Are Antibiotics Being Prescribed in the Paediatric Population Far Too Often?

As many as one million children are unnecessarily being prescribed antibiotics for asthma each year, despite guidelines not recommending the treatment.

That's just one of the findings of a recent study by a team at the Collegeof Medicine of Pennsylvania State University.

Putting the banner headlines which accompanied the release of the research aside, the study suggests there is still far to go in the management of even the most common diseases affecting the paediatric population.

Dr. Ian M Paul, lead researcher of the study, said it was clear that antibiotics are being prescribed far too often, what he did not believe was clear were the reasons behind this.

He admitted in some cases that parents might be asking doctors to prescribe their children antibiotics, while in others medical professionals treating those suffering from severe attacks may "feel the need to cover all their bases".

But he still concedes this should not account for the remarkably high levels of a treatment being prescribed in contravention to guidelines.

Indeed, the research, published in the journal Pediatrics, suggests the key to helping both doctors and parents better manage the disease is education. When advice on asthma was given antibiotics were prescribed 11 percent of the time, compared to 19 percent of the time when it was not.

"This suggests that we can educate families and patients and explain the causes of asthma and, hopefully, reduce unnecessary antibiotic prescribing," Paul said.
[inlinead]
Dr. Paul Krogstad, a professor of paediatric infectious diseases at the University of California, also recently published an editorial, claiming: "They don't understand the true nature of asthma as an inflammatory, not an infectious disorder."

The comments came after separate research conducted in Belgium found 35.6 percent of children who received asthma medication were also prescribed antibiotics.

Krogstad added: "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."

Of course, the most effective form of management of diseases is prevention, and there is evidence to suggest preventative measures undertaken with children are paying off

Recent work by the Centres for Disease Control, published in the New England Journal of Medicine, suggested a vaccination programme against bacterial meningitis has been very successful in cutting incidences of the disease among young children.

In 1999, incidence rates among children two to 23 months old were 10 in every 100,000. In 2007, this figure stood closer to four.

Much of this drop has been attributed to the introduction of the pneumococcal conjugate vaccine, which was created to protect against Streptococcus pneumonia, one of the main causes of bacterial meningitis.

The introduction of the heptavalent protein-polysaccharide pneumococcal vaccine was also found to have reduced cases of invasive pneumococcal disease in under fives by 75 percent.

However, problems still remain, the report explained: "With the success of pneumococcal and Hib conjugate vaccines in reducing the risk of meningitis among young children, the burden of bacterial meningitis is now borne more by older adults."

Management of the disease in children has, however, had a positive impact on the chances of exposure by older adults, who are unlikely to have received the same preventative measures.

But work must still be done. More measures are needed to manage the disease in very young children and the research recorded little change in the fatality rate, noting the "disease still often results in death".

These are of course a snap shot of the diseases which have been shown to significantly affect the paediatric population and a glimpse of the measures used to control them.

But what they demonstrate is that effective management of childhood diseases will pay dividends not only later in their life, but also for other members of the population.