Inappropriate Antibiotic Prescribing: Wind at Our Backs or Flapping in the Breeze?

My concern as a 'veteran' general pediatrician is witnessing the inappropriate prescribing of antibiotics, with little attention being paid to AAP guidelines on issues like otitis media and community-acquired respiratory infections. It seems to philosophically boil down to the question of individual decision-making by the health provider versus what is in the best interest of the public. As a reflective piece, the practitioner and trainee need to think about not only is this really evidence-based treatment for this particular patient, but also what is best in the context of the public well-being. Regarding otitis media. not only do I see practitioners and residents treating children over the age of two years with antibiotics versus medications for pain and low-grade fever as recommended by the AAP, I see antibiotic treatment prescribed for a red tympanic membrane where the diagnosis of otitis media is not even accurate. Another area of concern is use of antibiotics when a respiratory illness doesn't resolve quickly enough for the parents' expectations, sometimes pushing the pediatrician to prescribe a Z-pack without evidence of any bacterial involvement. Until we ingrain in trainees that when treating patients they need to think about the impact of their treatment regimens not only on their own patients but also on the overall population , we are not going to resolve this gap in the overuse of antibiotics..