Doctors are saying ‘hold the penicillin’

Doctors are writing fewer prescriptions for antibiotics, heeding warnings that overuse of the drugs could lead to widespread resistance to these medications. This is particularly true for most infections of the ear, throat, and sinuses in children and adolescents.

Fewer unnecessary prescriptions are also being dispensed for illnesses that don’t respond to antibiotics, such as colds, flu, coughs, and most bronchitis. These conditions are caused by viruses; antibiotics only work against bacteria.

“The threat of resistance to antibiotics by bacteria increased so dramatically from the 1970s to the mid-1990s that the Centers for Disease Control and Prevention (CDC) labeled it a national public health crisis,” said Jonathan Finkelstein of the Harvard Medical School and Harvard Pilgrim Health Care in Boston. The CDC has called on doctors to be sure their patients’ conditions really warrant use of the drugs, and to resist parental pressure to prescribe antibiotics for their children’s colds or flu.

This attention by public health agencies, the news media, and others appears to be working. Finkelstein and his colleagues did a study that reveals a steep drop in prescriptions written for children from 1996 to 2000. They checked information on 225,000 patients ages 3 months to 18 years in nine health plans in various parts of the United States. It found a 24 percent drop for kids ages 3 months to 3 years, 25 percent for those 3 to 6 years, and 16 percent for the 6- to 18-year group. The results have been published in the September issue of the journal Pediatrics.

Finkelstein says he has no data on whether the drop has continued to date. “I expect the decrease will level off eventually,” he commented. “The ultimate goal is to approach the (prescription) rate that balances the benefits of treating bacterial infections with the risks to individuals and the community.”

Doctors hear the message

A sharp decrease in prescriptions for middle ear infections (otitis media) accounts for more than half (59 percent) of the decrease in antibiotic use among children younger than 3 years. That, in turn, comes from a reduction in physicians’ diagnosis of this condition, caused by inflammation of the cavity between the eardrum and inner ear.

During ages 6 to 18 years, visits to doctors for sore throats and sinus infections increase. Decreased diagnosis of these conditions, along with those for middle ear infections, accounted for 78 percent of the drop in antibiotic prescriptions in patients 3 months to 18 years old.

Finkelstein and his colleagues believe that most of the decrease in prescribing for otitis comes from physicians adopting a higher threshold of infection before dispensing the drugs. Many ear infections clear up by themselves, but antibiotics are often given to shorten the course of symptoms like earaches and to prevent complications. “The practice of watchful waiting – prescribing antibiotics only if the infection does not go away in a day or two – is commonly used in Europe,” Finkelstein noted. “However, it is controversial among doctors in the U.S.”

Previous studies have revealed unduly high rates of antibiotic prescriptions for colds. The Harvard study, happily, found fewer children receiving such unnecessary medications. Coughs, even deep coughs or “bronchitis,” are usually caused by viruses. Only children with signs of pneumonia, a bacterial infection of the lungs, should be treated with antibiotics.

“The message has begun to sink in,” Finkelstein said. “The substantial decrease in antibiotics prescribing is rightfully hailed as a victory for public health campaigns, but is also a reflection of increased awareness by doctors and patients of the dangers of antibiotic overuse.”