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:

  1.  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.
  2. 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.
  3. 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.