by Children's Hospital of Philadelphia
Credit: CC0 Public Domain
When doctors prescribe antibiotics for children with common respiratory infections, a more selective approach is better. Researchers who studied pediatric treatment practices in 30,000 patients with earaches, strep throat and other common infections found that narrow-spectrum antibiotics, which act against a smaller range of bacteria, had fewer adverse effects than broad-spectrum antibiotics, which target a broader variety of bacteria.
When judged by both practical and clinical outcomes, narrow-spectrum antibiotics performed equally well or better than broad-spectrum ones, with fewer disruptions to family routines.
The study reflects an "antimicrobial stewardship" approach, guiding healthcare providers to prescribe the most appropriate antibiotic for a patient's specific type of infection, with the aim of improving individual outcomes and reducing the overall risk of antibiotic resistance—in which disease-causing microorganisms develop resistance to commonly used antibiotics.
"Many children unnecessarily receive broad-spectrum antibiotics for common infections, which can lead to antibiotic resistance and unnecessary side effects," said study leader Jeffrey Gerber, MD, PhD, associate director for Inpatient Research Activities in the Center for Pediatric Clinical Effectiveness at Children's Hospital of Philadelphia (CHOP). "This study showed that inappropriate prescribing of antibiotics also affects families at a much more practical level, such as missed days from school and work, side effects of the drugs, and costs for extra childcare. These can be a real burden for families."
Gerber and colleagues published their study in the Journal of the American Medical Association on Dec. 19, 2017. An award from the Patient-Centered Outcomes Research Institute (PCORI) funded this study.
The study team performed two complementary studies in 31 primary care practices in CHOP's pediatric network in Pennsylvania and New Jersey, between January 2015 and April 2016. They drew on electronic health records of infants and children up to age 12 diagnosed with an acute respiratory tract infection (ARTI) and prescribed an oral antibiotic. In a retrospective cohort of approximately 30,000 patients, 14 percent received broad-spectrum drugs and 86 percent received narrow-spectrum drugs.
The ARTIs in the analysis were acute otitis media (earache), Group A streptococcal pharyngitis (strep throat) and sinusitis (sinus infection). ARTIs account for the majority of antibiotic exposures in children. In addition to assessing clinical outcomes in a retrospective cohort of 30,000 children, the researchers studied a prospective cohort of 2,472 children, doing telephone interviews with caregivers to measure outcomes that parents had identified as their highest concerns: adverse drug effects, additional childcare costs, lingering symptoms and missed school days.
The study team found a significantly higher risk of adverse events for broad-spectrum antibiotics compared to narrow-spectrum antibiotics (3.7 percent vs. 2.7 percent as documented by clinicians, and 35.6 percent vs. 25.1 percent, as reported by patients and families). The rates of treatment failure were not significantly different between both types of antibiotics.
CHOP's Center for Pediatric Clinical Effectiveness (CPCE) recently issued a research brief and policy tip sheet summarizing seven years of research to develop a clinical practice model for antibiotic stewardship in pediatric outpatient settings. "Research tells us that antibiotic stewardship programs not only reduce the overall burden of antibiotic resistance, but also improve patient outcomes," said Gerber, who added, "Our previous research has also shown that these programs can lower costs for insurers and families that pay for prescriptions. These programs are a win-win-win for public health, families and insurers."
More information: Jeffrey S. Gerber et al, Association of Broad- vs Narrow-Spectrum Antibiotics With Treatment Failure, Adverse Events, and Quality of Life in Children With Acute Respiratory Tract Infections, JAMA (2017). DOI: 10.1001/jama.2017.18715
Journal information: Journal of the American Medical Association
Provided by Children's Hospital of Philadelphia
Antibiotic overuse in children could be reduced with improved communication
by National Communication Association
To help reduce unnecessary use of antibiotics for common childhood illnesses, parents would benefit from fuller communication from their health care providers, suggests new research published in the National Communication Association's Journal of Applied Communication Research.
The study's authors found that only 4% of parents advised to delay the use of antibiotics for their children's ear infections recalled receiving comprehensive advice, including information about the infection, the risks of antibiotics, and how to properly care for their children.
Importantly, the study also showed that parents who recalled receiving more detailed explanations from their health care providers were more likely to use antibiotics only if they were truly needed. By waiting to administer antibiotics, parents allow their children the chance to recover naturally.
Lead author Erina L. MacGeorge from Pennsylvania State University explained, "When we use antibiotics, the strongest bacteria still survive even though we feel well again. Over time, these bacteria adapt to become resistant 'superbugs' that even very strong antibiotics with dangerous side effects cannot kill. Our best defense is to avoid antibiotics whenever possible, with guidance from health care professionals."
Previous studies have shown this so-called "watchful waiting" approach to be an effective way to reduce unnecessary antibiotic use without affecting patient safety. However, the findings of this study suggest that parents' compliance with watchful waiting advice could be increased by enhancing physician instruction.
The research study examined 134 U.S. parents of children under five years old who were given antibiotics to administer in case their child's condition failed to improve within a certain timeframe. They were asked to recall their interactions with health care providers and report what they remembered being told to do. They were also asked if they ultimately used the antibiotics.
Review of participants' responses revealed that even when parents reported receiving explanations about the risks of antibiotics, their understanding of what they heard was not necessarily complete or correct. One participant reported, "If children are given antibiotics when it is not necessary, they can build up an immunity to them." However, it's bacteria, not children, that become immune to antibiotics, so the dangers of overuse extend beyond any individual child. This misunderstanding illustrates the challenge of understanding antibiotic resistance, and the need for health care providers to more clearly communicate the dangers of overuse.
According to American Academy of Pediatrics guidelines, parents advised to undertake watchful waiting should receive information from health care providers on the nature of ear infections, adverse effects of antibiotics, how to monitor and manage symptoms such as pain, and when to seek follow-up care.
With antibiotic-resistant infections currently responsible for 50,000 deaths per year in the United States and Europe alone, the results of this study suggest that further research is needed to help combat overuse.
More information: Erina L. MacGeorge et al. Reducing unwarranted antibiotic use for pediatric acute otitis media: the influence of physicians' explanation and instruction on parent compliance with 'watchful waiting', Journal of Applied Communication Research (2017). DOI: 10.1080/00909882.2017.1320575
Provided by National Communication Association
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