“From 1980 through 1992, antimicrobial prescribing rates for children by physicians in office-based practice in the United States increased by 48%.  ...The average population-based annual rate of overall antimicrobial prescriptions decreased 40% from…1989-1990 to 1999-2000.”

(Source: Linda F. McCaig, Richard E. Besser, and James M. Hughes, “Trends in Antimicrobial Prescribing Rates for Children and Adolescents,” JAMA, Vol. 287, No. 23 [June 19 2002], p. 3096-3102.)

“The crescendo of research during the past decade has established that (1) antibiotic overuse is a major public health problem; (2) approximately 50% of prescriptions for children written by community-based practitioners are unnecessary, and (3) the single most important factor in the emergence of antibiotic resistance among respiratory bacterial pathogens is selection pressure from antimicrobial agents.”

(Source: Michael E. Pichichero, “Dynamics of Antibiotic prescribing for Children,” JAMA, Vol. 287, No. 23 [June 19 2002], p. 3133-3135.)

For some time, public health authorities have worried about how excessive use of antibiotics is fostering the emergence of new antibiotic resistant pathogens. As a consequence, medical authorities are now urging physicians to cut back on their prescriptions for antibiotics. Unfortunately, if a study recently published in Pediatrics may be taken as any indication, the new efforts to reign in excessive antibiotic use may have only very limited success so long as the day-care center remains a common replacement for in-home parental care.

Analyzing data from a controlled community-intervention trial in northern Wisconsin, the authors of the new study documented the success of a multifaceted, community-based, educational intervention in reducing physician prescriptions for both liquid and solid (capsule/tablet) antibiotics. "The median number of solid antibiotic prescriptions per clinician," report the researchers, "declined 19% in the intervention region and 8% in the control region. The median number of liquid antibiotic prescriptions per clinician declined 11% in the intervention region, compared with an increase of 12% in the control region." This would be very good news for health officials–were it not for one glaring exception to this pattern of progress: "In child-care facilities," report the researchers, "there was no apparent impact on judicious antibiotic use." For all of the progress they see elsewhere, the authors of the new study admit that they were "unable to demonstrate a reduction in inappropriate antibiotic prescribing among children who attended child care."

In trying to explain "the absence of a reduction in antibiotic use among children in child care," the researchers conjecture that "parents of children who were in child care may have been more likely to expect or demand antibiotics compared with parents of children who were not attending child care." Parents’ making demands for antibiotics for children in day care seems especially likely in light of "evidence that child-care providers may encourage this behavior."

Since overuse of antibiotics helps incubate the emergence of antibiotic resistant supergerms, it is entirely predictable that the authors of the new study trace a statistical link between children’s colonization with penicillin-nonsusceptible pneumococci (PNP) and their hours per week in child-care facilities (p < .001). And unfortunately, these virulent new pathogens spread beyond the child-care facility. In speculating as to why the community-wide reduction in the use of antibiotics was "not associated with a measurable decline in PNP prevalence" in the community at large, the researchers implicate the day-care center. "There was no reduction in the rate of antibiotic prescribing for children in child care," they observe, "so selection pressure for antibiotic resistance may have been maintained in the child-care facilities despite community-wide reductions in antibiotic use."

The authors of the new study call for "further work" on the problem of antibiotic overuse and the consequent spread of antibiotic-resistant disease agents. But until the day-care centers close and children go home to parental care, that work may yield only meager results.

(Source: Edward A. Belongia et al., "A Community Intervention Trial to Promote Judicious Antibiotic Use and Reduce Penicillin-Resistant Streptococcus Pneumoniae Carriage in Children," Pediatrics 108 [2001]: 575-583.)