Division of General Pediatrics Pediatric Research

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Q&A: Keeping pediatric antibiotic prescription practices in check

Prescribing antibiotics judiciously, especially in children, is becoming “universally embraced as a virtue by clinicians.” So wrote Jonathan A. Finkelstein, MD, MPH, in his editorial in theJournal of the American Medical Associationlast month. Pediatric Dose asked Finkelstein a few questions about ongoing research in this field and its importance to the practice of pediatric care.

What is the goal of judicious antibiotic prescribing?

The goal is to avoid antibiotics when no clear benefit exists and to use agents that best balance the benefits and risks to the individual as well as population-level effects such as promotion of antibiotic resistance.

A recent analysis in JAMA assessed an intervention to improve prescribing for pediatric patients with acute respiratory tract infections [ARTIs]. What did Gerber et al evaluate and find?

The intervention included a one-hour physician education session based on current guidelines and audit and feedback of practice- and clinician-level prescribing rates in a network of 18 pediatric practices involving 162 clinicians. Gerber et al reported a 6.7 percent absolute decrease in the proportion of patients prescribed broad-spectrum agents in the intervention practices compared with control practices.

Do these findings represent wider spread efforts as well?

Studies like this one build upon more than 20 years of work by public health authorities, the American Academy of Pediatrics and other researchers to reduce unnecessary antibiotic prescribing in pediatric practices—the efforts of which have been remarkably successful. The decline in antibiotic use for young children with ARTIs of 25-35 percent over a decade represents a remarkable shift in clinical practice. These results reflect the willingness of pediatricians to prescribe more judiciously and the willingness of parents to understand when antibiotics are truly necessary.

Do the trends continue to point down?

Antibiotic use for children, overall, appears to be stabilizing near current rates. Unfortunately, there is some evidence to suggest the use of broad-spectrum agents is starting to increase, particularly broad-spectrum macrolides and third-generation cephalosporins. Neither of those is recommended first-line agents for common respiratory tract infections in children. If use of these agents continues to grow, then we’re likely to see increasing resistance. Parents may prefer these agents because they are given less frequently, even though they aren’t always necessarily helpful for children.

How have pediatricians contributed to the trends?

The major uses of antibiotics in children are for common illnesses and infections, such as otitis media and sinusitis. We’ve made incredible progress by refining the criteria we use to diagnose these conditions. As pediatricians, we have changed our thresholds for diagnosis, which has gone a long way toward changing antibiotic use for the better. Continuing to use standard criteria for diagnosis and treating pediatric patients with an antibiotic only when necessary is our best defense against the continuing threat of antibiotic resistance.
 

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