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07-06-2011 | Immunology | Article

‘Judicious’ antibiotic use urged in children with asthma, urinary tract infections



MedWire News: Results from two US studies suggest that physicians may be overprescribing antibiotics, particularly broad-spectrum antibiotics, to children with asthma and urinary tract infections.

"It is critical for pediatricians to promote the judicious use of antibiotics," said Michael Cabana (University of California at San Francisco) co-author of the asthma study.

Antibiotics are not recommended for the treatment of asthma unless justified by comorbidities such as bacterial infection.

Cabana and colleagues assessed the frequency of inappropriate antibiotic prescription (without an additional International Classification of Diseases, 9th Edition code justifying their use) in 60.4 million clinic and hospital visits for asthma occurring between 1998 and 2007 in children under 18 years of age.

They found that physicians prescribed antibiotics during 16% of these visits. The most common prescription being for macrolides, at 48.8% of all prescriptions.

Cabana and colleagues found that, after adjusting for confounders such as age, gender, and ethnicity, systemic corticosteroid use and treatment during the winter increased the likelihood of inappropriate antibiotic prescription a significant 2.69- and 1.92-fold, respectively.

The other study, carried out by Hillary Copp, also from the University of California at San Francisco, and colleagues, focused on antibiotic prescriptions for urinary tract disorders in children included in the National Ambulatory Medical Care Survey and National Hospital Ambulatory Medical Care Survey.

They found that during 1828 clinician visits for pediatric urinary tract infections between 1998 and 2007, 70% of the children were prescribed antibiotics. Broad-spectrum antibiotics, which are known to cause more bacterial resistance, were the drug of choice over narrow-spectrum antibiotics in one out of three visits.

Although the use of broad-spectrum antibiotics in general did not increase over the study period, the use of third-generation cephalosporin increased significantly from 12% to 25% between 1998 and 2007.

Copp and team say that this is concerning, as narrow-spectrum, more targeted antibiotics, which are less likely to cause resistance, are equally effective against these infections.

"It is always concerning when we see a rise in a particular antibiotic class, as this can create drug resistance through antibiotic selection pressures," said Copp.

"It is okay to prescribe broad-spectrum antibiotics if a doctor thinks the clinical scenario warrants it. However, when this is done, a urine sample should be obtained so therapy can be tailored accordingly and patients can transition to a more narrow-spectrum drug based on the urine culture results."

Both studies are published in the journal Pediatrics.

MedWire ( is an independent clinical news service provided by Springer Healthcare Limited. © Springer Healthcare Ltd; 2011

By Helen Albert

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