A study was conducted by Dr. Ian M. Paul, Department of Pediatrics and Public Health Sciences, Penn State College of Medicine , Hershey, Pennsylvania, and the other was led by Dr. Kris De Boeck, PhD, Department of Pediatric Pulmonology and Infectious Diseases, University Hospital of Leuven in Belgium. The two studies were released recently in the online version and the print version of Pediatrics .
According to Dr. Paul and his colleagues, the guidelines of the National Program for Education and Asthma Prevention specify that "antibiotics should not be used as part of chronic treatment of asthma or acute exacerbations with the exception of patients who have concomitant bacterial infections such as pneumonia or sinusitis. "
It is believed that macrolide antibiotics have anti-inflammatory actions and ketolides, but the results of studies related to its use in asthmatics have been ambivalent and "neither the U.S. nor international guidelines for asthma treatment currently recommended antibiotic therapy in exacerbations of the disease, "say the authors.
Dr. Paul and his colleagues determined how often doctors were prescribing antibiotics for U.S. pediatric visits for asthma in the absence of a documented comorbidity. Evaluated the data from the National Ambulatory Medical Care Survey and National Hospital Ambulatory Medical Care, collected between 1998 and 2007, for consultations for asthma in the office and in the emergency department for children (<18 years).
The authors note: "It is estimated to have occurred 60.4 million visits for asthma without other code ( Classification of Diseases, Ninth Edition) to justify the prescription of antibiotics. " However, nearly 16% of these visits were prescribed antibiotics to patients.
The antibiotic most often prescribed was a macrolide (48.8%). In a multivariate analysis, factors associated with an increased chance of antibiotic prescriptions were concomitant prescribing of systemic corticosteroids (odds ratio [OR] 2.69, confidence interval [CI] 95% CI 1.68 to 4.30) and treatment during the winter (OR: 1.92, 97% CI 1.05 to 3.52).
In contrast, treatment in an emergency department was associated with less chance of antibiotic prescription (OR 0.48, 95% CI 0.26 to 0.89). In addition, during consultations at clinics, information about asthma was associated with fewer antibiotic prescriptions (OR 0.46, 95% CI 0.24 to 0.86).
In a second large study led by Dr. De Boeck, we evaluated a database of health insurance that included prescription of antibiotics and asthma drugs during the course of a year to 892,841 Belgian children under 18 years of age.
Antibiotics were prescribed for 44.21% of the children, while asthma drugs were prescribed to 16.04%. The highest proportion of patients who received either of the two treatments was less than three years old.
In general, prescribed an antibiotic to 73.50% of children who also received an anti-asthmatic drug compared to 38.62% of those receiving only one antibiotic ( p <0.0001). Overall, regardless of age, children were about twice as likely to receive an antibiotic and also received asthma treatment (OR 1.90, 95% CI 1.89 to 1.91), p <0 , 0001). On more than one third of children who received an anti-asthmatic drug was prescribed an antibiotic the same day.
Dr. Rita Mangione-Smith, MPH and Dr. Paul Krogstad, authors of a related commentary, observed: "A major strength of these studies is the great power that provided the extensive series of databases that were assessed." Mangione-Smith Dr. in the Department of Pediatrics at the University of Washington in Seattle, and Dr. Krogstad in the Department of Pediatrics and Molecular and Medical Pharmacology at the David Geffen School of Medicine, University of California, Los Angeles .
According to commentators, "the results indicate that Belgian and American physicians prescribe antibiotics to patients with a presumptive diagnosis of asthma or bronchospasm to a previously unsuspected level: with a frequency of up to one in six American children consultations, which million or more is a dubious recipe for years. "
Mangione-Smith Dr. and Dr. Krogstad note that some of these recipes may be due to diagnostic uncertainty and medicolegal concerns, and to pressure or influence exerted by parents who want a prescription for an antibiotic for your child .
They add: "The new battle to stop the unjustified use of antibiotics in the pediatric outpatient setting requires that we focus on reducing inappropriate bacterial diagnoses and decreasing the use of broad-spectrum antimicrobial."
None of the studies had trade finance. Researchers and commentators have disclosed no relevant financial conflicts of interest.
References
Pediatrics . 2011, 127:1014-1021, 1022 to 1026 from 1174 to 1176
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