In 1999, 12.6 million American children under the age of 15 were diagnosed with otitis media infections in a visit to their doctor's office.  Another 2.1 million children made emergency room visits for the same illness.

(Source: U. S. Center for Health Statistics, Advance Data, Nos. 320, 321, and 322, June 25, 2001, June 26, 2001, and July 10, 2001; in U.S. Census Bureau, Statistical Abstract of the United States: 2001 [121st edition], Washington, DC, 2001, p. 109.) 

"'If you look at all randomized controlled trials for patients with acute bronchitis, in none of those trials did they ever document worse outcomes for those who didn't get antibiotics compared to those who did,' he said. 'In no cases were they able to show any benefit.'"

(Source: Dr. Ralph Gonzales, associate professor of medicine at University of California at San Francisco, in Laurie Tarkan, "Doctor and Patient Wage Tug of War on Antibiotics," The New York Times, October 15, 2002; http://www.nytimes.com/2002/10/15/health/policy/15FLU.html?8vd.)

"From 1980 through 1992, antimicrobial prescribing rates for children by physicians in office-based practice in the United States increased by 48%.  The increased use of antimicrobial drugs coincided with the emergence of antimicrobial resistance, an important clinical and public health problem."  Thus begins a new study from three Centers for Disease Control and Prevention researchers, published in the Journal of the American Medical Association.

Using data from the National Ambulatory Medical Case Study (NAMCS), including up to 13,600 pediatric visits to 2500 to 3500 physicians in 1989-1990 and 1999-2000, the researchers describe some good news concerning the prescription of antibiotics.  Even though there was no significant difference in the rate at which children and adolescents visited physicians' offices, the number of antimicrobials prescribed dropped from 45.5 million in 1989-1990 to 30.3 million in 1999-2000.  This constitutes a 40% decline in "[t]he average population-based annual rate of overall antimicrobial prescriptions...from 838 (95% CI, 711-966) per 1000 children and adolescents younger than 15 years in 1989-1990 to 503 (95% CI, 419-588) in 1999-2000 (P for slope <.001)."  There was an identical 40% decrease in prescriptions for children younger than five years of age (95% CI; P for slope <.001).

The rate of prescriptions per office visit also decreased by a more modest 29%, "from 330 (95% CI, 305-355) antimicrobials per 1000 visits among children and adolescents younger than 15 years in 1989-990 to 234 (95% CI, 210-257) in 1999-2000 (P for slope <.001)."  Similarly, prescriptions for children under five decreased by 27% (95% CI; P for slope <.001).

In addition to measuring rates for all pediatric patients, the CDC researchers were also able to establish specific antimicrobial prescribing rates for five respiratory tract infections, finding that, "Trends in population- and visit-based antimicrobial prescribing rates for the five specific respiratory tract infections were concordant for pharyngitis, sinusitis, an upper respiratory tract infection.  For otitis media and bronchitis, however, decreases were found in the population-based but not visit-based antimicrobial prescribing rates, which indicates hat there was no change in antimicrobial prescribing for patients who came into the office."

Past and continuing high rates of antimicrobial prescriptions for upper respiratory tract infections "raise concern about appropriateness of antimicrobial prescribing," according to the authors.  Moreover, given that "[a] major limitation of this study is that diagnoses cannot be associated with a particular drug, dose, or duration of therapy," the researchers were unable to assess the "appropriateness of an antimicrobial prescription" in the rest of the cases.

While the dependence upon antimicrobials seems to be waning, we would do well to monitor this progression, lest this prescription for change becomes a prescription for disaster.

(Source: Linda F. McCaig, Richard E. Besser, and James M. Hughes, "Trends in Antimicrobial Prescribing Rates for Children and Adolescents," Journal of the American Medical Association, Vol. 287, No. 23 [June 19 2002], p. 3096-3102.)