Understanding antibiotic overuse for respiratory tract infections in children.

Abstract

Despite the rise in antibiotic resistance among bacterial respiratory pathogens that has developed over the last decade,1–6 continuing advances in antibiotic development have allowed pediatricians to provide effective treatment for the vast majority of these infections. Warnings about antibiotic overuse from academic and particularly infectious disease specialists have been around since the advent of antibiotics. Yet, it has always seemed that as soon as a resistance problem became important, the pharmaceutical industry had a replacement agent available in the wings. Only now, as we approach the new millennium, antibiotic discovery is no longer keeping pace with the emergence of bacterial resistance. Realizing that inappropriate use of antibiotics should be reduced, there is now a search for ways to rein in overzealous prescribing habits. So, what are the barriers to reducing inappropriate antibiotic use for respiratory tract infections (RTIs)? In this issue of Pediatric s, Watson et al7 describe management of RTIs based on a survey of Georgia physicians and they correlate reported prescribing habits with actual practice and parent beliefs. This is an important article because it provides starting point information, reflecting general practices before the publication of principles propagated by the Centers for Disease Control and Prevention (CDC) for more judicious use of antibiotics in pediatric RTIs.8–13 The doctors surveyed are not bad doctors; they believe they are doing the best they can according to what they view as appropriate care for their patients. Why are these doctors prescribing antibiotics as often as they do when they probably recognize that most of the infections are viral? The main reason physicians overprescribe antibiotics for RTIs relates to diagnostic uncertainty (Table 1). Faced with an ill-appearing, febrile child and anxious parents, physicians are reluctant to offer only symptomatic therapy. If the physician were more certain that the infection …