Parental pressure, rather than concerns about malpractice or a desire to be efficient, is the major reason pediatricians prescribe antibiotics to children who probably don't need them, researchers at Boston University School of Medicine report in a study published in the February issue of the journal Pediatrics.
Howard Bauchner and his colleagues Stephen I. Pelton and Jerome O. Klein surveyed 610 pediatricians around the country who are members of the American Academy of Pediatrics. The researchers sought to determine how parents influence pediatricians' prescribing practices, as well as strategies to reduce the use of unnecessary antibiotics.
In the past decade the widespread practice of unnecessary antibiotic use has emerged as a major public health problem. Scientists warn that indiscriminate use of the drugs has contributed to the growing problem of drug resistance.
Medicines that were once effective against certain bacterial infections are now unable to control these infections, because bacteria have developed resistance to them. The Centers for Disease Control and Prevention has announced a national campaign to reduce resistance by, among other things, eliminating the practice of prescribing antibiotics for illnesses that are likely to be viral.
The problem is particularly acute in pediatrics, because children get sick a lot and are often prescribed antibiotics, in part because it can be difficult to distinguish between viral and bacterial infections.
The ear infection otitis media, one of the most common maladies that a growing number of pediatricians believe does not require drug therapy, is a case in point.
In 1980 4.2 million prescriptions were written for amoxicillin, a drug most often used to treat otitis. In 1992, 12.4 million prescriptions were written. The use of another class of antibiotics, cephalosporins, grew from 876,000 prescriptions in 1980 to nearly 7 million in 1992.
The problem, as Bauchner and his colleagues note, is that pediatricians continue to prescribe antibiotics inappropriately for viral infections, such as colds, against which such drugs are useless. Antibiotics are only effective against bacterial infections.
One reason for unnecessary prescriptions is undoubtedly parental pressure, the authors said.
Their survey found that 96 percent of those polled had been asked by parents to prescribe the drugs during the previous month. Forty percent said such a request had been made at least 10 times, while 30 percent said that parents had asked them over the phone for antibiotics 10 or more times during the previous month. Nearly 80 percent of doctors said they rarely or never prescribed antibiotics over the phone.
But one in three pediatricians said they often or occasionally prescribed antibiotics they believed to be unnecessary, in order to appease parents.
Most of those surveyed said that educating parents about appropriate antibiotic use is the single most important factor in reducing unnecessary drug use.
"Parents must be re-educated, either directly by clinicians or through public health campaigns," the researchers concluded, "and physicians need to sharpen their diagnostic skills and become more familiar with specific indications for antibiotics."
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