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Antibiotic resistance a serious issue facing medical professionals


Aug. 27, 2012
SPRINGFIELD — More than 100 different antibiotics exist on the market today designed to cure minor, as well as life-threatening infections.

"These same drugs created to help patients are now sometimes working against them because of their overuse and misuse, especially for children who have the highest rates of antibiotic use," Dr. John Snyder of Baystate Children's Hospital said.

The increasing prevalence of antibiotic resistance has been considered by the Centers for Disease Control and Prevention (CDC) to be "one of the world's most pressing public health problems" today.

"Despite the push to limit the inappropriate use of antibiotics, many parents come to the pediatrician expecting, or even demanding, that their child receive an antibiotic when there is no medical need for one," Snyder, medical director of Baystate High Street Health Center - Pediatrics, said.

The problem is that when infectious organisms such as bacteria are exposed to an appropriate antibiotic, they are normally killed or slowed down enough for the body to destroy them. However, random mutations that occur during multiplication lead to antibiotic resistance in a small number of these organisms. These mutated, antibiotic-resistant microbes are then able to continue to multiply, unaffected by the antibiotic.

In addition to spreading to others, they also produce a worsening disease compounded by the difficulty to now find an appropriate antibiotic that will work.

Snyder noted that in addition to the overuse of antibiotics, some studies have shown that 40 percent to 50 percent of all antibiotics are prescribed inappropriately. The most common conditions for which antibiotics are inappropriately prescribed in children are acute upper respiratory tract infections. These include the common cold, sinusitis, and ear infections, most of which are self-limited — meaning they will resolve within a specific time period and require no treatment or there is no treatment available — and viral in nature, and are not affected by the use of antibiotics.

Middle ear infections, or acute otitis media (AOM), are the most common childhood upper respiratory tract infections treated with antibiotics. In 2004, the American Academy of Pediatrics (AAP) and the American Academy of Family Practitioners issued new guidelines recommending the "observation option" for certain children with AOM. This approach withholds antibiotics for the initial 48 to 72 hours in children over the age of two, who do not have high fever or severe ear pain.

"This is a prudent option since most children will improve whether or not an antibiotic is prescribed. Unfortunately, few pediatricians have adopted the watchful waiting approach," Snyder said.

Studies show that up to 20 children would need to be treated with the appropriate antibiotic before even one benefits from it. Regardless of whether a child is treated with an antibiotic or with a placebo, 61 percent with AOM will have improved within 24 hours, and 72 percent of these cases will have resolved completely within seven days. Antibiotics remain the most frequently prescribed drugs in children, and amoxicillin, the drug of choice for the treatment of AOM, remains the most prescribed antibiotic in pediatrics.

Snyder said he is encouraged that strong educational efforts by organizations like the AAP have resulted in some headway being made in decreasing the inappropriate use of antibiotics in children.

According to a report by the federal Food and Drug Administration (FDA), antibiotic prescriptions for children declined 14 percent from 2002 to 2010. Unfortunately, most of this decrease occurred from 2002 to 2003 and has been stable since then. Another study, published in June in the journal Pediatrics, showed a similar downward trend in antibiotic use in Massachusetts children from 2000 to 2004, with the downward trend ending by 2004 to 2005. One finding of concern from that study was the increasing use of second generation macrolide antibiotics in children ages 4 to 6 for some common childhood conditions like ear infections. These antibiotics are more expensive and possibly less effective than amoxicillin for treating these infections.

Snyder said to win the battle, further education of pediatric health care providers and parents is needed. He noted providers and other professionals who work with kids need to educate parents about the difference between viral and bacterial infections, and the futility and danger of treating viral illnesses, such as colds, with antibiotics.

"They need to be reminded of the importance of reserving antibiotics for infections that warrant them, and the danger of antibiotic resistance which can result with their inappropriate use," said the Baystate Children's Hospital pediatrician.

"Providers must resist parental pressures for antibiotics when they are not indicated, and refrain from giving in to those pressures. Being knowledgeable about the educational resources that are available to parents and directing them to those resources or providing materials in the office is an important step in this educational process," he added.

The AAP periodically reviews its guidelines for antibiotics to assist parents in their appropriate use. The Academy's latest recommendations for parents and caregivers include:
  • Making sure that you give the medicine exactly as directed by following the recommended dosage and schedule on the label.

  • Not stopping the medicine early, even if a child feels better. Your child needs to take the entire course of antibiotics. Microbes may still remain in your child's body and complications can develop if the infection is not completely wiped out.

  • Never giving your child antibiotics prescribed for another person, or previously prescribed for an earlier illness. They may be wrong for the problem you are attempting to treat on your own or they may be outdated. This could result in the growth of resistant microbes and a longer and more serious infection.

  • Asking your pediatrician whether your child should be seen by the doctor after their course of antibiotics is completed.

  • Telling your doctor if your child hasn't gotten better after taking the full course of antibiotics. Your youngster's infection may be caused by germs that are resistant to the medicine given and another antibiotic may be prescribed.
Additional resources for parents to learn more about antibiotics include CDC: Get Smart: Know When Antibiotics Work at cdc.gov/GETSMART/ and AAP: Antibiotic Prescriptions For Children at tinyurl.com/bnbrjw6 .

For more information on Baystate Children's Hospital, visit baystatehealth.org .



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