One of the most common reasons medical providers prescribe antibiotics to patients is for the diagnosis of sinusitis. Yesterday on The PediaBlog, we defined sinusitis as inflammation of the paranasal sinuses, and looked at its four main causes:

  1. Acute viral upper respiratory infections (colds)
  2. Allergic rhinitis
  3. Airborne pollution
  4. Acute bacterial infection

 

The first three causes of sinusitis are not caused by bacteria and, therefore, not treatable with antibiotics. Unfortunately, prescriptions are still being written at unacceptable rates for non-bacterial illnesses in the United States. Maggie Fox says one-third of antibiotics are prescribed inappropriately in this country:

Despite decades of ever-more-frantic warnings from health officials, doctors are still writing prescriptions for colds, ear infections and bronchitis, even though they do not help, the Centers for Disease Control and Prevention said.

And these unneeded antibiotics are helping drive a surge in drug-resistant superbugs, CDC said in the report, issued jointly with the Pew Charitable Trusts.

 

Parents don’t like to see their kids sick. After a few days of runny nose, cough, and maybe even a low-grade fever, parents often wonder when their congested children will turn the corner and get better. After a week where the congestion may be affecting appetite, sleep, and even behavior, parents can be forgiven if they feel like throwing in the towel and asking their pediatrician for an antibiotic. As we discovered yesterday, it may not be easy for us to make that call. “What harm would an antibiotic do?” a parent might ask, desperate for a better night’s sleep. The answer, says the  CDC’s director, goes beyond any single child and the potential horrible diarrhea, diaper dermatitis, or allergic rash they might acquire as a side effect of antibiotics:

“Antibiotics are lifesaving drugs, and if we continue down the road of inappropriate use we’ll lose the most powerful tool we have to fight life-threatening infections,” said CDC Director Dr. Tom Frieden.

“Losing these antibiotics would undermine our ability to treat patients with deadly infections, cancer, provide organ transplants, and save victims of burns and trauma.”

 

A new study looking at data from 2010-11 found that about 13% of all outpatient doctor visits resulted in a prescription for an antibiotic, with children under 2 years old prescribed the most. Half of these were for upper respiratory conditions in which antibiotics are worthless, including colds, allergic rhinitis, some sinus infections and ear infections, viral sore throats and tonsillitis (most sore throats that kids and adults get are not caused by the strep bacteria), bronchitis, bronchiolitis, asthma, influenza, and viral pneumonia. In all, researchers found that 30% of antibiotics prescribed were unnecessary. Fox explains how antimicrobial resistance works, resulting in 23,000 deaths in the U.S. every year:

It’s not just a waste of money. Every time someone uses an antibiotic, the bacteria in their body begin to evolve resistance to it. It’s impossible to wipe out every single bacterium in the body, so those that survive are stronger, and can not only re-infect the patient, but can be passed to others.

That means the antibiotic doesn’t work as well the next time.

 

My impression is that things are changing. Today’s parents are much more informed about the risks of antibiotics and their side effects, and most have a good, basic scientific understanding about bacterial resistance. More often than not, parents would prefer not using antibiotics for their children unless they really need it. I don’t know any pediatrician who would disagree.

Parents and pediatricians work most effectively when we work as a team. If we feel an antibiotic is warranted to treat your child’s illness, we should let you know why. If we don’t, we should let you know why not. Let us (and not some stranger employed by a “Doc-in-the-Box”) work it out with you.

That’s what we do.

 

More information from the CDC’s Get Smart program here.

More about antibiotic resistance on The PediaBlog here, here, and here.

 

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