Oral Antibiotic Use in Children: Some Very Good News

Journal Watch. 2002;1(3) 

Summary

Promoting the appropriate use of oral antibiotics has been a major theme in child health care during the past decade. In 2 recent studies, investigators examined changes in antibiotic prescribing habits.

Using survey data from office-based physicians, CDC researchers noted a dramatic reduction in oral antibiotic prescribing to children (age, <15 years) from 1989 through 2000. Overall, antibiotic prescriptions per 1000 children decreased significantly, from 838 prescriptions in 1989-1990 to 503 in 1999-2000. The visit-based prescribing rate also decreased significantly, from 330 to 234 prescriptions per 1000 visits. The greatest decline in visit-based prescriptions was seen in visits for upper respiratory infections.

Investigators also evaluated the effectiveness of a year-long, community-wide, educational program (including lectures and printed materials for providers, printed material for parents, and public-service announcements) in Knox County, Tennessee. One year after the intervention, antibiotic prescription rates among children who received Medicaid had declined 19% in Knox County compared with 8% in 3 control counties -- a significant difference. The greatest decline was seen among prescriptions for 1- to 5-year-olds. No reductions were found in bacterial resistance rates among Streptococcus pneumoniae isolates.

These gratifying data suggest that antibiotic prescription rates are decreasing dramatically and that community-wide educational efforts might help to bring about such reductions. Whether reductions in antibiotic use result in changes in bacterial resistance patterns remains less certain. However, more appropriate prescribing should help to delay the emergence of resistance to new antibiotics, while reducing health care expenditures and the incidence of drug side effects.

— Howard Bauchner, MD

McCaig LF et al. Trends in antimicrobial prescribing rates for children and adolescents. JAMA 2002 Jun 19; 287:3096-102.

Perz JF et al. Changes in antibiotic prescribing for children after a community-wide campaign. JAMA 2002 Jun 19; 287:3103-9.

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