Good news comes in all sizes and shapes. This month’s report in the Journal of the American Medical Association that antibiotic prescriptions for children decreased 40 percent during the 1990s is a super-sized piece of good news. But that doesn’t mean the trend will continue.
The biggest difference came during intervention, or public health campaigns aimed at doctors and parents, said Dr. Stuart B. Levy, a physician at Tufts University School of Medicine and founder of the Alliance for Prudent Use of Antibiotics (APUA). “Unless we maintain reminders, people will resort to the previous behavior of overprescribing antibiotics,” he said.
That behavior flies in the face of research showing that taking antibiotics too frequently or unnecessarily increases the body’s susceptibility to harmful bacteria. Antibiotic resistance means medications, even stronger ones, might not work during the next and potentially more serious illness.
“Parents call us, tell us they were sick and that they got better in one or two days by taking antibiotics,” said Dr. Irwin Benuck, an Evanston pediatrician associated with Children’s Memorial Hospital in Chicago. “Now their child is sick and they want a prescription. A lot of times they don’t even want to bring the child into the office.”
Benuck said the process of informing physicians and patients about antibiotic resistance is ongoing.
“As pediatricians we need to do our best to educate parents about how to use antibiotics prudently,” Benuck said. “We tell parents of young children to expect their child is likely to be sick four to six times per year.”
You have likely heard the story line. Bacteria, which are imaginative and hardy organisms, can figure out a way to beat antibiotic medicines. They become “superbugs” in part because antibiotics kill all bacteria, including the good varieties that protect us by fighting off harmful bacteria.
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“There is still a misconception that having bacteria around us is harmful,” Levy said. “Not all bacteria are bad.”
Levy is a visionary on the subject. He formed APUA in 1981, long before medical schools put antibiotic resistance on must-discuss lists.
“There might have been three antibiotics available when I was doing my residency at Children’s Memorial,” Benuck said. “These days there are dozens of new antibiotics, and the number of resistant bacteria is way up.”
In 1992 Levy published his book “The Antibiotic Paradox: How Miracle Drugs are Destroying the Miracle” (Perseus, $17.50). By the mid-1990s, the media and medical schools alike deemed antibiotic resistance to be reaching crisis mode. Levy has updated the book this year with new findings on antibiotic resistance and antimicrobial cleaners (not worth the extra money and might result in not allowing good bacteria to do their positive jobs).
He is encouraged by the new report based on a national survey conducted by federal researchers. The numbers were down in all three categories of total number of prescriptions, prescriptions per child and prescriptions per trip to the doctor.
“What’s best about the decline is we aren’t reducing to a point that children are any more susceptible to illness,” Levy said. “We are using antibiotics more wisely.”
The researchers found that lectures to doctors and printed handouts to new parents were effective in discouraging overuse of antibiotics. An accompanying study showed these strategies dramatically reduced antibiotic prescription-writing in Knoxville, Tenn., which happens to be the U.S. town with the highest per-capita use of prescription drugs in the country.
“What the physicians truly appreciate is patients getting the same message about antibiotic use,” Levy said. The message includes an explanation that antibiotics won’t fight viruses that can cause colds, flu and ear infections, among other conditions.
“It saves them from having to calm down some parents who don’t understand why a doctor might send a child home without a prescription,” Levy said.
Levy doesn’t overlook patients themselves. He regularly talks to schoolchildren, including kindergartners.
“I talk to them about good germs and bad germs,” he said. “I discuss bacteria and viruses. We might do some simple work with petri dishes to show them bacteria that aren’t usually seen. It is always a useful session. Believe me, the little kids are the first ones to go home and tell their parents not to use antibiotics for a cold or other virus.”
– A programming note for parents: Starting at 9 p.m. Tuesday, WTTW-Ch. 11 will air a weekly PBS series called “Children’s Hospital.” The first six episodes feature Children’s Memorial Hospital in Chicago. It is a detailed, insightful look at how parents, doctors, nurses and others care for sick kids.