spectrum (designed to treat a huge array of different species of bacteria, rather than just a select targeted few).
- 70% of the time antibiotics were prescribed in children, respiratory infections were to blame. However, by looking at the diagnostic codes used for the visits, researchers deduced that 23% of the time antibiotics were prescribed, they were not clearly indicated. Meaning it’s possible that 1 in 5 times antibiotics were given, it would have been better if they weren’t. A shortcoming of the study is that the researchers only used diagnostic codes (the name of the diagnosis the doctor assigned to the visit) and not full chart reviews. It’s possible that a peditrician could have coded a visit “sore throat” when in reality the test in the office was positive for Strep throat (requiring antibiotics for treatment).
- Projecting the results to our pediatric population at large, researchers concluded that prescribing of unnecessary antibiotics happens in over 10 million visits for children each year.
- They found that children were more likely to be given an antibiotic if a child was younger (under age 6), lived in the Southern parts of the US, and if they had private insurance.
Okay, so like you’ve heard before, antibiotics are often prescribed when they are unnecessary — most often for colds and cough. So what can you do to protect your child?
3 Tips For Improving Antibiotic Use:
- When a clinician offers an antibiotic for treatment at a clinic visit, ask why? Inquire if the antibiotic is a “broad spectrum” medication (does it treat a huge variety of bacteria). If it is, inquire if it would make sense to start with a more “narrow spectrum” antibiotic. Further, if the clinician starts your child on TWO antibiotics at once, inquire why. I see this pattern in practice often, and there may be other options for your child.
- When offered a antibiotic for your child, ask what other options exist? For example, even though antibiotics are indicated for ear infections, often when kids are over 2 years of age, we can avoid using antibiotics altogether by offering good pain control for the first 48 hours of the infection.
- Ask the clinician about taking concurrent probiotics or “good bacteria” while your child takes antibiotics for a presumed or laboratory-proven bacterial infection. There is good evidence that probiotics may help preserve the healthy bacteria in your child’s body and stave off side effects for your child in many cases.
Could it.be a spoonful of.regular honey from the supermarket or specifically the buckwheet honey, and where does one obtain that?
I think you hit the nail on the head when you mention how much easier it is to just give the script. I am an family medicine doc who still delivers babies and consequently still sees a lot of kiddos. I hate to admit it… but….. early in the day ( or week) when I have lots of energy to burn I am MUCH better about resisting the push for pills. But after 5 days of dirty glares and patient complaints…. sometimes I cave and give the z-pak, or amoxicillin. People will actually call the office and request to not have to pay because all I did was tell them they had a cold.
I would love to know how your conversations go about avoiding the antibiotics!
Thank you for addressing this very important topic. I’ve been wondering about the American (ab)use of antibiotics for a while and I think the issue is not so much the pediatrician or the parent but rather the healthcare system. When you have a co-pay for seeing a doctor and you feel a little blue, then you expect the doc to fix your problem(s). You paid for that, right? So if the doc just looks at you and doesn’t prescribe anything (because you have the flu, a cold or something similar) then you don’t feel like you were treated or maybe even taken seriously. However, if the doc had the time to explain and educate the patient maybe we could turn things around and people would stop seeing a doctor (or at least stop expecting a prescription for something) when all they have is the flu and an aching body. I’m not suggesting you shouldn’t go see the doctor unless you have broken bones or blood rushing out of your body, but I think that education and a much better healthcare system is the way forward.
Lastly, to the doc who posted above, thank you for being a doc, I know you work hard and you have busy and long days, but you must resist letting people go home with prescriptions they don’t need. You are most likely better educated on that topic than your patients so it’s your duty to inform the less informed about the use of antibiotics. Less is more! You tell them that too.
As a pediatrician I sometimes feel extremely pressured by both the parents and the fear of missing an infection. Until the laws change in favor of physicians, defensive medicine is going to flourish and prescribing antibiotics is a part of that.
Wendy Sue Swanson, MD says
I feel pressured to prescribe meds sometimes, too. All very cultural (wanting a “FIX” to a problem) I suppose. But I feel less of this pressure with antibiotics over the years, and I’m not sure why. I don’t know if it is my patient population that knows my philosophies and works hard to avoid unnecessary interventions as well or if the public is more and more aware of the risks of meds (when unnecessary).
Yet I think you bring up another issue and problem primary care. We need really good follow-up care and our systems don’t currently provide that. When our patient leaves the exam room, the visit is done, and sincerely it isn’t. Health/wellness and then illness reside over time and aren’t simply episodic, but rather ongoing. If for example we could check back in with patients daily until symptoms resolved (or didn’t resolve), we’d have an easier way to avoid interventions and still know that no bacterial infection remains. And when symptoms didn’t improve as expected or desired, it would be more logical to intervene and prescribe. Problem is, our current system leaves no time for this close of follow up. Soon, I hope, we will have better and better models to keep care ongoing when our patients walk out of the office and it will be included (and compensated) in standard care.
As a parent of an almost 2-year-old, this hits home for me. My daughter had back-to-back ear infections last year starting at 9-months old. She had 6 courses of antibiotics in 5 months. Her pediatrician and I talked about the antibiotic use, but also the fact that she needed them. My daughter ended up with tubes last spring. This fall, after a cold and then 6 weeks of night time coughing, she was diagnosed with a sinus infection and due to the length of time it had been ongoing, was given antibiotics which did clear things up. For those of us with small children who have had a lot of antibitoics that were needed, what is the risk for her down the road? It is concerning to me, but I also realize there are times when antibiotics are needed–seems like a fine line at times. However, due to all the superbugs out there, each antibitoic that is given makes me nervous.
I am a mother of a 16 month old and I am concerned about the amount of times I have had to turn down the antibiotic prescriptions. Antibiotics I feel are prescribed as a quick fix to get me out the door and the next patient in.
The health of millions of children is at stake here for Drs laziness.
As I watch the kids around my son become sicker and sicker and when I ask the mothers the question “Have they had antibiotics recently? ” the answer is always yes.
We need to stop! My son has tackled each illness including a UTI naturally. He is almost never sick and he recovers from any sickness very quickly. I give him plenty of fermented vege and drink. Probiotics and healthy organic fruit and vege.
Ask ourselves what did we do before the over use of antibiotics?
Colloidal silver and food grade hydrogen peroxide (found in human breast milk) were the answer. These natural ‘antibiotics’ are completely safe for our good bacteria and help illiminate bad bacteria.
We need to remember that antibiotics were invented by big pharma as a money making medication. Hydrogen peroxide and coloidal silver could not be patented. Antibiotics could. Don’t believe me?…. Do your own research please. For the sake of your children for the sake of your health.
Pls my son’s! Een having chesty cough due cold and respiratory infection. He’s been given antibiotics twice ( back to back) now the cough and running nose keeps coming back. My husband insisted I get another Antibiotics which am not comfortable with. What can I do