Many doctors continue to inappropriately prescribe antibiotics for children suffering from colds and other viral infections against which the drugs are useless, according to a study published in the Journal of the American Medical Assn.
Overprescription is considered a critical factor in the increasing ability of infectious germs to resist antibiotics designed to kill them.
The practice is prevalent across all medical specialties, but is more common among family physicians than among pediatricians, reported a team of researchers headed by Ann-Christine Nyquist, an infectious-disease specialist at the University of Colorado Health Sciences Center.
Nyquist and her colleagues analyzed data from the 1992 National Ambulatory Medical Care Survey conducted annually by the National Center for Health Statistics.
They found that antibiotics were prescribed in 44% of cases involving the common cold and about 70% of bronchitis cases. One-third of the antibiotics prescribed in 1992 for children younger than 18 were to treat otitis media, an ear infection that studies have found often clears up without treatment.
Overall, more than 20% of antibiotics prescribed to children by office-based physicians were for colds, sore throats not caused by streptococcus bacteria and bronchitis.
While insurance status did not appear to influence the decision about whether to prescribe, Nyquist's team found that non-pediatricians were more likely than pediatricians to give patients drugs for these conditions. Children between 5 and 11 were also more likely to receive an antibiotic for a respiratory illness.
"Since parents of school-aged children often do not have mechanisms in place to care for their child at home," the authors wrote, "they may perceive antibiotic treatment as reassurance that 'everything possible is being done' and feel more comfortable returning the child with a respiratory illness back to school."
In an accompanying editorial Benjamin Schwartz and his coauthors suggest that the reasons for overprescribing are related to "education, experience, expectations and economics."
They suggest that ignorance of the natural course of viral infections may play an important role. A study of Virginia pediatricians and family physicians published last year found that 71% of family physicians and 53% of pediatricians would immediately prescribe an antibiotic for a child who had experienced one day of a low-grade fever and a scant light yellow-green nasal discharge.
Schwartz and his coauthors also suggest that managed care, with its emphasis on treating a large volume of patients quickly, may contribute to antibiotic overuse.
"Pressure to see an increasing number of patients means that physicians spend less time with each, and writing an antibiotic prescription is perceived as more time efficient than explaining to a patient why one is not needed," they wrote.