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Vincent Iannelli, M.D.

Trends in Outpatient Antibiotic Use and Overuse

By February 5, 2014

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Young girl being given medication - Photo by Peter Cade/Getty ImagesThe overuse of antibiotics, which can lead to an increase in resistant bacteria (antibiotics can't kill them anymore), has been a problem that the Centers for Disease Control and Prevention, the American Academy of Pediatrics, and other experts have been combating for some time. In fact, it is now considered a critical public health threat.

A new study that will appear in the February issue of Pediatrics, "Recent Trends in Outpatient Antibiotic Use in Children," has found "antibiotic dispensing for children may have reached a new plateau" and "that the downward trend in antibiotic use for children, observed for more than a decade, is coming to an end."

That is very disturbing, especially when you consider that the CDC warns that antibiotic resistance already causes at least 2,049,442 illnesses and 23,000 deaths each year.

Looking at children between the ages of 3 months and 18 years in New England, the Mountain West, and the Midwest, the study found that:

  • children between the ages of 3 and 24 months got the most antibiotic prescriptions
  • depending on the child's age, common reasons to get an antibiotic prescription included ear infections, pharyngitis (sore throat), sinusitis, pneumonia, UTIs, skin infections, and acne
  • there has been an increase in the use of broad-spectrum, third-generation cephalosporins  (cefdinir (Omnicef), cefixime (Suprax), cefpodoxime (Vantin), etc.) between 2000 and 2010 for the treatment of kids with ear infections, sore throats, and sinus infections
  • there has been an increase in the use of macrolides (erythromycin, clarithromycin(Biaxin), azithromycin (Zithromax), etc.) in most age groups, especially to treat ear infections, sore throats, viral respiratory tract infections, and pneumonia

Most surprising, the children in the Midwest had "lower dispensing rates across all age groups." Did they have fewer bacterial infections that required antibiotics or does this simply represent differences in "local prescribing patterns at the level of the health system, practice, or clinician?"

The study concluded that "Along with identifying best practices in low-prescribing areas, decreasing broad-spectrum use for particular conditions should be a continuing focus of intervention efforts." That's a good idea, as both azithromycin and cefdinir were among the top 5 most prescribed medications for children in 2010.

And when you consider that some experts believe that up to 50% of antibiotic use is unnecessary, even with the declines of the last 10 to 20 years, there is still a lot of work to do.

Do your part. Get Smart About Antibiotics.

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