Antibiotic orders declining, but battle against overuse not done

When Allan Lieberthal, MD, a pediatrician with Kaiser Permanente in Panorama City, Calif., writes a prescription for an antibiotic, his patients' parents frequently question whether it's really necessary.

This response is a far cry from that what was typical a decade ago.

"Before, if I didn't prescribe antibiotics, the [parents] would complain," said Dr. Lieberthal, who is also co-chair of the American Academy of Pediatrics and the American Academy of Family Physicians' subcommittee on management of acute otitis media, which issued a practice guideline in 2004 to reduce antibiotic misuse for this complaint.

That patients' parents are increasingly less eager for an antibiotic prescription is not a phenomenon limited to Dr. Lieberthal's office. This trend, combined with doctors' hesitancy to write such scripts, is leading to decreases in antibiotic use that are starting to be reflected in national data.

In April, the Agency for Healthcare Research and Quality released a report that found use of these drugs by those 14 or younger had decreased markedly from 1996 to 2001. Parents also were less likely to take children to the doctor for minor infections.

Experts credit this success to years of aggressive campaigns from public health agencies and medical societies.

The American Medical Association also encourages the federal government to promote effective education on appropriate antibiotic use and urges physicians to educate patients.

"These findings suggest that educational campaigns are working and that parents now are more selective about when they seek medical treatment and antibiotics for their children," said AHRQ Director Carolyn M. Clancy, MD.

Experts cautioned, however, that the numbers were still not low enough, and constant vigilance is necessary to keep this effort on track. Also, although statistics for this five-year period appear rosy, the numbers from 2001, the most recent year that data are available, suggest movement in the wrong direction again. For example, the percentage of children prescribed an antibiotic for otitis media declined from 14.4% in 1996 to 11.5% in 2001, but this is a slight increase from its lowest point at 10.9% in 2000.

"We are going back up," said John Hickner, MD, professor of family medicine at the University of Chicago. "Not everybody is buying it. We need to keep at it. We need public education for patients, physicians and nurses."

Those working to further reduce antibiotic use also recommended using delayed prescriptions, to be filled only if the child is not better within 48 hours, and shorter courses if the drugs are actually prescribed. Oral analgesics may also be enough to address a child's discomfort.