Overuse of Antibiotics in Children

Antibiotics are one of the most commonly prescribed medication classes for children in the U.S. today. Unfortunately, millions of these prescriptions are unnecessary, given for viral illnesses for which they provide no benefit and end up doing more harm than good, according to a study published in the December 2011 issue of the journal Pediatrics.

Researchers examined national data from outpatient clinics and centers collected between 2006 and 2008 and found that antibiotics were prescribed in 49 million pediatric clinic visits every year, or more than 1 in 5 visits overall. Of these prescriptions, half were for broad-spectrum antibiotics, powerful drugs that are more likely to cause adverse events and promote antibiotic resistance — and usually reserved as second-line therapies.

The most concerning finding, however, was that at least 10 million of these antibiotic prescriptions (1 in 5) were completely unnecessary. Most were for viral respiratory infections (the common cold and the flu), against which antibiotics are useless, with almost 30 percent of children having symptoms of these conditions receiving the drugs.

One reason for this overuse, according to study leader Dr. Adam Hersh of the University of Utah in Salt Lake City, is an unclear diagnosis in many childhood diseases such as respiratory and ear infections. This prompts doctors to err “on the safe side” and prescribe therapies they know may not help.

But as Dr. Hersh and others observed, choosing to give antibiotics is not always the safe option. When given needlessly, these drugs can eliminate most of the body’s normal, “good” bacteria, such as those in the colon, increasing the risk of serious infections and other adverse events, as noted by Betsy Foxman, an epidemiologist from the University of Michigan School of Public Health not involved with the discussed study. “We think of antibiotics as being wholly beneficial, but they are not very specific[;] they hit everything in your body. By making our microbes that are supposed to be with us disappear, we can be causing other health problems we don’t know about,” she said.

From a public health standpoint, in addition to increasing health care costs, such inappropriate widespread use of antibiotics contributes to the proliferation of antibiotic-resistant bacteria, or “superbugs.” These organisms are resistant to many of the antibiotics on the market and are increasingly outpacing the development of effective treatments to combat them, putting all patients — children and adults alike — at risk in the future.

Dr. Hersh said one way to avoid overprescription might be simply to wait for several days and check the child again. “If the diagnosis is still a little unclear, ask if it would be safe to wait a day or two with close follow up rather than starting the antibiotic right away.” If an antibiotic is justified, the one with the narrowest spectrum of activity needed to treat the infection should be prescribed.