CDC guidelines urge doctors to curb antibiotic use for children

Doctors are being urged to cautiously prescribe antibiotics for children because the drugs are unnecessary for most upper respiratory illnesses, say government health authorities who released new guidelines on using the medicines.

Pressure to curtail antibiotic use for all age groups has mounted in recent years as drug resistance grows and fewer medicines can combat emerging "superbugs." The new guidelines, released by the Centers for Disease Control and Prevention in cooperation with the American Academy of Pediatrics, call on doctors to prescribe an antibiotic only for laboratory-confirmed bacterial infections.

Doctors say the over-prescription of antibiotics has numerous causes: Some physicians prescribe them as a way to hurry patients out of their offices, while others write scripts under pressure from parents.

"Taking antibiotics can sometimes do more harm than good, but there are a lot of doctors who think it's easier to prescribe an antibiotic and pacify Mom than to do the right thing," said Dr. Neil Soskel, a specialist in family medicine at South Nassau Communities Hospital in Oceanside.

"Half of all sore throats and earaches are probably viral and not bacterial," said Soskel, referring to two common childhood afflictions for which antibiotics are routinely prescribed. "But it takes a lot more guts not to prescribe an antibiotic than to go ahead and do it."

The common cold and flu are two other conditions for which pediatric prescriptions have been written, but the drugs could portend more harm than benefit, experts said Tuesday.

"Many people have the misconception that since antibiotics are commonly used that they are harmless," Dr. Lauri Hicks, a co-author of the new CDC report, said Tuesday.

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As many as 10 million children nationwide risk side effects from antibiotic prescriptions that are not likely to help upper respiratory conditions, according to data in the report.

A flurry of scientific papers in recent years have shown a high degree of bacterial resistance to the drug amoxicillin, which has been rendered useless in vast populations of children worldwide because of its overuse. Amoxicillin, an antibiotic in the penicillin family, is commonly prescribed to children.

A 2010 study, reported in the journal Pediatrics, found an alarming number of urinary tract infections caused by drug-resistant bacteria among children who had been given antibiotics to treat other illnesses.

Antibiotic resistance occurs when bacteria mutate and evolve strategies, allowing them to outfox the very medications designed to destroy them.

Once that happens, even common infections become difficult to treat, experts say.

"Our medicine cabinet is nearly empty of antibiotics to treat some infections," CDC director Dr. Thomas Frieden said in a statement Tuesday.

"If doctors prescribe antibiotics carefully and patients take them as prescribed, we can preserve these lifesaving drugs and avoid entering a post-antibiotic era," Frieden said.

Yet, a report in the British medical journal The Lancet this week declared that the post-antibiotic era is already here. Among the dire predictions: a continuing rise in new species of superbugs, and a possible resumption of death rates for simple infections comparable to those of the early 20th century, before antibiotics existed.

Soskel, who treats children as well as adults, said he often reasons with adult patients as to why they probably don't need an antibiotic.

"I will say: 'I know you are very smart and know the difference between a virus and a bacterium and that antibiotics have no effect on viruses.

"And when I word things that way, they seem to understand why an antibiotic is not a good idea," Soskel said.

New CDC guidelines for children's antibiotics

The federal Centers for Disease Control and Prevention has called on pediatricians and family medicine physicians to prescribe antibiotics for children more judiciously to avoid further emergence of drug-resistant bacteria and other side effects associated with the drugs. The agency is asking doctors to abide by three principles:

Determine the likelihood of an infection: Antibiotics should never be used for viral infections, especially after a concurrent bacterial infection has been reasonably excluded.

Always weigh benefits versus harms of antibiotics: Symptom reduction and prevention and complications should be weighed against the risk for side effects and drug resistance as well as cost.

Implement accurate prescribing strategies: Select an appropriate antibiotic and an appropriate dose for the shortest duration required.

Source: Centers for Disease Control and Prevention