Antibiotic Overuse in Kids: Lessons Learned

Theoklis E. Zaoutis, MD, MSCE


August 18, 2014

Editorial Collaboration

Medscape &

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Hello. My name is Theo Zaoutis. I'm Chief of Infectious Diseases at The Children's Hospital of Philadelphia. I am here today to discuss antibiotic use as specifically related to a recent survey that was conducted by WebMD and Medscape in cooperation with the Centers for Disease Control and Prevention (CDC).

As we all recognize, antibiotics are the most commonly used medication in children in the outpatient setting. Although antibiotics have been a major breakthrough in promoting and securing the health of children, antibiotics have significant downsides. We all recognize that antibiotic resistance is a major problem right now, as indicated by both the CDC and the World Health Organization. The implications of antibiotic resistance are that we are losing antibiotics that are able to treat common infections in children.

Besides antibiotic resistance, antibiotics are associated with significant side effects: rashes, diarrhea, Clostridium difficile infection, and, more recently, an evolving literature that suggests that antibiotics alter the normal bacteria that are part of our gastrointestinal tract, the so-called microbiome, leading to consequences downstream such as autoimmune disease, allergies, asthma, and potentially obesity.

The survey specifically asks several questions that I will discuss. The first: Do pediatricians prescribe antibiotics when they're not necessary? What was very interesting and startling was that more than 50% of the time, pediatricians prescribe antibiotics when they are not absolutely certain that they are necessary. Second, the survey tried to look at reasons for antibiotic prescribing. What was very interesting is a belief among pediatricians that a lot of antibiotic use is driven by parental request. However, the survey found that in less than 20% of the cases was the request for antibiotics driven by parents. That means than 80% of the time, the antibiotics were prescribed at the discretion of the pediatrician.

Another point to be discussed from the survey is [a question asking respondents whether they agreed with the statement] that "antibiotics won't hurt if not needed and could help the patient sooner if used correctly." Thirteen percent of the surveyed pediatricians agreed with this statement. In fact, I think there is a misperception that antibiotics do not cause harm. As we mentioned earlier, antibiotics have significant side effects such as resistance. Most of the times when we use them to treat viral infections for which they're not useful, they will not help the patient get better sooner.

Finally, as an adjunct to office practice in pediatrics, rapid tests are often used; specifically, the rapid test that's more commonly used is the test for strep throat. About a quarter of the pediatricians said that they use the strep test only sometimes to document strep throat, which is the only cause of pharyngitis that requires antibiotic therapy.

To summarize the key messages from this survey:

Antibiotics are still prescribed when they are not absolutely necessary; and

There is still a misconception that antibiotics are not harmful.

Thank you very much for listening today. This is Theo Zaoutis, from The Children's Hospital of Philadelphia.