Pediatric respiratory tract infections and antibiotics: overprescribing?

10344775_815628761791470_2583354142570698374_nAntimicrobial resistance is a serious threat to human health. As the WHO global report published in April 2014 highlighted, it is no longer a concern for the future but happening right now, in every part of the world. It threatens to undo many of the achievements of modern medicine that allow people to live longer and healthier.

A number of concerted actions are needed to tackle the resistance problem, and one of them is to improve the way antibiotics are currently used, both in agriculture and in medicine. Mostly, this means curbing antibiotics use.

A study published in the journal Pediatrics in October tried to assess how often antibiotics were prescribed in cases of acute respiratory tract infections in children in the US in relation to how often these infections actually involved bacteria (many of these infections are indeed caused by viruses).

The researchers performed a meta-analysis of studies published between 2000 and 2011 to evaluate the bacterial prevalence rates in pediatric acute respiratory tract infections that were seen in outpatient clinical settings. Their data showed that bacterial prevalence was about 65% in acute otitis media (based on 12 studies) and 78% in sinusitis (based on only one study, as the researchers could not find more that met their inclusion criteria). The prevalence of the bacteria Streptococcus pyogenes in cases of pharyngitis was only about 20% (based on 11 studies). No studies on bronchitis or upper respiratory infection met the restrictive inclusion criteria set by the researchers for their meta-analysis, so no data was available for these conditions. (Bronchitis is however known to be typically caused by a virus, and the medical guidelines are to not prescribe any antibiotics.)

In parallel, the researchers analyzed data from the US National Ambulatory Medical Care Survey to determine national estimates for antimicrobial prescriptions in cases of pediatric acute respiratory tract infections. They found that the mean annual national antibiotics prescription rates were 86% for acute otitis media, 89% for sinusitis, and 57% for pharyngitis. (The rate was about 72% for bronchitis – despite the current medical guidelines.)

In all, the results from this study indicate that antibiotics are overprescribed in a relatively sizeable proportion of pediatric acute respiratory tract infections. Of course, there are many limitations to such a study, but it has the merit to at least raise awareness about the issue of unnecessary antibiotics prescriptions. The main take-away message here is perhaps not the numbers per se, but the fact that rapid diagnostic tools allowing to distinguish bacterial from viral infections are needed in order to help decrease unnecessary use of antibiotics.

It is nevertheless interesting to note that the biggest difference between bacterial prevalence and antibiotics prescription estimates obtained in this study is for pharyngitis, when there actually is a rapid and simple way to check whether a sore throat – the primary symptom of pharyngitis – is due to a viral or bacterial infection (with a throat swab). Are pediatricians being over-careful with their patients, and some of them perhaps still prescribing antibiotics “just in case” ? Unfortunately, the authors of the Pediatrics study do not discuss the case of pharyngitis specifically. It could be worth further investigating routine medical practice for such cases.

Also:
Other researchers have tried to evaluate the antibiotics prescription rates for adults who seek medical care for sore throats or bronchitis, and found that the rates were about 60% and 73% respectively, when they should be about 10% and 0%. See article on Medscape here.

Reference
Bacterial Prevalence and Antimicrobial Prescribing Trends for Acute Respiratory Tract Infections. Kronman MP, Zhou C, Mangione-Smith R. Pediatrics. Vol. 134 No. 4 October 1, 2014 pp. e956 -e965. doi: 10.1542/peds.2014-0605
PMID: 25225144

ResearchBlogging.orgKronman MP, Zhou C, & Mangione-Smith R (2014). Bacterial prevalence and antimicrobial prescribing trends for acute respiratory tract infections. Pediatrics, 134 (4) PMID: 25225144

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