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Too Many Kids Getting Antibiotics for Asthma
Date:5/24/2011

By Steven Reinberg
HealthDay Reporter

TUESDAY, May 24 (HealthDay News) -- Although guidelines don't recommend antibiotics for asthma, almost 1 million children with the respiratory condition are prescribed the medications each year in the United States, a new study finds.

"We are trying to reduce unnecessary antibiotic prescriptions, and this suggests that we as pediatricians are prescribing them way too often," said lead researcher Dr. Ian M. Paul, an associate professor of pediatrics at the College of Medicine of Pennsylvania State University in Hershey.

Why doctors are prescribing antibiotics for asthma is not clear, Paul said. One reason might be that doctors treating severe asthma attacks "feel the need to cover all their bases by also prescribing antibiotics," he suggested.

Sometimes parents may ask doctors to give their child antibiotics, but it doesn't seem to be a big factor, Paul noted. "It probably exists to some degree in clinical practice, but I don't think it happens all that frequently -- certainly not in one in every six visits for asthma," he said.

"The one encouraging finding was, when asthma education was delivered as part of the visit, antibiotics were less likely to be prescribed," he added. When asthma education was not part of the visit, 19 percent of the time antibiotics were prescribed, compared with 11 percent when asthma education was given.

"This suggests that we can educate families and patients and explain the causes of asthma and, hopefully, reduce unnecessary antibiotic prescribing," Paul said.

The dangers of overprescribing antibiotics are that it promotes the development of antibiotic-resistant bacteria and there are side effects for the drugs themselves, Paul pointed out.

The report was published in the May 23 online edition of Pediatrics.

For the study, Paul's team used data from the National Ambulatory Medical Care Surveys and National Hospital Ambulatory Medical Care Survey to see the rate of antibiotics prescribed for children between 1998 and 2007.

Over that time, there were some 60.4 million medical care visits for children with asthma for which no prescription for antibiotics was warranted. However, antibiotics were prescribed 16 percent of the time, the researchers found.

Primary care doctors were most likely to prescribe antibiotics, while emergency department doctors were least likely to prescribe them, Paul said.

Other factors that were linked with increased antibiotic prescribing included use of inhaled corticosteroids and being treated in the winter, the researchers noted.

However, when visits to primary care doctors included asthma education, the rate of antibiotic prescribing went down, Paul stated.

In a second study in the same journal, Belgian investigators led by Dr. Kris De Boeck, from the department of pediatric pulmonology and infectious diseases at the University Hospital of Leuven, found similar overprescribing of antibiotics to asthmatic children.

These researchers found children treated with asthma medications were 1.9 times more likely to also get a prescription for antibiotics, compared with children not treated with asthma drugs.

In fact, 35.6 percent of children who were prescribed asthma drugs were also prescribed antibiotics, the researchers found.

"This finding highlights the need for educational opportunities to inform clinicians that such co-prescription should be limited," the authors concluded.

Commenting on both studies, Dr. Paul Krogstad, a professor of pediatric infectious diseases at the University of California, Los Angeles, and co-author of an accompanying journal editorial, said that "these articles indicate that asthma medications and antibiotics were very commonly prescribed in tandem both here and in Belgium, which conflicts with domestic and international recommendations that point out that antibiotics have no routine use in the care of asthmatics."

Antibiotic overuse confuses patients and family, Krogstad said. "They don't understand the true nature of asthma as an inflammatory, not an infectious disorder," he explained.

In addition, overprescribing antibiotics entails personal and societal risks, Krogstad said.

"Personal risks include allergic reactions, side effects, drug interactions and expense. Societal costs include medication-related costs and selection for drug-resistant bacteria. Antibiotic overuse is being reduced, but this remains an area where improvement is sorely needed," he said.

More information

For more information on asthma, visit the U.S. National Library of Medicine.

SOURCES: Ian M. Paul, M.D., associate professor, pediatrics, College of Medicine, Pennsylvania State University, Hershey, Pa.; Paul Krogstad, M.D., professor, pediatric infectious diseases, University of California, Los Angeles; May 23, 2011, Pediatrics, online


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