A Spoonful Of Nothing

Antibiotics and other drugs are often overprescribed for children, when sometimes the best medicine is no medicine

September 06, 2007|By Chris Emery | Chris Emery,Sun reporter

Yara Cheikh expected her pediatrician to diagnose the sickly rattle in her infant son's chest as a bacterial infection. "I went in looking for antibiotics," said the Towson mother of four.

The pediatrician made a different call: Nine-month-old Hugh DeBrabander's illness was viral, an infection antibiotics are powerless against. Cheikh accepted the explanation and was happy to spare her son an unnecessary dose of medication.

Not all young children are so fortunate. Many receive ineffective or even dangerous drugs for common illnesses such as colds, flu, sore throats and earaches.

Parents spoon out over-the-counter cold medicines despite evidence that they don't work and have even been linked to children's deaths. Doctors prescribe antibiotics for conditions they can't improve, driving today's proliferation of dangerous, drug-resistant infections.

Medical professionals and parents alike are growing more aware of the problems - especially overused antibiotics. But experts say the practice persists, in part reflecting an understandable desire by parents and doctors to ease a child's suffering. In other cases, impatience plays a role, as busy parents struggle with an irritable child, or busy doctors appease demanding parents.

For many common childhood ailments, the best medicine is often no medicine. Yet strong medicine is what our culture has come to expect.

"We have to somehow educate ourselves and patients that we should not always rely on medications to make us well," said Dr. Caroline B. Hall, a professor of pediatrics at the University of Rochester School of Medicine and Dentistry.

She conceded, however, that the message is difficult to convey when faced with a suffering child. "You look at a child who's wheezing and their chest is retracting," she said, "it's hard to say, `I'm going to do nothing.'"

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Dr. Joshua Sharfstein, Baltimore's health commissioner, said the nurturing instinct makes parents vulnerable to pitches from the makers of ineffective over-the-counter medications.

"Some of the marketing preys on parents' guilt," Sharfstein said. "I think the marketing creates an expectation that a medication is necessary for treatment."

Sharfstein argues that many common cough and cold remedies, some linked to the deaths of several children in recent years, are ineffective and unsafe for children younger than 6.

Although drug industry representatives argue that the medicines are clearly labeled for use by adults and that adverse reactions are the result of misuse, Sharfstein and other experts have asked the Food and Drug Administration to restrict marketing of the drugs for use in young children.

In the case of antibiotics, many parents think they're a panacea. In fact, antibiotics target bacterial infections and are useless for killing viruses - including the bugs responsible for the common cold.

Resistance to drugs

In recent years, nearly every significant type of bacterial infection worldwide has developed resistance to antibiotics that were once effective at killing them, according to the Centers for Disease Control and Prevention. This is largely the result of doctors overprescribing the strong drugs, and a misconception among patients that antibiotics are effective against viruses.

A 2003 study by University of Tennessee Health Science Center researchers found that out of 2,076 office visits, pediatricians around the country misprescribed antibiotics in 883 cases, or 42 percent.

Pediatricians will prescribe antibiotics 65 percent of the time if they perceive parents expect the drugs, but only 12 percent of the time if they perceive parents don't expect them, according to the CDC.

"A lot of parents come with the expectation that they are going to get something when they leave," said Dr. Marion Hare, a pediatrics professor and the lead author of the 2003 study. "If the physician doesn't prescribe antibiotics, patients don't want to see that physician any longer."

Doctors report that some parents will shop around for a pediatrician willing to prescribe antibiotics, even within the same medical practice.

In some cases, Hare said, busy doctors prescribe the drugs to get demanding parents out of their hair. "If you've been in a pediatrician's office in the winter time," she said, "you know how many children they are seeing."

Her research, however, suggests it takes a doctor about the same amount of time to explain why antibiotics aren't appropriate than to write a prescription and explain what it is.

"It may take a little longer to explain the first time a pediatrician meets a parent," she said, "but if you do that on the front end, then they don't come in with that expectation later."

Respiratory infections

Another reason children get drugs they don't need is confusion over their diagnoses and controversy over a respiratory infection known as bronchiolitis.

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