Reducing inappropriate oral antibiotic use: a prescription for change.

Abstract

* Abbreviations: AOM = : acute otitis media • AAP = : American Academy of Pediatrics • NAMCS = : National Ambulatory Medical Care Survey • URTI = : upper respiratory tract infection • OME = : otitis media with effusion There is increasing concern in the medical community1-5 about inappropriate oral antibiotic use. This concern is fueled by changes in antibiotic susceptibility patterns of many bacteria. In pediatrics, the increasing resistance of Streptococcus pneumoniae to penicillins is particularly worrisome, because S pneumoniae is the leading bacterial cause of acute otitis media (AOM), sinusitis, pneumonia, bacteremia, and meningitis.6 In some communities, the rate of resistance has influenced antibiotic therapy for AOM,7 and, because of concerns about pneumococcal resistance, the American Academy of Pediatrics' (AAP) Red Book has changed its recommendation for empiric antibiotic therapy for life-threatening infections in which the pneumococcus is a possible etiologic agent.8 The purpose of this commentary is to review what we know about inappropriate oral antibiotic use and to suggest a series of steps that primary care physicians can take to promote the judicious use of antibiotics. The campaign to reduce inappropriate oral antibiotic use must be balanced—patients and physicians must both be reeducated about antibiotics. Our premise is that to reduce inappropriate oral antibiotic use pediatricians will need to discuss with parents the role of antibiotics in the care of children with minor infectious disease, sharpen their diagnostic skills, and become more familiar with specific indications for antibiotics and other therapeutic options. While current efforts to reduce inappropriate antibiotic use have focused on the need to reeducate physicians, and although we believe these efforts are important, primary care pediatricians have indicated overwhelmingly that educating families is the most important aspect of promoting judicious use of antibiotics (Bauchner H, Pelton SI, Klein JO. Parents, physicians, and antibiotic use. Submitted for publication.) In addition, patient education can impact on physician behavior. Davis and others9 reported in a metaanalysis of 99 trials that patient-mediated interventions are one of four strategies that are effective …