Study: White children more likely to receive unnecessary antibiotics from ED
Thursday, September 21, 2017
White children were nearly twice as likely to receive antibiotics for viral illnesses from emergency departments as compared with minority children, according to a new study.
Viral respiratory tract infections are a leading cause of pediatric visits to emergency departments. Children develop six viral RTIs each year on average, according to Merck Manual. Rhinoviruses, influenza viruses, parainfluenza viruses, enteroviruses, respiratory syncytial virus (RSV), coronaviruses, and some adenovirus strains are the primary causes of viral respiratory infections in children.
Antibiotics are the backbone of treatment for bacterial infections, and children receive antibiotics more frequently than they do another other class of drugs. Unfortunately, many children may be receiving antibiotics inappropriately.
The Centers for Disease Control and Prevention (CDC) says that at least 30 percent of antibiotics currently prescribed in outpatient settings are unnecessary. Total inappropriate antibiotic use, which includes unnecessary use and inappropriate selection of antibiotic, dosing and duration of treatment, may be as high as 50 percent.
Inappropriate antibiotic use, such as using antibiotics to treat viral infections, contributes to the development of antibiotic-resistant bacteria. More than 2 million people in the United States are infected with antibiotic-resistant bacteria annually, according to the CDC, and at least 23,000 perish from these infections each year.
"Our study is the first to report racial and ethnic differences in unnecessary antibiotic use for treatment of viral infections in the emergency departments," says senior author Elizabeth R. Alpern, M.D., in a press release. "Similar differences have been observed in the primary care setting, and we need a better understanding of why this occurs."
The study, published this month in Pediatrics, show that unnecessary antibiotic prescribing rates for viral respiratory tract infections (RTIs) in pediatric emergency departments vary according to race and ethnicity.
Researchers from Stanley Manne Children's Research Institute at Ann & Robert H. Lurie Children's Hospital of Chicago analyzed electronic health data they gathered from the Pediatric Emergency Care Applied Research Network Registry, which is the nation's first federally funded pediatric emergency medicine research network.
The scientists performed a retrospective cohort study of 39,445 encounters for viral acute RTIs at seven pediatric EDs in 2013. Of the study subjects, 50.5 percent were black, 46 percent were female, and 77.5 percent were covered by Medicaid; the participants were 3.3 years old on average.
The researchers found that clinicians prescribed antibiotics at an average of 2.6 percent of visits for viral respiratory illnesses. Specifically, they prescribed antibiotics to treat the viral infections in 4.3 percent of white, 2.6 percent of Hispanic and 1.9 percent of black children.
White children in the study were twice as likely to receive antibiotics as were black children, and about 1.5 times more likely to receive antibiotics than were Hispanic children with viral respiratory tract infections.
The study did not investigate the underlying reasons for racial and ethnic differences in the overprescribing of antibiotics, but the researchers suggest clinicians feel pressure to treat children with antibiotics, and that there might be differences in parental expectations between the various groups. Implicit bias on the part of clinicians may also contribute to antibiotic overprescribing.
"We know from previous studies, racial and ethnic differences that favor white children over minority children may be due to caregiver's or provider's perception that more is better, even when more is not clinically indicated as is the case with antibiotic use for viral illnesses," Alpern said.
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