Antibiotic Prescribing in Paediatric Practice

Dr Victor Grech MD MRCP PhD

Research in the past decade has clearly shown that antibiotic overuse is a major public health problem. It has been calculated that at least 50% of antibiotic prescriptions for children by doctors are unnecessary.

Why are we concerned about antibiotic overusage?

On a personal and practical level, parents should be aware that all medications may produce side effects. Indeed, one in one million penicillin prescriptions is fatal.

On a broader level, antibiotic over-usage leads to antibiotic resistance. This means that doctors lose the ability to treat relatively simple bacterial infections that are acquired in the community. Moreover, bacterial antibiotic resistance decreases doctors’ ability to deal with serious infections that require hospital treatment. Doctors are repeatedly told to reduce over-usage of antibiotics by health authorities and by the medical literature.

So why are antibiotics over-prescribed?

Well, there are several reasons and these consist of parent factors and doctor factors.

Parent factors

Most parents are unsatisfied if the general practitioner does not prescribe an antibiotic for a febrile illness and may then, in any case, find a pharmacy that provides an antibiotic without a doctor prescription.

Doctor factors

Doctors may worry that a child that appears to have a febrile viral infection may in fact be harboring a serious bacterial infection, and that the parents may not bring the child back to be reexamined even if the child’s condition deteriorates. In these circumstances, a doctor may prescribe an antibiotic ‘just in case’. An economic factor is that doctors are generally very busy individuals who work in a competitive, private practice environment. Not meeting parent expectations may mean that parents may shift to using another doctor.

The situation is difficult to reverse as mathematical models predict that it would take years or even decades for substantial reductions in bacterial antibiotic resistance solely as a result of more prudent use of antibiotics. It will therefore take a very concerted effort for both patients, parents and doctors to improve the current situation.

January 2003