Antibiotics prescribed unnecessarily in kids, more antimicrobial stewardship needed

Dr Kronman

As many as 11.4 million antibiotic prescriptions written each year for children and teens may be unnecessary, according to a study in the October 2014 issue of Pediatrics, published online Sept. 15.

BLOG: Optimize antibiotic stewardship

Matthew P. Kronman, MD, MSCE, of Seattle Children's Hospital, and colleagues wanted to determine bacterial prevalence rates for 5 common childhood acute respiratory tract infection (ARTI), including acute otitis media, sinusitis, bronchitis, upper respiratory tract infection, and pharyngitis-and to compare these rates to nationally representative antimicrobial prescription rates for these ARTI.

The researchers performed a meta-analysis of English language pediatric studies published between 2000 and 2011 in Medline, Embase, and the Cochrane library to determine ARTI rates. The researchers also looked at a retrospective cohort analysis of children aged <18 years evaluated in ambulatory clinics sampled by the 2000 to 2010 National Ambulatory Medical Care Survey to determine estimated US ARTI antimicrobial prescribing rates.

Antimicrobial drugs are sometimes prescribed for ARTI and many are viral, so cannot be helped with antibiotics.

Based on the prevalence of bacteria in ear and throat infections, and considering that pneumococcal vaccine is now preventing many bacterial infections, the researchers estimated that 27.4% of US children with ARTI have bacterial illness. However, antibiotics are prescribed for about 56.95% of ARTI visits.

Other than the rapid strep test for throat infections, the authors wrote that currently there are no practical tools for clinicians to use to distinguish viral from bacterial illness. These tools are urgently needed, they stated.

“The findings may be more pertinent to managed care organizations-since our study focused on outpatients-as they find ways to encourage and incentivize appropriate use of antibiotics for these common childhood infections, knowing that up to half of antibiotic prescriptions for these conditions may be unnecessary,” said Dr Kronman, who is assistant professor, division of infectious diseases, University of Washington.

“The results may be less relevant to hospital formulary managers, unless their formularies/pharmacies also serve outpatient clinics. In that case, our results would again stimulate them to encourage and incentivize appropriate use of antibiotics for these infections,” he said.