Overprescribing Antibiotics to Children

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By Elliott McMurchy

The discovery of antimicrobial drugs (antibiotics) is regarded as one of the greatest scientific breakthroughs of the 20th century. Before this discovery, many simple infections were fatal to young children.[1] With drug companies creating dozens of antibiotics, physicians have been taking advantage of this effective means of treatment for many ailments, prescribing high levels of antibiotics to children. In a ten year study (2000-2010), researchers from Boston Children’s Hospital and Harvard Medical School studied children ranging in age from three months to 18 years and found that children aged from three to <24 months were the highest utilizers of antibiotics.[2] Recent research studies have hypothesized that the use of antibiotics in infants may lead to several long-term health risks including inflammatory bowel disease, celiac disease, and infant obesity. While the chief cause in this linkage remains to be elucidated, many studies are pointing to a change in the gut microbiota, which is highly dynamic during the early years of life.[3]

As a summer undergraduate research student with the Institute of Medical Science in an immunology lab that specializes in researching the gut microbiota, the effects of antibiotics on the microbiota was a focal area of investigation using mouse models. It is well documented in the literature that a change does occur in the gut microbiota after antibiotic use, with a conclusive link between antibiotic use and antibiotic resistance. Ghosh et al. concluded that this is a global health problem having found “an alarmingly high abundance of antibiotic resistance genes in two infant gut microbiomes.”[4] Researchers are now working to better understand the link between antibiotic use, a change in the microbiota, and long-term health problems.

Although prescriptions of antibiotics seemed to have leveled off in the latter part of the 20th century with the finding of antibiotic resistance, this issue remains controversial since, as noted in the Harvard study, overprescribing of antibiotics by physicians persists.2 A 2013 ParentsCanada survey showed that 8% of parents pressure their doctors to provide antibiotic prescriptions, and a 2006 Centres for Disease Control study showed that 65% of doctors prescribed antibiotics when they felt the parent expected them to compared with only 12% when there was no pressure.[5] Until parents become more informed about the accumulating evidence of long-term harms from over-prescribed antibiotic use, they will continue to pressure physicians into prescribing antibiotics to their children.

While researchers, including those at the University of Toronto, have found an association between overuse of antibiotics and changes in the microbiota of young children, research must continue in this field as the stakeholders in the medical and healthcare field remain divided: parents eager for access to antibiotic medications, physicians pressured to service their clientele, and researchers not yet having the conclusive evidence to support the hypothesized microbial changes due to overuse of antibiotics.

References:

1. The history of antibiotics. [Internet] 2006 Nov 1 [updated 2014 Mar 31; cited 2014 Aug 12]. Available from: http://www.healthychildren.org/English/health-issues/conditions/treatments/Pages/The-History-of-Antibiotics.aspx.

2. Vaz LE, Kleinman KP, Raebel MA, et al. Recent trends in outpatient antibiotic use in children. Pediatrics. 2014;133(3):375-85.

3. American Gastroenterological Association. Tricky balancing act: antibiotics versus the gut microbiota. [Internet]. ScienceDaily. 2014 [updated 2014 Mar 10; cited 2014 Aug 12]. Available from: http://www.sciencedaily.com/releases/2014/03/140310111539.htm.

4. Ghosh TS, Gupta SS, Nair GB, et al. In silico analysis of antibiotic resistance genes in the gut microflora of individuals from diverse geographies and age-groups. PLoS One. 2013;8(12):e83823.

5.  Dourcet J. Are parents hooked on antibiotics? ParentsCanada. [Internet]. 2014 Feb 10 [cited 2014 Aug 12]. Available from: http://www.parentscanada.com/health/are-parents-hooked-on-antibiotics.