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PEDIATRICS Vol. 102 No. 1 July 1998, pp. 142-144
| The first 300 words of the full text of this article appear below. |
There is increasing concern in the medical community1-5 about inappropriate oral antibiotic use. This concern is fueled by changes in antibiotic susceptibility patterns of many bacteria. In pediatrics, the increasing resistance of Streptococcus pneumoniae to penicillins is particularly worrisome, because S pneumoniae is the leading bacterial cause of acute otitis media (AOM), sinusitis, pneumonia, bacteremia, and meningitis.6 In some communities, the rate of resistance has influenced antibiotic therapy for AOM,7 and, because of concerns about pneumococcal resistance, the American Academy of Pediatrics' (AAP) Red Book has changed its recommendation for empiric antibiotic therapy for life-threatening infections in which the pneumococcus is a possible etiologic agent.8
The purpose of this commentary is to review what we know about
inappropriate oral antibiotic use and to suggest a series of steps that
primary care physicians can take to promote the judicious use of
antibiotics. The campaign to reduce inappropriate oral antibiotic use
must be balanced
patients and physicians must both be reeducated about
antibiotics. Our premise is that to reduce inappropriate oral
antibiotic use pediatricians will need to discuss with parents the role
of antibiotics in the care of children with minor infectious disease,
sharpen their diagnostic skills, and become more familiar with specific
indications for antibiotics and other therapeutic options. While
current efforts to reduce inappropriate antibiotic use have focused on
the need to reeducate physicians, and although we believe these efforts
are important, primary care pediatricians have indicated overwhelmingly
that educating families is the most important aspect of promoting
judicious use of antibiotics (Bauchner H, Pelton SI, Klein JO. Parents, physicians, and antibiotic use. Submitted for publication.) In addition, patient education can impact on physician behavior. Davis and
others9 reported in a metaanalysis of 99 trials that patient-mediated interventions are one of four strategies that are
effective in changing physician behavior. They
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