New data released in Pediatrics this week describes the prevalence of antibiotic prescribing in pediatric ambulatory care visits. Antibiotics are prescribed in just over 20% of such visits, with a majority of these prescriptions for respiratory conditions. Broad-spectrum antibiotic use is prevalent, accounting for 50% of all prescriptions.
“In the Mexican port of Veracruz, a sculptor was putting the finishing touches on a bronze statue of a 5-year-old boy who is the country's earliest confirmed case of swine flu. The boy, Edgar Hernandez, recovered after being treated with antibiotics, and state officials said the statue will be a symbol of hope.” Associated Press, May 25, 2009.
There are a number of studies that show that physicians face a lot of pressure to not deny patients antibiotics. A common excuse for prescribing is that “if I don’t prescribe an antibiotic then the patient is just going to find another doctor who will”. Many of these are self-reported studies and it's not clear if physicians were offering the excuse of patient pressure ex-post to justify their prescribing behavior or if there really was an effect.
Will the swine flu epidemic emanating from Mexico be the next great pandemic that everyone fears? It is hard to say. The Mexican government seems to be doing all it can to limit the spread of the infection, and travel advisories attest that other governments are taking this seriously as well. The high number of deaths in Mexico is worrisome, but the low number of hospitalizations elsewhere is encouraging. With significant trade and travel, if this is the start of a new pandemic, it is likely that this virus will spread faster than any previous pandemic.
This isn't news to most of you keeping up with this blog and Extending the Cure, but it turns out 13% of physicians in a recent national survey of internists and rheumatologists reported using antibiotics as placebos.
When a physician decides what to prescribe a patient, the expectation that antibiotic treatment will provide some benefit to the patient often outweighs the concern that this use will contribute to the shared problem of antibiotic resistance.