Study: Doctors often issue unneeded drugs to children

Tuesday, November 29, 2005

Given the success of antibiotics in recent decades in fighting infections, many parents take their sick children to the doctor expecting to leave with a prescription for those medicines.

Many times they do get those drugs even when the drugs aren't warranted, a new study reports.

More than half of all children with sore throats are given antibiotics even though at least two-thirds of those cases likely result from viral rather than bacterial infections, says a study published this month in the Journal of the American Medical Association. Antibiotics don't work on viruses such as the common cold. They work on bacterial infections.

Local doctors and nurse practitioners who regularly see sick children aren't surprised by the study.

"I think there still is a tendency to over-prescribe," said Linda Brown, a family nurse practitioner in Cape Girardeau. "A lot of times you will go ahead and prescribe an antibiotic because parents are really pushing for it."

Harvard Medical School researchers say doctors should prescribe antibiotics less often.

Researchers analyzed data of children ages 3 to 17 who were treated by doctors at medical offices and hospitals from 1995 to 2003. Doctors handled 7.3 million pediatric cases involving sore throats. They prescribed antibiotics 53 percent of the time, the study found.

Researchers said that's higher than the estimated 15 percent to 36 percent of children who actually had a bacterial strep throat infection and needed the antibiotics.

Cape Girardeau pediatrician Dr. Gary Olson said parents want antibiotics for their sick children in hopes of getting quick results.

"We don't want to wait in lines," he said. "We don't want to wait for our food. We want instant cures."

In today's two-income society, mothers and fathers often find it hard to take off work to stay home with a sick child, Brown said.

"None of us are really good at letting things run their course," she said. "Sometimes you just need to lie in bed and let your body heal."

Brown said schools and day cares add to the parental demand for antibiotics. Schools and day cares routinely want children to have been on antibiotics for 24 hours before they return to the classroom.

But it's often difficult for parents to tell if their child has a cold or a sinus infection, Olson said.

Green mucus can occur with a virus or a bacterial infection, he said. "There are so many gray areas in medicine," Olson said.

He and other doctors said overuse of antibiotics can cause some bacteria to become resistant to the medicine. That makes it harder to kill the infection.

Federal health officials have estimated that the cost of treating antibiotic-resistant infections in hospitals totals at least $1.3 billion annually.

Olson said doctors are seeing some bacterial infections that are resistant to new antibiotics that have been on the market for less than five years. Part of the problem, he said, is that patients often don't take all the doses of prescribed antibiotics or resort to left-over pills when they get sick again, allowing bacteria to build up resistance to medications.

In 1995, the federal Centers for Disease Control launched a national campaign to educate people about proper use of antibiotics. Among its slogans: "Snort. Sniffle. Sneeze. No antibiotics please."

The campaign has helped educate the public about proper use of antibiotics, Olson said, but many parents still see antibiotics as the ultimate cure for their sick children. Parents, he said, get frustrated when doctors don't prescribe antibiotics initially and the infection gets worse.

Olson tries to educate parents on the differences between viruses and bacterial infections and said he won't indiscriminately prescribe antibiotics.

He recently saw a couple of children who had high fevers. He didn't prescribe antibiotics because he didn't think they were warranted. But he monitored the situation so he could prescribe antibiotics if necessary.

High-risk children, such as those with asthma, often require antibiotics to fight infections, Olson said. "There are truly some kids that when they get something, they won't get over it until they get antibiotics," he said.

The latest study said overuse of antibiotics remains a problem. It faults physicians for too often failing to do strep tests before prescribing antibiotics.

But Olson said the tests aren't 100 percent accurate and add to the cost of an office visit.

Researchers don't take into account the compassion of doctors who may prescribe antibiotics for sick children around the holidays or when a family is preparing to go on vacation even though it is unclear whether the patients have bacterial infections, Olson said.

"I think we tend to err on the side of over-treatment."

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* Most illnesses are caused by two kinds of germs: Bacteria and viruses.

* Antibiotics can cure bacterial infections but not viral infections.

* Bacteria cause strep throat, pneumonia and sinus infections.

* Viruses cause the common cold, most coughs and the flu.

Source: Centers for Disease Control

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